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Given the abundance of new research, it can be challenging to stay current on the latest advancements and findings. Oncology Times is here to help with summaries of the newest studies to ensure you are up-to-date on the latest innovations in oncology practice.



Low rates of patient-reported physician-patient discussion about lung cancer screening among current smokers: data from health information national trends survey

Low rates of physician-patient discussions about lung cancer screening have declined further since 2012 and were not associated with current smokers' intents or attempts to quit smoking, according to recent findings (Cancer Epidemiol Biomarkers Prev 2019; doi:10.1158/1055-9965.EPI-18-0629). Since 2011, three events in support of lung cancer screening took place: 1) In 2011, the National Lung Screening Trial demonstrated that low-dose CT scans reduced lung cancer mortality by 20 percent; 2) in 2013, the USPSTF issued a recommendation for lung cancer screening; and, 3) in 2015, the Centers for Medicare & Medicaid Services released a lung cancer screening policy. Researchers analyzed data from the NCI's Health Information National Trends Survey (HINTS) in 2012, 2014, and 2017, right after the three events. The HINTS survey included questions on whether a respondent had talked with their doctor about having a test to check for lung cancer in the past year and their smoking status. The researchers analyzed the prevalence of physician-patient discussions about lung cancer screening by age group, smoking status, insurance coverage, and ethnicity. Among 9,433 individuals surveyed, the overall prevalence of lung cancer screening discussions was very low and decreased significantly from 6.7 percent in 2012 to 4.3 percent in 2017. Further analysis by age and smoking status revealed that the highest discussion rates in 2017 were for current smokers older than 74 years (22.1%), current smokers aged 55-74 (17.9%), and former smokers older than 74 years (16.3%). Among current smokers, patients more likely to have engaged in discussions with physicians were non-Hispanic Blacks, Hispanics, individuals covered by insurance, and those diagnosed with heart or lung disease. "Developing communication strategies for promoting beneficial lung cancer screening among lung cancer screening-eligible smokers and strategies for improving the quality of discussion on lung cancer screening integrating smoking cessation are needed to reduce the burden of lung cancer," study authors wrote.



Progression risk stratification of asymptomatic Waldenstrom macroglobulinemia

By analyzing data from hundreds of patients with asymptomatic Waldenstrom macroglobulinemia (WM), researchers have devised a risk model for determining whether patients with asymptomatic WM have a low, intermediate, or high risk of developing symptomatic WM, which requires chemotherapy treatment (J Clin Oncol 2019; doi:10.1200/JCO.19.00394). Under this system, patients' risk is assessed using four measures: bone marrow lymphoplasmacytic infiltration; serum immunoglobulin M levels; [beta]2 microglobulin levels; and albumin levels. And patients were stratified into three risk groups with median time to progression of 2, 5, and 9 years. Higher values of the four biomarkers were associated with a significant risk of progression to the symptomatic disease within a few years. This risk score was generated based on 439 patients with asymptomatic WM at Dana-Farber over a period of 23 years. To expand the usage and benefit of this new risk model, the researchers developed an open-access web application for this model in the form of a calculator, where oncologists and patients can enter the values of the four biomarkers and get information about which risk group the patient belongs to at this time point. "This classification system is positioned to inform patient monitoring and care and, for the first time to our knowledge, to identify patients with high-risk asymptomatic WM who may need closer follow-up or benefit from early intervention," according to study authors.



Resistance to neoadjuvant chemotherapy in triple-negative breast cancer mediated by a reversible drug-tolerant state

Researchers have discovered that triple-negative breast cancer (TNBC) cells can develop resistance to frontline chemotherapy not by acquiring permanent adaptations, but rather transiently turning on molecular pathways that protect the cells (Sci Transl Med 2019; doi:10.1126/scitranslmed.aav0936). To study how TNBC cells become resistant to treatment, the researchers created patient-derived xenografts (PDXs) of TNBC using tumor samples from patients enrolled in the ARTEMIS clinical trial (NCT02276443).The investigators identified several PDX models that responded to chemotherapy at first, but eventually developed resistance and resumed tumor growth. If treatment was paused, however, the residual tumors once again became sensitive to chemotherapy, indicating the resistance was temporary. Barcode-mediated clonal tracking and genomic sequencing of PDX tumors revealed that residual tumors remaining after treatment with standard frontline chemotherapies, doxorubicin combined with cyclophosphamide (AC), maintained the subclonal architecture of untreated tumors, yet their transcriptomes, proteomes, and histologic features were distinct from those of untreated tumors, according to study authors. "Once treatment was halted, residual tumors gave rise to AC-sensitive tumors with similar transcriptomes, proteomes, and histological features to those of untreated tumors." They concluded that, "AC resistance in treatment-naive TNBC can be mediated by nonselective mechanisms that confer a reversible chemotherapy-tolerant state with targetable vulnerabilities."



Association of the usability of electronic health records with cognitive workload and performance levels among physicians

A recent study examined the impact of electronic health records (EHR) on physician workload and performance in managing critical or abnormal test results (JAMA Netw Open 2019; doi:10.1001/jamanetworkopen.2019.1709). The study tested the impact of an enhancement in the EHR on providers' ability to manage abnormal test results that provided decision support instructions for abnormal results. In a simulation run between April 1, 2016, and Dec. 23, 2016, resident and fellows used either a baseline EHR (n=20) or an enhanced EHR (n=18). Data analyses were conducted from Jan. 9, 2017, to March 30, 2018. "The EHR with enhanced usability segregated in a dedicated folder previously identified critical test results for patients who did not appear for a scheduled follow-up evaluation and provided policy-based decision support instructions for next steps," study authors outlined. "The baseline EHR displayed all patients with abnormal or critical test results in a general folder and provided no decision support instructions for next steps." Researchers studied the users' performance and workload, and also their ability to follow-up on abnormal or critical test results. The 20 participants allocated to the baseline EHR compared with the 18 allocated to the enhanced EHR demonstrated statistically significantly higher cognitive workload as quantified by blink rate (mean [SD] blinks per minute, 16 [9] vs. 24 [7]; blink rate, -8 [95% CI, -13 to -2]; p=.01), according to the findings. The baseline group showed statistically significantly poorer performance compared with the enhanced group who appropriately managed 16 percent more abnormal test results. The study authors concluded that "relatively basic usability enhancements to the EHR system appear to be associated with better physician cognitive workload and performance; this finding suggests that next-generation systems should strip away non-value-added EHR interactions, which may help physicians eliminate the need to develop their own suboptimal workflows."