Caleb Rans

Newly discovered insights into the underlying molecular and immune mechanisms of endometrial carcinoma may reveal novel therapeutic targets and improve immunotherapy selection for patients, according to a proteogenomic study.

Further insights into the regulatory mechanisms of the disease were also identified, based on findings from genome-wide phosphoproteome and acetylome surveys.

“This study provides a comprehensive overview of the molecular systems of endometrial carcinoma at the genomic, transcriptomic, and proteomic levels,” wrote Yongchao Dou, PhD, of Baylor College of Medicine, Houston, and colleagues. The findings were published in Cell.

The researchers prospectively analyzed proteogenomic data from 95 endometrial carcinoma tumors, including 83 endometrioid and 12 serous samples, and 49 nonmalignant tissue samples. Whole genome and exome, DNA methylation, and total and microRNA sequencing analyses were performed for each sample.

An integrated evaluation of proteins, posttranslational modifications (phosphorylation and acetylation), DNA, and RNA were used to detect novel regulatory mechanisms and potential therapeutic targets.

The researchers confirmed previous data on the impact of gain-of-function TP53 mutations on the Aurora kinase pathway, notably the relationship between AURKA expression and negative outcomes in endometrial carcinoma.

“[These findings] provide a theoretical basis for the use of AURKA inhibitors in these tumors,” the researchers wrote.

In addition, the team found evidence of a new regulatory pathway involving ESRP2, circular RNA (circRNA), and QKI, each of which plays a key role in regulatory function.

“Through its known function in isoform regulation, ESRP2 could also directly regulate circRNA levels, and, if so, it could compete with QKI in circRNA-mediated gene regulation,” the researchers wrote.

Furthermore, they identified several gene products that could play a role in optimizing selection of patients for checkpoint blockade immunotherapy. One product in particular, CDK12, may better clinical response rates to immune checkpoint blockade.

The researchers also found evidence to suggest that measuring tumor antigen presentation defects could be more effective than measuring tumor mutation burden when selecting immunotherapy for patients with endometrial carcinoma.

“Although the results presented herein are predominantly observational, they provide the basis for multiple hypotheses of clinical relevance that can and should be further explored,” the researchers concluded.

The study was funded by the National Cancer Institute, the Cancer Prevention & Research Institutes of Texas, and the Robert and Janice McNair Foundation. The authors reported having no conflicts of interest.

SOURCE: Dou Y et al. Cell. 2020 Feb 13. doi: 10.1016/j.cell.2020.01.026.

Newly discovered insights into the underlying molecular and immune mechanisms of endometrial carcinoma may reveal novel therapeutic targets and improve immunotherapy selection for patients, according to a proteogenomic study.

Further insights into the regulatory mechanisms of the disease were also identified, based on findings from genome-wide phosphoproteome and acetylome surveys.

“This study provides a comprehensive overview of the molecular systems of endometrial carcinoma at the genomic, transcriptomic, and proteomic levels,” wrote Yongchao Dou, PhD, of Baylor College of Medicine, Houston, and colleagues. The findings were published in Cell.

The researchers prospectively analyzed proteogenomic data from 95 endometrial carcinoma tumors, including 83 endometrioid and 12 serous samples, and 49 nonmalignant tissue samples. Whole genome and exome, DNA methylation, and total and microRNA sequencing analyses were performed for each sample.

An integrated evaluation of proteins, posttranslational modifications (phosphorylation and acetylation), DNA, and RNA were used to detect novel regulatory mechanisms and potential therapeutic targets.

The researchers confirmed previous data on the impact of gain-of-function TP53 mutations on the Aurora kinase pathway, notably the relationship between AURKA expression and negative outcomes in endometrial carcinoma.

“[These findings] provide a theoretical basis for the use of AURKA inhibitors in these tumors,” the researchers wrote.

In addition, the team found evidence of a new regulatory pathway involving ESRP2, circular RNA (circRNA), and QKI, each of which plays a key role in regulatory function.

“Through its known function in isoform regulation, ESRP2 could also directly regulate circRNA levels, and, if so, it could compete with QKI in circRNA-mediated gene regulation,” the researchers wrote.

Furthermore, they identified several gene products that could play a role in optimizing selection of patients for checkpoint blockade immunotherapy. One product in particular, CDK12, may better clinical response rates to immune checkpoint blockade.

The researchers also found evidence to suggest that measuring tumor antigen presentation defects could be more effective than measuring tumor mutation burden when selecting immunotherapy for patients with endometrial carcinoma.

“Although the results presented herein are predominantly observational, they provide the basis for multiple hypotheses of clinical relevance that can and should be further explored,” the researchers concluded.

The study was funded by the National Cancer Institute, the Cancer Prevention & Research Institutes of Texas, and the Robert and Janice McNair Foundation. The authors reported having no conflicts of interest.

SOURCE: Dou Y et al. Cell. 2020 Feb 13. doi: 10.1016/j.cell.2020.01.026.

Newly discovered insights into the underlying molecular and immune mechanisms of endometrial carcinoma may reveal novel therapeutic targets and improve immunotherapy selection for patients, according to a proteogenomic study.

Further insights into the regulatory mechanisms of the disease were also identified, based on findings from genome-wide phosphoproteome and acetylome surveys.

“This study provides a comprehensive overview of the molecular systems of endometrial carcinoma at the genomic, transcriptomic, and proteomic levels,” wrote Yongchao Dou, PhD, of Baylor College of Medicine, Houston, and colleagues. The findings were published in Cell.

The researchers prospectively analyzed proteogenomic data from 95 endometrial carcinoma tumors, including 83 endometrioid and 12 serous samples, and 49 nonmalignant tissue samples. Whole genome and exome, DNA methylation, and total and microRNA sequencing analyses were performed for each sample.

An integrated evaluation of proteins, posttranslational modifications (phosphorylation and acetylation), DNA, and RNA were used to detect novel regulatory mechanisms and potential therapeutic targets.

The researchers confirmed previous data on the impact of gain-of-function TP53 mutations on the Aurora kinase pathway, notably the relationship between AURKA expression and negative outcomes in endometrial carcinoma.

“[These findings] provide a theoretical basis for the use of AURKA inhibitors in these tumors,” the researchers wrote.

In addition, the team found evidence of a new regulatory pathway involving ESRP2, circular RNA (circRNA), and QKI, each of which plays a key role in regulatory function.

“Through its known function in isoform regulation, ESRP2 could also directly regulate circRNA levels, and, if so, it could compete with QKI in circRNA-mediated gene regulation,” the researchers wrote.

Furthermore, they identified several gene products that could play a role in optimizing selection of patients for checkpoint blockade immunotherapy. One product in particular, CDK12, may better clinical response rates to immune checkpoint blockade.

The researchers also found evidence to suggest that measuring tumor antigen presentation defects could be more effective than measuring tumor mutation burden when selecting immunotherapy for patients with endometrial carcinoma.

“Although the results presented herein are predominantly observational, they provide the basis for multiple hypotheses of clinical relevance that can and should be further explored,” the researchers concluded.

The study was funded by the National Cancer Institute, the Cancer Prevention & Research Institutes of Texas, and the Robert and Janice McNair Foundation. The authors reported having no conflicts of interest.

SOURCE: Dou Y et al. Cell. 2020 Feb 13. doi: 10.1016/j.cell.2020.01.026.

Older long-term survivors of non-Hodgkin lymphoma (NHL) may have worse cognitive outcomes compared with the noncancer aging population, according to a cross-sectional study.

The findings suggest additional research is needed to better understand cognitive decline in older survivors of NHL.

“The aim of the present study was to examine the difference in cognitive status between a group of long-term older survivors of NHL compared with a group of noncancer controls of the same age,” wrote Domenico La Carpia, MD, of Fondazione ANT Italia Onlus, Florence, Italy, and colleagues.

The researchers conducted a multicenter cross-sectional cohort study involving 63 long-term survivors of NHL and 61 age-matched controls. Their report was published in the Journal of Geriatric Oncology.

Eligible survivors and controls were aged 65 years and older. Among both groups, the mean age of study participants was 74 years, and most survivors were women (58.7%).

While cognitive decline was assessed via standardized neuropsychological testing, the team also evaluated polypharmacy, functional status, and level of multimorbidity in the cohort.

Other clinical data, including the time from complete remission, type of treatment received, and histopathological type of tumor, were collected from patient charts and included in the analysis.

After analysis, the researchers found that NHL survivors had a higher mean number of chronic conditions (3.4 vs. 2.3; P = .003), were receiving more medications (3.4 vs. 2.3; P = .03), and had worse functional status compared with controls.

In addition, survivors had impaired executive functioning compared with control subjects (Trail Making Test B-A, 47.9 vs. 32.1; P = .04), but scores on the Mini Mental State Examination (MMSE) did not differ between the groups.

“A small, statistically significant difference was also observed in verbal memory scores between the two groups,” they reported.

The researchers acknowledged that a key limitation was the cross-sectional nature of the study; hence, causality cannot be inferred from the data.

“Comprehensive geriatric assessment for older cancer survivors is advisable to identify those individuals who are at highest risk of developing disability and to implement tailored early interventions,” they concluded.

No funding sources were reported. The authors reported having no conflicts of interest.

SOURCE: La Carpia D et al. J Geriatr Oncol. 2020 Jan 31. doi: 10.1016/j.jgo.2020.01.007.

Older long-term survivors of non-Hodgkin lymphoma (NHL) may have worse cognitive outcomes compared with the noncancer aging population, according to a cross-sectional study.

The findings suggest additional research is needed to better understand cognitive decline in older survivors of NHL.

“The aim of the present study was to examine the difference in cognitive status between a group of long-term older survivors of NHL compared with a group of noncancer controls of the same age,” wrote Domenico La Carpia, MD, of Fondazione ANT Italia Onlus, Florence, Italy, and colleagues.

The researchers conducted a multicenter cross-sectional cohort study involving 63 long-term survivors of NHL and 61 age-matched controls. Their report was published in the Journal of Geriatric Oncology.

Eligible survivors and controls were aged 65 years and older. Among both groups, the mean age of study participants was 74 years, and most survivors were women (58.7%).

While cognitive decline was assessed via standardized neuropsychological testing, the team also evaluated polypharmacy, functional status, and level of multimorbidity in the cohort.

Other clinical data, including the time from complete remission, type of treatment received, and histopathological type of tumor, were collected from patient charts and included in the analysis.

After analysis, the researchers found that NHL survivors had a higher mean number of chronic conditions (3.4 vs. 2.3; P = .003), were receiving more medications (3.4 vs. 2.3; P = .03), and had worse functional status compared with controls.

In addition, survivors had impaired executive functioning compared with control subjects (Trail Making Test B-A, 47.9 vs. 32.1; P = .04), but scores on the Mini Mental State Examination (MMSE) did not differ between the groups.

“A small, statistically significant difference was also observed in verbal memory scores between the two groups,” they reported.

The researchers acknowledged that a key limitation was the cross-sectional nature of the study; hence, causality cannot be inferred from the data.

“Comprehensive geriatric assessment for older cancer survivors is advisable to identify those individuals who are at highest risk of developing disability and to implement tailored early interventions,” they concluded.

No funding sources were reported. The authors reported having no conflicts of interest.

SOURCE: La Carpia D et al. J Geriatr Oncol. 2020 Jan 31. doi: 10.1016/j.jgo.2020.01.007.

Older long-term survivors of non-Hodgkin lymphoma (NHL) may have worse cognitive outcomes compared with the noncancer aging population, according to a cross-sectional study.

The findings suggest additional research is needed to better understand cognitive decline in older survivors of NHL.

“The aim of the present study was to examine the difference in cognitive status between a group of long-term older survivors of NHL compared with a group of noncancer controls of the same age,” wrote Domenico La Carpia, MD, of Fondazione ANT Italia Onlus, Florence, Italy, and colleagues.

The researchers conducted a multicenter cross-sectional cohort study involving 63 long-term survivors of NHL and 61 age-matched controls. Their report was published in the Journal of Geriatric Oncology.

Eligible survivors and controls were aged 65 years and older. Among both groups, the mean age of study participants was 74 years, and most survivors were women (58.7%).

While cognitive decline was assessed via standardized neuropsychological testing, the team also evaluated polypharmacy, functional status, and level of multimorbidity in the cohort.

Other clinical data, including the time from complete remission, type of treatment received, and histopathological type of tumor, were collected from patient charts and included in the analysis.

After analysis, the researchers found that NHL survivors had a higher mean number of chronic conditions (3.4 vs. 2.3; P = .003), were receiving more medications (3.4 vs. 2.3; P = .03), and had worse functional status compared with controls.

In addition, survivors had impaired executive functioning compared with control subjects (Trail Making Test B-A, 47.9 vs. 32.1; P = .04), but scores on the Mini Mental State Examination (MMSE) did not differ between the groups.

“A small, statistically significant difference was also observed in verbal memory scores between the two groups,” they reported.

The researchers acknowledged that a key limitation was the cross-sectional nature of the study; hence, causality cannot be inferred from the data.

“Comprehensive geriatric assessment for older cancer survivors is advisable to identify those individuals who are at highest risk of developing disability and to implement tailored early interventions,” they concluded.

No funding sources were reported. The authors reported having no conflicts of interest.

SOURCE: La Carpia D et al. J Geriatr Oncol. 2020 Jan 31. doi: 10.1016/j.jgo.2020.01.007.

Confirmatory genetic testing may be useful in the diagnosis of hemoglobinopathies for newborns with an abnormal hemoglobin (Hb) pattern, according to a recent study.

The findings suggest further research is needed to evaluate whether genetic testing programs for newborns could have diagnostic value in the clinical setting.

“We studied a consecutive cohort of newborns with an ‘FSA’ pattern (a suspected diagnosis of HbSbeta⁺) on the initial newborn screening test,” explained Lisa M. Shook of the University of Cincinnati and colleagues. The results were published in the International Journal of Neonatal Screening.

The retrospective study included a total of 1,151 newborns with an abnormal Hb pattern, 31 of which had an FSA pattern. The newborns were screened for hemoglobinopathies from 2015 to 2018. The findings of the initial newborn screening test (a suspected diagnosis of HbSbeta⁺) were compared with the diagnosis established using both protein-based and genetic confirmatory testing. Protein-based testing cannot accurately detect several hemoglobinopathies in newborns, especially when beta-thalassemia mutations are involved, according to the authors.

“During this study period, genetic testing was not universally applied in advance; it was used based on clinical suspicion,” the researchers wrote.

Among newborns with an FSA pattern, the mean gestational age was 38.7 weeks. In total, 17 newborns received genetic testing, and 30 had protein-based confirmatory testing.

“In this consecutive cohort of 31 newborns with a suspected diagnosis of HbSbeta⁺ based on initial newborn screening (an FSA pattern), none actually had HbSbeta⁺. All had the sickle cell trait (HbAS), instead; that is, we found that an initial FSA pattern was much more likely to indicate a final diagnosis of HbAS than HbSbeta⁺,” the authors wrote.

This meant that two-thirds of these newborns had a correct diagnosis of HbAS established at 2-4 weeks of age by protein-based confirmatory testing (and confirmed by genetic testing in a subset), but that the remaining one-third still had an incorrect, suspected diagnosis of HbSbeta⁺. This could lead to unnecessary treatment and testing of infants and incorrect, disease-focused counseling of parents and family members, according to the authors.

Two key limitations of the study were the small sample size and retrospective design.

“Based on this experience in which genetic testing was not universally applied, we now perform simultaneous protein-based and genetic testing as our standard clinical practice,” they concluded.

The study was funded by the National Institutes of Health and the Ohio Department of Health. The authors reported having no conflicts of interest.

SOURCE: Shook LM et al. Int J Neonatal Screen. 2020 Jan 31. doi: 10.3390/ijns6010007

Confirmatory genetic testing may be useful in the diagnosis of hemoglobinopathies for newborns with an abnormal hemoglobin (Hb) pattern, according to a recent study.

The findings suggest further research is needed to evaluate whether genetic testing programs for newborns could have diagnostic value in the clinical setting.

“We studied a consecutive cohort of newborns with an ‘FSA’ pattern (a suspected diagnosis of HbSbeta⁺) on the initial newborn screening test,” explained Lisa M. Shook of the University of Cincinnati and colleagues. The results were published in the International Journal of Neonatal Screening.

The retrospective study included a total of 1,151 newborns with an abnormal Hb pattern, 31 of which had an FSA pattern. The newborns were screened for hemoglobinopathies from 2015 to 2018. The findings of the initial newborn screening test (a suspected diagnosis of HbSbeta⁺) were compared with the diagnosis established using both protein-based and genetic confirmatory testing. Protein-based testing cannot accurately detect several hemoglobinopathies in newborns, especially when beta-thalassemia mutations are involved, according to the authors.

“During this study period, genetic testing was not universally applied in advance; it was used based on clinical suspicion,” the researchers wrote.

Among newborns with an FSA pattern, the mean gestational age was 38.7 weeks. In total, 17 newborns received genetic testing, and 30 had protein-based confirmatory testing.

“In this consecutive cohort of 31 newborns with a suspected diagnosis of HbSbeta⁺ based on initial newborn screening (an FSA pattern), none actually had HbSbeta⁺. All had the sickle cell trait (HbAS), instead; that is, we found that an initial FSA pattern was much more likely to indicate a final diagnosis of HbAS than HbSbeta⁺,” the authors wrote.

This meant that two-thirds of these newborns had a correct diagnosis of HbAS established at 2-4 weeks of age by protein-based confirmatory testing (and confirmed by genetic testing in a subset), but that the remaining one-third still had an incorrect, suspected diagnosis of HbSbeta⁺. This could lead to unnecessary treatment and testing of infants and incorrect, disease-focused counseling of parents and family members, according to the authors.

Two key limitations of the study were the small sample size and retrospective design.

“Based on this experience in which genetic testing was not universally applied, we now perform simultaneous protein-based and genetic testing as our standard clinical practice,” they concluded.

The study was funded by the National Institutes of Health and the Ohio Department of Health. The authors reported having no conflicts of interest.

SOURCE: Shook LM et al. Int J Neonatal Screen. 2020 Jan 31. doi: 10.3390/ijns6010007

Confirmatory genetic testing may be useful in the diagnosis of hemoglobinopathies for newborns with an abnormal hemoglobin (Hb) pattern, according to a recent study.

The findings suggest further research is needed to evaluate whether genetic testing programs for newborns could have diagnostic value in the clinical setting.

“We studied a consecutive cohort of newborns with an ‘FSA’ pattern (a suspected diagnosis of HbSbeta⁺) on the initial newborn screening test,” explained Lisa M. Shook of the University of Cincinnati and colleagues. The results were published in the International Journal of Neonatal Screening.

The retrospective study included a total of 1,151 newborns with an abnormal Hb pattern, 31 of which had an FSA pattern. The newborns were screened for hemoglobinopathies from 2015 to 2018. The findings of the initial newborn screening test (a suspected diagnosis of HbSbeta⁺) were compared with the diagnosis established using both protein-based and genetic confirmatory testing. Protein-based testing cannot accurately detect several hemoglobinopathies in newborns, especially when beta-thalassemia mutations are involved, according to the authors.

“During this study period, genetic testing was not universally applied in advance; it was used based on clinical suspicion,” the researchers wrote.

Among newborns with an FSA pattern, the mean gestational age was 38.7 weeks. In total, 17 newborns received genetic testing, and 30 had protein-based confirmatory testing.

“In this consecutive cohort of 31 newborns with a suspected diagnosis of HbSbeta⁺ based on initial newborn screening (an FSA pattern), none actually had HbSbeta⁺. All had the sickle cell trait (HbAS), instead; that is, we found that an initial FSA pattern was much more likely to indicate a final diagnosis of HbAS than HbSbeta⁺,” the authors wrote.

This meant that two-thirds of these newborns had a correct diagnosis of HbAS established at 2-4 weeks of age by protein-based confirmatory testing (and confirmed by genetic testing in a subset), but that the remaining one-third still had an incorrect, suspected diagnosis of HbSbeta⁺. This could lead to unnecessary treatment and testing of infants and incorrect, disease-focused counseling of parents and family members, according to the authors.

Two key limitations of the study were the small sample size and retrospective design.

“Based on this experience in which genetic testing was not universally applied, we now perform simultaneous protein-based and genetic testing as our standard clinical practice,” they concluded.

The study was funded by the National Institutes of Health and the Ohio Department of Health. The authors reported having no conflicts of interest.

SOURCE: Shook LM et al. Int J Neonatal Screen. 2020 Jan 31. doi: 10.3390/ijns6010007

The majority of hepatitis B virus (HBV)–associated non-Hodgkin lymphoma (NHL) cases in Western Europe were patients with advanced-stage diffuse large B-cell lymphoma (DLBCL), according to results of a retrospective study.

The findings suggest additional research is needed to better understand the nature of HBV-related lymphomas in nonendemic regions.

“Our aim was to describe the characteristics and outcomes of patients with NHL and active hepatitis B in France and Italy, where the prevalence of HBV is low,” wrote Marine Lemaitre of the Centre Hospitalier de Versailles in Le Chesnay, France, and colleagues. The findings were published in the Journal of Infection.

The researchers retrospectively studied a cohort of 39 patients with B-cell NHL and active HBV infection. Clinical data was collected from medical records at three hematology centers in France and Italy. The team evaluated clinical characteristics, including histologic subtype of the lymphoma, type of treatment, patient demographics, and prognostic outcomes. In addition, they compared these data with a separate cohort of patients with B-cell NHL and active HCV infection. Among study patients, the median age at lymphoma diagnosis was 59 years (range, 29-88 years), and most were men. The most common subtype of lymphoma was DLBCL (62%), followed by other subtypes (38%), including marginal zone lymphomas, follicular lymphomas, and mantle cell lymphomas. With respect to treatment, 92% of patients with DLBCL were treated with R-CHOP or a similar regimen, while 90% of patients received antivirals, resulting in a complete remission for 75% of patients. At 12-month follow-up, 88% and 87% of patients with DLBCL and other B-cell lymphomas were alive, respectively.

“Patients had predominantly advanced-stage DLBCL, with frequent liver involvement, and frequent long-term hematological responses when they received a combination of immuno-chemotherapy and antiviral treatment,” the researchers explained. They also noted that extra-nodal involvement was frequently seen in both HBV- and HCV-associated NHL.

“Additional studies are needed to explore the lymphomagenesis of [these] association[s],” they concluded.

No funding sources were reported. The authors reported having no conflicts of interest.

SOURCE: Lemaitre M et al. J Infect. 2019 Dec 14. doi: 10.1016/j.jinf.2019.12.005.

The majority of hepatitis B virus (HBV)–associated non-Hodgkin lymphoma (NHL) cases in Western Europe were patients with advanced-stage diffuse large B-cell lymphoma (DLBCL), according to results of a retrospective study.

The findings suggest additional research is needed to better understand the nature of HBV-related lymphomas in nonendemic regions.

“Our aim was to describe the characteristics and outcomes of patients with NHL and active hepatitis B in France and Italy, where the prevalence of HBV is low,” wrote Marine Lemaitre of the Centre Hospitalier de Versailles in Le Chesnay, France, and colleagues. The findings were published in the Journal of Infection.

The researchers retrospectively studied a cohort of 39 patients with B-cell NHL and active HBV infection. Clinical data was collected from medical records at three hematology centers in France and Italy. The team evaluated clinical characteristics, including histologic subtype of the lymphoma, type of treatment, patient demographics, and prognostic outcomes. In addition, they compared these data with a separate cohort of patients with B-cell NHL and active HCV infection. Among study patients, the median age at lymphoma diagnosis was 59 years (range, 29-88 years), and most were men. The most common subtype of lymphoma was DLBCL (62%), followed by other subtypes (38%), including marginal zone lymphomas, follicular lymphomas, and mantle cell lymphomas. With respect to treatment, 92% of patients with DLBCL were treated with R-CHOP or a similar regimen, while 90% of patients received antivirals, resulting in a complete remission for 75% of patients. At 12-month follow-up, 88% and 87% of patients with DLBCL and other B-cell lymphomas were alive, respectively.

“Patients had predominantly advanced-stage DLBCL, with frequent liver involvement, and frequent long-term hematological responses when they received a combination of immuno-chemotherapy and antiviral treatment,” the researchers explained. They also noted that extra-nodal involvement was frequently seen in both HBV- and HCV-associated NHL.

“Additional studies are needed to explore the lymphomagenesis of [these] association[s],” they concluded.

No funding sources were reported. The authors reported having no conflicts of interest.

SOURCE: Lemaitre M et al. J Infect. 2019 Dec 14. doi: 10.1016/j.jinf.2019.12.005.

The majority of hepatitis B virus (HBV)–associated non-Hodgkin lymphoma (NHL) cases in Western Europe were patients with advanced-stage diffuse large B-cell lymphoma (DLBCL), according to results of a retrospective study.

The findings suggest additional research is needed to better understand the nature of HBV-related lymphomas in nonendemic regions.

“Our aim was to describe the characteristics and outcomes of patients with NHL and active hepatitis B in France and Italy, where the prevalence of HBV is low,” wrote Marine Lemaitre of the Centre Hospitalier de Versailles in Le Chesnay, France, and colleagues. The findings were published in the Journal of Infection.

The researchers retrospectively studied a cohort of 39 patients with B-cell NHL and active HBV infection. Clinical data was collected from medical records at three hematology centers in France and Italy. The team evaluated clinical characteristics, including histologic subtype of the lymphoma, type of treatment, patient demographics, and prognostic outcomes. In addition, they compared these data with a separate cohort of patients with B-cell NHL and active HCV infection. Among study patients, the median age at lymphoma diagnosis was 59 years (range, 29-88 years), and most were men. The most common subtype of lymphoma was DLBCL (62%), followed by other subtypes (38%), including marginal zone lymphomas, follicular lymphomas, and mantle cell lymphomas. With respect to treatment, 92% of patients with DLBCL were treated with R-CHOP or a similar regimen, while 90% of patients received antivirals, resulting in a complete remission for 75% of patients. At 12-month follow-up, 88% and 87% of patients with DLBCL and other B-cell lymphomas were alive, respectively.

“Patients had predominantly advanced-stage DLBCL, with frequent liver involvement, and frequent long-term hematological responses when they received a combination of immuno-chemotherapy and antiviral treatment,” the researchers explained. They also noted that extra-nodal involvement was frequently seen in both HBV- and HCV-associated NHL.

“Additional studies are needed to explore the lymphomagenesis of [these] association[s],” they concluded.

No funding sources were reported. The authors reported having no conflicts of interest.

SOURCE: Lemaitre M et al. J Infect. 2019 Dec 14. doi: 10.1016/j.jinf.2019.12.005.

Preoperative computerized tomography (CT) demonstrated limited value in the clinical management of patients with early-stage vulvar squamous cell carcinoma (VSCC) analyzed in a single-center study.

The findings suggest preoperative CT imaging could be excluded prior to sentinel inguinal lymph node biopsy or staging surgery in patients with early-stage disease.

“In this study, we aimed to investigate if preoperative CT scan influences the overall course of VSCC management in patients without clinical evidence of groin lymphadenopathy,” wrote Rachel Pounds, MD, of the University of Birmingham (England) and colleagues. The study was published in Gynecologic Oncology.

The researchers prospectively studied a cohort of 225 patients with primary or recurrent VSCC who underwent staging surgery at a single institution in the United Kingdom. The patients’ mean age was 67 years (range, 54-79 years), and most had stage 1B disease (57.8%).

The researchers compared preoperative imaging findings with histological results from sentinel inguinal lymph node biopsy. Other clinical information, including surgery type, evidence of groin node involvement, and age at diagnosis was collected from patient files and included in the analysis.

In all, 51.6% of patients underwent preoperative CT imaging. Among these patients, 37.9% had a positive report of radiological groin lymphatic metastases.

“True groin node metastases, confirmed histologically, were observed in 26 patients (22.4%) with a radiologically positive scan report (true positives) and in 18 patients (15.5%) with a radiological negative scan report (false negatives),” the researchers wrote.

The specificity and sensitivity of preoperative CT to detect groin lymphatic metastasis were 77.8% and 59.1%, respectively. The positive and negative predictive values were 61.9% and 75.7%, respectively.

There was no significant difference in overall survival, disease-specific or disease-free survival, or groin node recurrence between patients who underwent preoperative CT and patients who did not.

Groin node recurrence was observed in 10.3% of patients with preoperative CT and 11.5% of patients without it (P = .7768). Disease-specific death occurred in 16.4% of patients with preoperative CT and 13.5% of patients without it (P = .5451).

“Our results highlight the poor reliability of preoperative CT scans in detecting inguinal lymphatic metastasis,” the researchers wrote. “Preoperative CT scan may be omitted in early stage VSCC prior to surgical staging as it does not affect overall management and surgical outcomes.”

No funding sources were reported for this study. The authors reported having no conflicts of interest.

SOURCE: Pounds R et al. Gynecol Oncol. 2020 Jan 24. doi: 10.1016/j.ygyno.2020.01.031.

Preoperative computerized tomography (CT) demonstrated limited value in the clinical management of patients with early-stage vulvar squamous cell carcinoma (VSCC) analyzed in a single-center study.

The findings suggest preoperative CT imaging could be excluded prior to sentinel inguinal lymph node biopsy or staging surgery in patients with early-stage disease.

“In this study, we aimed to investigate if preoperative CT scan influences the overall course of VSCC management in patients without clinical evidence of groin lymphadenopathy,” wrote Rachel Pounds, MD, of the University of Birmingham (England) and colleagues. The study was published in Gynecologic Oncology.

The researchers prospectively studied a cohort of 225 patients with primary or recurrent VSCC who underwent staging surgery at a single institution in the United Kingdom. The patients’ mean age was 67 years (range, 54-79 years), and most had stage 1B disease (57.8%).

The researchers compared preoperative imaging findings with histological results from sentinel inguinal lymph node biopsy. Other clinical information, including surgery type, evidence of groin node involvement, and age at diagnosis was collected from patient files and included in the analysis.

In all, 51.6% of patients underwent preoperative CT imaging. Among these patients, 37.9% had a positive report of radiological groin lymphatic metastases.

“True groin node metastases, confirmed histologically, were observed in 26 patients (22.4%) with a radiologically positive scan report (true positives) and in 18 patients (15.5%) with a radiological negative scan report (false negatives),” the researchers wrote.

The specificity and sensitivity of preoperative CT to detect groin lymphatic metastasis were 77.8% and 59.1%, respectively. The positive and negative predictive values were 61.9% and 75.7%, respectively.

There was no significant difference in overall survival, disease-specific or disease-free survival, or groin node recurrence between patients who underwent preoperative CT and patients who did not.

Groin node recurrence was observed in 10.3% of patients with preoperative CT and 11.5% of patients without it (P = .7768). Disease-specific death occurred in 16.4% of patients with preoperative CT and 13.5% of patients without it (P = .5451).

“Our results highlight the poor reliability of preoperative CT scans in detecting inguinal lymphatic metastasis,” the researchers wrote. “Preoperative CT scan may be omitted in early stage VSCC prior to surgical staging as it does not affect overall management and surgical outcomes.”

No funding sources were reported for this study. The authors reported having no conflicts of interest.

SOURCE: Pounds R et al. Gynecol Oncol. 2020 Jan 24. doi: 10.1016/j.ygyno.2020.01.031.

Preoperative computerized tomography (CT) demonstrated limited value in the clinical management of patients with early-stage vulvar squamous cell carcinoma (VSCC) analyzed in a single-center study.

The findings suggest preoperative CT imaging could be excluded prior to sentinel inguinal lymph node biopsy or staging surgery in patients with early-stage disease.

“In this study, we aimed to investigate if preoperative CT scan influences the overall course of VSCC management in patients without clinical evidence of groin lymphadenopathy,” wrote Rachel Pounds, MD, of the University of Birmingham (England) and colleagues. The study was published in Gynecologic Oncology.

The researchers prospectively studied a cohort of 225 patients with primary or recurrent VSCC who underwent staging surgery at a single institution in the United Kingdom. The patients’ mean age was 67 years (range, 54-79 years), and most had stage 1B disease (57.8%).

The researchers compared preoperative imaging findings with histological results from sentinel inguinal lymph node biopsy. Other clinical information, including surgery type, evidence of groin node involvement, and age at diagnosis was collected from patient files and included in the analysis.

In all, 51.6% of patients underwent preoperative CT imaging. Among these patients, 37.9% had a positive report of radiological groin lymphatic metastases.

“True groin node metastases, confirmed histologically, were observed in 26 patients (22.4%) with a radiologically positive scan report (true positives) and in 18 patients (15.5%) with a radiological negative scan report (false negatives),” the researchers wrote.

The specificity and sensitivity of preoperative CT to detect groin lymphatic metastasis were 77.8% and 59.1%, respectively. The positive and negative predictive values were 61.9% and 75.7%, respectively.

There was no significant difference in overall survival, disease-specific or disease-free survival, or groin node recurrence between patients who underwent preoperative CT and patients who did not.

Groin node recurrence was observed in 10.3% of patients with preoperative CT and 11.5% of patients without it (P = .7768). Disease-specific death occurred in 16.4% of patients with preoperative CT and 13.5% of patients without it (P = .5451).

“Our results highlight the poor reliability of preoperative CT scans in detecting inguinal lymphatic metastasis,” the researchers wrote. “Preoperative CT scan may be omitted in early stage VSCC prior to surgical staging as it does not affect overall management and surgical outcomes.”

No funding sources were reported for this study. The authors reported having no conflicts of interest.

SOURCE: Pounds R et al. Gynecol Oncol. 2020 Jan 24. doi: 10.1016/j.ygyno.2020.01.031.

Considerable differences in ovarian cancer survival exist between high-income countries, especially for older women with advanced disease, according to a recent study.

The findings suggest additional research is needed to evaluate international differences in both treatment- and patient-specific factors affecting survival.

“This study [evaluated] differences in survival by age and stage at diagnosis within and across seven high-income countries,” wrote Citadel J. Cabasag, PhD, of the International Agency for Research on Cancer in Lyon, France, and colleagues. The results were published in Gynecologic Oncology.

The researchers conducted a retrospective analysis of population-based registry data from 2010 to 2014. Data were collected from 21 cancer registries located in Canada, United Kingdom, New Zealand, Norway, Ireland, Australia, and Denmark.

The cohort included 58,161 women with epithelial and nonepithelial ovarian cancer. The majority of cases were advanced stage, with a median age of 63-67 years at diagnosis, depending on the country.

The researchers compared age- and stage-specific net survival between countries at 1 and 3 years post diagnosis.

The 3-year all-ages net survival was highest for Norway (57%) and Australia (56%), followed by Denmark (54%), Canada (50%), United Kingdom (47%), New Zealand (46%), and Ireland (45%).

Most patients were diagnosed with distant disease (range, 64%-71%), with the greatest proportion of women in the 65- to 74- and 75- to 99-year age categories. The lowest 3-year age-specific survival (range, 20%-34%) was observed in the 75- to 99-year age category.

Marked differences in 3-year net survival between countries were found for women in the 75- to 99-year age group with distant disease (range, 12%-25%).

“International survival differences by age groups were less stark for early-stage disease,” the researchers reported. “Interjurisdictional differences within countries were also observed.”

The researchers acknowledged a key limitation of the analysis was the use of registry data. Variability between, and incomplete data within, registries could have lowered the accuracy of the survival estimates.

“[F]urther research investigating international differences in access to and quality of treatment, and prevalence of comorbid conditions particularly in older women with advanced disease [is needed],” the researchers concluded.

The study was supported by funding provided to the International Cancer Benchmarking Partnership. The authors reported having no conflicts of interest.

SOURCE: Cabasag CJ et al. Gynecol Oncol. 2020 Jan 28. doi: 10.1016/j.ygyno.2019.12.047.

Considerable differences in ovarian cancer survival exist between high-income countries, especially for older women with advanced disease, according to a recent study.

The findings suggest additional research is needed to evaluate international differences in both treatment- and patient-specific factors affecting survival.

“This study [evaluated] differences in survival by age and stage at diagnosis within and across seven high-income countries,” wrote Citadel J. Cabasag, PhD, of the International Agency for Research on Cancer in Lyon, France, and colleagues. The results were published in Gynecologic Oncology.

The researchers conducted a retrospective analysis of population-based registry data from 2010 to 2014. Data were collected from 21 cancer registries located in Canada, United Kingdom, New Zealand, Norway, Ireland, Australia, and Denmark.

The cohort included 58,161 women with epithelial and nonepithelial ovarian cancer. The majority of cases were advanced stage, with a median age of 63-67 years at diagnosis, depending on the country.

The researchers compared age- and stage-specific net survival between countries at 1 and 3 years post diagnosis.

The 3-year all-ages net survival was highest for Norway (57%) and Australia (56%), followed by Denmark (54%), Canada (50%), United Kingdom (47%), New Zealand (46%), and Ireland (45%).

Most patients were diagnosed with distant disease (range, 64%-71%), with the greatest proportion of women in the 65- to 74- and 75- to 99-year age categories. The lowest 3-year age-specific survival (range, 20%-34%) was observed in the 75- to 99-year age category.

Marked differences in 3-year net survival between countries were found for women in the 75- to 99-year age group with distant disease (range, 12%-25%).

“International survival differences by age groups were less stark for early-stage disease,” the researchers reported. “Interjurisdictional differences within countries were also observed.”

The researchers acknowledged a key limitation of the analysis was the use of registry data. Variability between, and incomplete data within, registries could have lowered the accuracy of the survival estimates.

“[F]urther research investigating international differences in access to and quality of treatment, and prevalence of comorbid conditions particularly in older women with advanced disease [is needed],” the researchers concluded.

The study was supported by funding provided to the International Cancer Benchmarking Partnership. The authors reported having no conflicts of interest.

SOURCE: Cabasag CJ et al. Gynecol Oncol. 2020 Jan 28. doi: 10.1016/j.ygyno.2019.12.047.

Considerable differences in ovarian cancer survival exist between high-income countries, especially for older women with advanced disease, according to a recent study.

The findings suggest additional research is needed to evaluate international differences in both treatment- and patient-specific factors affecting survival.

“This study [evaluated] differences in survival by age and stage at diagnosis within and across seven high-income countries,” wrote Citadel J. Cabasag, PhD, of the International Agency for Research on Cancer in Lyon, France, and colleagues. The results were published in Gynecologic Oncology.

The researchers conducted a retrospective analysis of population-based registry data from 2010 to 2014. Data were collected from 21 cancer registries located in Canada, United Kingdom, New Zealand, Norway, Ireland, Australia, and Denmark.

The cohort included 58,161 women with epithelial and nonepithelial ovarian cancer. The majority of cases were advanced stage, with a median age of 63-67 years at diagnosis, depending on the country.

The researchers compared age- and stage-specific net survival between countries at 1 and 3 years post diagnosis.

The 3-year all-ages net survival was highest for Norway (57%) and Australia (56%), followed by Denmark (54%), Canada (50%), United Kingdom (47%), New Zealand (46%), and Ireland (45%).

Most patients were diagnosed with distant disease (range, 64%-71%), with the greatest proportion of women in the 65- to 74- and 75- to 99-year age categories. The lowest 3-year age-specific survival (range, 20%-34%) was observed in the 75- to 99-year age category.

Marked differences in 3-year net survival between countries were found for women in the 75- to 99-year age group with distant disease (range, 12%-25%).

“International survival differences by age groups were less stark for early-stage disease,” the researchers reported. “Interjurisdictional differences within countries were also observed.”

The researchers acknowledged a key limitation of the analysis was the use of registry data. Variability between, and incomplete data within, registries could have lowered the accuracy of the survival estimates.

“[F]urther research investigating international differences in access to and quality of treatment, and prevalence of comorbid conditions particularly in older women with advanced disease [is needed],” the researchers concluded.

The study was supported by funding provided to the International Cancer Benchmarking Partnership. The authors reported having no conflicts of interest.

SOURCE: Cabasag CJ et al. Gynecol Oncol. 2020 Jan 28. doi: 10.1016/j.ygyno.2019.12.047.

Newly discovered gene mutations in the progression of venetoclax-treated relapsed chronic lymphocytic leukemia (CLL) may improve understanding of clinical resistance mechanisms underlying the disease, according to recent research.

“We investigated patients with progressive CLL on venetoclax harboring subclonal BCL2 Gly101Val mutations for the presence of additional acquired BCL2 resistance mutations,” wrote Piers Blombery, MBBS, of the University of Melbourne in Victoria, Australia, and his colleagues in Blood.

Among 67 patients with relapsed disease treated with the BCL2 inhibitor venetoclax, the researchers identified a total of 11 patients with co-occurring BCL2 Gly101Val mutations. Each patient was enrolled in an early phase clinical trial at an institution in Australia.

With respect to testing methods, next-generation sequencing (NGS) and hybridization-based target enrichment technologies were used to detect novel acquired mutations in the BCL2 coding region.

Among those harboring the Gly101Val mutation, additional BCL2 mutations were identified in 10 patients (91%), with a median of three mutations detected per patient (range, 1-7). Previously undescribed mutations included an in-frame insertion mutation (Arg107_Arg110dup), and other substitutions (Asp103/Val156) in the BCL2 gene.

“As with the Gly101Val, these observations support the specificity of these mutations for the context of venetoclax resistance,” they wrote.

The investigators further explained that the BCL2 Asp103Glu mutation could have particular significance in the context of venetoclax sensitivity because of selective targeting of the BCL2 gene.

In comparison to wild-type aspartic acid, the BCL2 Asp103Glu substitution was linked to an approximate 20-fold reduction in affinity for venetoclax, they reported.

“[Our findings] consolidate the paradigm emerging across hematological malignancies of multiple independent molecular mechanisms underpinning an ‘oligoclonal’ pattern of clinical relapse on targeted therapies,” they concluded.

Further studies are needed to fully characterize the relationship between acquired BCL2 mutations and venetoclax resistance.

The study was funded by the Snowdome Foundation, Vision Super and the Wilson Centre for Lymphoma Genomics, the Leukemia and Lymphoma Society, the National Health and Medical Research Council of Australia, and other grant funding sources provided to the study authors. The authors reported financial affiliations with AbbVie, Genentech, and the Walter and Eliza Hall Institute.

Newly discovered gene mutations in the progression of venetoclax-treated relapsed chronic lymphocytic leukemia (CLL) may improve understanding of clinical resistance mechanisms underlying the disease, according to recent research.

“We investigated patients with progressive CLL on venetoclax harboring subclonal BCL2 Gly101Val mutations for the presence of additional acquired BCL2 resistance mutations,” wrote Piers Blombery, MBBS, of the University of Melbourne in Victoria, Australia, and his colleagues in Blood.

Among 67 patients with relapsed disease treated with the BCL2 inhibitor venetoclax, the researchers identified a total of 11 patients with co-occurring BCL2 Gly101Val mutations. Each patient was enrolled in an early phase clinical trial at an institution in Australia.

With respect to testing methods, next-generation sequencing (NGS) and hybridization-based target enrichment technologies were used to detect novel acquired mutations in the BCL2 coding region.

Among those harboring the Gly101Val mutation, additional BCL2 mutations were identified in 10 patients (91%), with a median of three mutations detected per patient (range, 1-7). Previously undescribed mutations included an in-frame insertion mutation (Arg107_Arg110dup), and other substitutions (Asp103/Val156) in the BCL2 gene.

“As with the Gly101Val, these observations support the specificity of these mutations for the context of venetoclax resistance,” they wrote.

The investigators further explained that the BCL2 Asp103Glu mutation could have particular significance in the context of venetoclax sensitivity because of selective targeting of the BCL2 gene.

In comparison to wild-type aspartic acid, the BCL2 Asp103Glu substitution was linked to an approximate 20-fold reduction in affinity for venetoclax, they reported.

“[Our findings] consolidate the paradigm emerging across hematological malignancies of multiple independent molecular mechanisms underpinning an ‘oligoclonal’ pattern of clinical relapse on targeted therapies,” they concluded.

Further studies are needed to fully characterize the relationship between acquired BCL2 mutations and venetoclax resistance.

The study was funded by the Snowdome Foundation, Vision Super and the Wilson Centre for Lymphoma Genomics, the Leukemia and Lymphoma Society, the National Health and Medical Research Council of Australia, and other grant funding sources provided to the study authors. The authors reported financial affiliations with AbbVie, Genentech, and the Walter and Eliza Hall Institute.

Newly discovered gene mutations in the progression of venetoclax-treated relapsed chronic lymphocytic leukemia (CLL) may improve understanding of clinical resistance mechanisms underlying the disease, according to recent research.

“We investigated patients with progressive CLL on venetoclax harboring subclonal BCL2 Gly101Val mutations for the presence of additional acquired BCL2 resistance mutations,” wrote Piers Blombery, MBBS, of the University of Melbourne in Victoria, Australia, and his colleagues in Blood.

Among 67 patients with relapsed disease treated with the BCL2 inhibitor venetoclax, the researchers identified a total of 11 patients with co-occurring BCL2 Gly101Val mutations. Each patient was enrolled in an early phase clinical trial at an institution in Australia.

With respect to testing methods, next-generation sequencing (NGS) and hybridization-based target enrichment technologies were used to detect novel acquired mutations in the BCL2 coding region.

Among those harboring the Gly101Val mutation, additional BCL2 mutations were identified in 10 patients (91%), with a median of three mutations detected per patient (range, 1-7). Previously undescribed mutations included an in-frame insertion mutation (Arg107_Arg110dup), and other substitutions (Asp103/Val156) in the BCL2 gene.

“As with the Gly101Val, these observations support the specificity of these mutations for the context of venetoclax resistance,” they wrote.

The investigators further explained that the BCL2 Asp103Glu mutation could have particular significance in the context of venetoclax sensitivity because of selective targeting of the BCL2 gene.

In comparison to wild-type aspartic acid, the BCL2 Asp103Glu substitution was linked to an approximate 20-fold reduction in affinity for venetoclax, they reported.

“[Our findings] consolidate the paradigm emerging across hematological malignancies of multiple independent molecular mechanisms underpinning an ‘oligoclonal’ pattern of clinical relapse on targeted therapies,” they concluded.

Further studies are needed to fully characterize the relationship between acquired BCL2 mutations and venetoclax resistance.

The study was funded by the Snowdome Foundation, Vision Super and the Wilson Centre for Lymphoma Genomics, the Leukemia and Lymphoma Society, the National Health and Medical Research Council of Australia, and other grant funding sources provided to the study authors. The authors reported financial affiliations with AbbVie, Genentech, and the Walter and Eliza Hall Institute.

The incorporation of medical scribes into an outpatient oncology setting may lower physician burnout and improve patient care, according to a retrospective study.

“The objective of this study was to determine the effect of scribe integration on clinic workflow efficiency and physician satisfaction and quality of life in outpatient oncology clinics,” wrote Rebecca W. Gao, MD, of Stanford (Calif.) Medicine, and colleagues in the Journal of Oncology Practice.

The researchers retrospectively analyzed patient and survey data from 129 physicians connected with a tertiary care academic medical center during 2017-2019. In the study, 33 physicians were paired with a scribe, while 96 others were not.

During each patient encounter, visit duration times were recorded into an electronic medical record by a medical scribe. The scribes also performed a variety of other tasks, including collating lab results, documenting medical history, and completing postvisit summaries.

In the analysis, the team compared average visit duration times between physicians with and without a scribe. The effects of scribe integration on individual physician’s visit times were also assessed.

After analysis, the researchers found that physicians with a scribe experienced a 12.1% reduction in overall average patient visit duration, compared with visit times before scribe integration (P less than .0001). They also reported that less time was spent charting at the end of the day (P = .04).

“Compared with their peers, oncologists with scribes showed a 10%-20% decrease in the duration of all patient visits,” they explained.

With respect to patient care, survey results revealed that 90% of physicians strongly agreed they spent additional time with patients, and less time at the computer. “100% of physicians surveyed ‘strongly agreed’ that scribes improved their quality of life,” they added.

The researchers acknowledged that a key limitation of the study was the single-center design. As a result, these findings may not be applicable to physicians practicing in community-based settings.

Further studies could include financial analyses to evaluate the cost-effectiveness of medical scribe use in oncology practices, they noted.

“Our study suggests that scribes can be successfully integrated into oncology clinics and may benefit physician quality of life, clinic workflow efficiency, and the quality of physician-patient interactions,” they concluded.

The study was funded by the Stanford Cancer Center. One study author reported financial affiliations with SurgVision, Vergent Biotechnology, Novadaq Technologies, and LI-COR Biosciences.

SOURCE: Gao RW et al. J Oncol Pract. 2019 Dec 5. doi: 10.1200/JOP.19.00307.

The incorporation of medical scribes into an outpatient oncology setting may lower physician burnout and improve patient care, according to a retrospective study.

“The objective of this study was to determine the effect of scribe integration on clinic workflow efficiency and physician satisfaction and quality of life in outpatient oncology clinics,” wrote Rebecca W. Gao, MD, of Stanford (Calif.) Medicine, and colleagues in the Journal of Oncology Practice.

The researchers retrospectively analyzed patient and survey data from 129 physicians connected with a tertiary care academic medical center during 2017-2019. In the study, 33 physicians were paired with a scribe, while 96 others were not.

During each patient encounter, visit duration times were recorded into an electronic medical record by a medical scribe. The scribes also performed a variety of other tasks, including collating lab results, documenting medical history, and completing postvisit summaries.

In the analysis, the team compared average visit duration times between physicians with and without a scribe. The effects of scribe integration on individual physician’s visit times were also assessed.

After analysis, the researchers found that physicians with a scribe experienced a 12.1% reduction in overall average patient visit duration, compared with visit times before scribe integration (P less than .0001). They also reported that less time was spent charting at the end of the day (P = .04).

“Compared with their peers, oncologists with scribes showed a 10%-20% decrease in the duration of all patient visits,” they explained.

With respect to patient care, survey results revealed that 90% of physicians strongly agreed they spent additional time with patients, and less time at the computer. “100% of physicians surveyed ‘strongly agreed’ that scribes improved their quality of life,” they added.

The researchers acknowledged that a key limitation of the study was the single-center design. As a result, these findings may not be applicable to physicians practicing in community-based settings.

Further studies could include financial analyses to evaluate the cost-effectiveness of medical scribe use in oncology practices, they noted.

“Our study suggests that scribes can be successfully integrated into oncology clinics and may benefit physician quality of life, clinic workflow efficiency, and the quality of physician-patient interactions,” they concluded.

The study was funded by the Stanford Cancer Center. One study author reported financial affiliations with SurgVision, Vergent Biotechnology, Novadaq Technologies, and LI-COR Biosciences.

SOURCE: Gao RW et al. J Oncol Pract. 2019 Dec 5. doi: 10.1200/JOP.19.00307.

The incorporation of medical scribes into an outpatient oncology setting may lower physician burnout and improve patient care, according to a retrospective study.

“The objective of this study was to determine the effect of scribe integration on clinic workflow efficiency and physician satisfaction and quality of life in outpatient oncology clinics,” wrote Rebecca W. Gao, MD, of Stanford (Calif.) Medicine, and colleagues in the Journal of Oncology Practice.

The researchers retrospectively analyzed patient and survey data from 129 physicians connected with a tertiary care academic medical center during 2017-2019. In the study, 33 physicians were paired with a scribe, while 96 others were not.

During each patient encounter, visit duration times were recorded into an electronic medical record by a medical scribe. The scribes also performed a variety of other tasks, including collating lab results, documenting medical history, and completing postvisit summaries.

In the analysis, the team compared average visit duration times between physicians with and without a scribe. The effects of scribe integration on individual physician’s visit times were also assessed.

After analysis, the researchers found that physicians with a scribe experienced a 12.1% reduction in overall average patient visit duration, compared with visit times before scribe integration (P less than .0001). They also reported that less time was spent charting at the end of the day (P = .04).

“Compared with their peers, oncologists with scribes showed a 10%-20% decrease in the duration of all patient visits,” they explained.

With respect to patient care, survey results revealed that 90% of physicians strongly agreed they spent additional time with patients, and less time at the computer. “100% of physicians surveyed ‘strongly agreed’ that scribes improved their quality of life,” they added.

The researchers acknowledged that a key limitation of the study was the single-center design. As a result, these findings may not be applicable to physicians practicing in community-based settings.

Further studies could include financial analyses to evaluate the cost-effectiveness of medical scribe use in oncology practices, they noted.

“Our study suggests that scribes can be successfully integrated into oncology clinics and may benefit physician quality of life, clinic workflow efficiency, and the quality of physician-patient interactions,” they concluded.

The study was funded by the Stanford Cancer Center. One study author reported financial affiliations with SurgVision, Vergent Biotechnology, Novadaq Technologies, and LI-COR Biosciences.

SOURCE: Gao RW et al. J Oncol Pract. 2019 Dec 5. doi: 10.1200/JOP.19.00307.

A new and simple nomogram for predicting the risk of bladder cancer in patients with microscopic hematuria could optimize the diagnostic work up process, according to a recent study.

The tool may help improve patient understanding about their risk of bladder cancer, as well as alleviate unnecessary diagnostic evaluations for some patients.

“The goal of this study was to identify objective clinical factors associated with a bladder cancer diagnosis and to use these factors to create a nomogram that accurately predicts risk of bladder cancer,” wrote Richard S. Matulewicz, MD, MS, of Northwestern University, Chicago, and colleagues in Urologic Oncology.

Researchers identified 4,178 patients with a new diagnosis of microscopic hematuria from 2007 to 2015. Data was collected from an enterprise data repository of the Northwestern Medicine healthcare system. Study participants who underwent a full microhematuria evaluation were randomized to either a training or validation subgroup. In the training cohort, logistic regression analysis was used to detect factors linked to the diagnosis of bladder cancer. In the model, receiver operating curves were built to predict a diagnosis of bladder cancer among participants. In addition, calibration plots were computed for both subgroups to evaluate the discriminative ability of the model. After analysis, the researchers found significant differences in urinalysis results and demographics among patients with and without a diagnosis of bladder cancer. Patients with bladder cancer had a higher amount of microhematuria (RBC/hpf) on urinalysis (P less than .0001), were more likely previous or current smokers (P = .001), were more often male (68.2% vs. 49.7%; P = .0002), and were older (69.1 vs. 58.2 years; P less than .0001).

With respect to the predictive ability of the model, the area under the curve (AUC) in the training and validation set was 0.79 (95% confidence interval, 0.75-0.83) and 0.74 (95% CI, 0.67-0.80), respectively.

In addition, calibration plots demonstrated that the tool was able to predict the risk of bladder cancer diagnosis for patients with a probability of 0.3 or below.

“These results indicate that the model works best for a range of probabilities of (0-0.30), which is the vast majority of patients clinically and in our data,” the researchers explained.

The team acknowledged that characterizing risk beyond these levels should be done with caution given poor calibration beyond this threshold.

“External validation [of the model] and continued evolution of risk stratification models are needed,” they concluded.

The study was funded by the National Institutes of Health and the American Association of Medical Colleges. The authors reported having no conflicts of interest.

SOURCE: Matulewicz RS et al. Urol Oncol. 2020 Jan 14. doi: 10.1016/j.urolonc.2019.12.010.

A new and simple nomogram for predicting the risk of bladder cancer in patients with microscopic hematuria could optimize the diagnostic work up process, according to a recent study.

The tool may help improve patient understanding about their risk of bladder cancer, as well as alleviate unnecessary diagnostic evaluations for some patients.

“The goal of this study was to identify objective clinical factors associated with a bladder cancer diagnosis and to use these factors to create a nomogram that accurately predicts risk of bladder cancer,” wrote Richard S. Matulewicz, MD, MS, of Northwestern University, Chicago, and colleagues in Urologic Oncology.

Researchers identified 4,178 patients with a new diagnosis of microscopic hematuria from 2007 to 2015. Data was collected from an enterprise data repository of the Northwestern Medicine healthcare system. Study participants who underwent a full microhematuria evaluation were randomized to either a training or validation subgroup. In the training cohort, logistic regression analysis was used to detect factors linked to the diagnosis of bladder cancer. In the model, receiver operating curves were built to predict a diagnosis of bladder cancer among participants. In addition, calibration plots were computed for both subgroups to evaluate the discriminative ability of the model. After analysis, the researchers found significant differences in urinalysis results and demographics among patients with and without a diagnosis of bladder cancer. Patients with bladder cancer had a higher amount of microhematuria (RBC/hpf) on urinalysis (P less than .0001), were more likely previous or current smokers (P = .001), were more often male (68.2% vs. 49.7%; P = .0002), and were older (69.1 vs. 58.2 years; P less than .0001).

With respect to the predictive ability of the model, the area under the curve (AUC) in the training and validation set was 0.79 (95% confidence interval, 0.75-0.83) and 0.74 (95% CI, 0.67-0.80), respectively.

In addition, calibration plots demonstrated that the tool was able to predict the risk of bladder cancer diagnosis for patients with a probability of 0.3 or below.

“These results indicate that the model works best for a range of probabilities of (0-0.30), which is the vast majority of patients clinically and in our data,” the researchers explained.

The team acknowledged that characterizing risk beyond these levels should be done with caution given poor calibration beyond this threshold.

“External validation [of the model] and continued evolution of risk stratification models are needed,” they concluded.

The study was funded by the National Institutes of Health and the American Association of Medical Colleges. The authors reported having no conflicts of interest.

SOURCE: Matulewicz RS et al. Urol Oncol. 2020 Jan 14. doi: 10.1016/j.urolonc.2019.12.010.

A new and simple nomogram for predicting the risk of bladder cancer in patients with microscopic hematuria could optimize the diagnostic work up process, according to a recent study.

The tool may help improve patient understanding about their risk of bladder cancer, as well as alleviate unnecessary diagnostic evaluations for some patients.

“The goal of this study was to identify objective clinical factors associated with a bladder cancer diagnosis and to use these factors to create a nomogram that accurately predicts risk of bladder cancer,” wrote Richard S. Matulewicz, MD, MS, of Northwestern University, Chicago, and colleagues in Urologic Oncology.

Researchers identified 4,178 patients with a new diagnosis of microscopic hematuria from 2007 to 2015. Data was collected from an enterprise data repository of the Northwestern Medicine healthcare system. Study participants who underwent a full microhematuria evaluation were randomized to either a training or validation subgroup. In the training cohort, logistic regression analysis was used to detect factors linked to the diagnosis of bladder cancer. In the model, receiver operating curves were built to predict a diagnosis of bladder cancer among participants. In addition, calibration plots were computed for both subgroups to evaluate the discriminative ability of the model. After analysis, the researchers found significant differences in urinalysis results and demographics among patients with and without a diagnosis of bladder cancer. Patients with bladder cancer had a higher amount of microhematuria (RBC/hpf) on urinalysis (P less than .0001), were more likely previous or current smokers (P = .001), were more often male (68.2% vs. 49.7%; P = .0002), and were older (69.1 vs. 58.2 years; P less than .0001).

With respect to the predictive ability of the model, the area under the curve (AUC) in the training and validation set was 0.79 (95% confidence interval, 0.75-0.83) and 0.74 (95% CI, 0.67-0.80), respectively.

In addition, calibration plots demonstrated that the tool was able to predict the risk of bladder cancer diagnosis for patients with a probability of 0.3 or below.

“These results indicate that the model works best for a range of probabilities of (0-0.30), which is the vast majority of patients clinically and in our data,” the researchers explained.

The team acknowledged that characterizing risk beyond these levels should be done with caution given poor calibration beyond this threshold.

“External validation [of the model] and continued evolution of risk stratification models are needed,” they concluded.

The study was funded by the National Institutes of Health and the American Association of Medical Colleges. The authors reported having no conflicts of interest.

SOURCE: Matulewicz RS et al. Urol Oncol. 2020 Jan 14. doi: 10.1016/j.urolonc.2019.12.010.

Chemoradiotherapy impairs health-related quality of life (HRQoL) after the initiation of treatment in patients with muscle-invasive bladder cancer, according to an exploratory analysis of trial data.

However, HRQoL scores improved to pretreatment levels within 6 months, and improvements were maintained at 5-year follow up.

“[We] planned a prospective assessment of patient-reported outcomes within BC2001, using the Functional Assessment of Cancer Therapy–Bladder (FACT-BL) questionnaire,” wrote Robert A. Huddart, MBBS, MRCP, FRCR, PhD, of the Institute of Cancer Research, England, and colleagues. Their report is in European Urology.

The exploratory analyses of HRQoL data included 452 patients from the phase 3 BC2001 trial. The objective of the analysis was to evaluate the impact of chemoradiotherapy on HRQoL in trial participants.

The BC2001 trial randomized patients to either radiotherapy (standard or reduced high-dose volume radiotherapy) and/or chemotherapy (radiotherapy or chemoradiotherapy) comparison groups. The primary outcome was the change in bladder cancer subscale (BLCS) scores from baseline to 12 months.

At trial baseline, study subjects were enrolled into the optional substudy, which involved completion of the FACT-BL questionnaire. Follow-up assessment was conducted at various time points after the start of radiotherapy.

After analysis, the researchers found that HRQoL scores deteriorated at end of treatment (BLCS: –5.06; 99% confidence interval, –6.12 to –4.00; overall FACT-BL: –8.22; 99% CI, –10.76 to –5.68), but improved to baseline levels at 6 months, and were maintained thereafter.

“Two-thirds of patients report stable or improved HRQoL on long-term follow-up,” they reported. “There [was] no evidence of impairment in HRQoL resulting from the addition of chemotherapy,” the researchers said.

In addition, the team found that pretrial administration of neoadjuvant chemotherapy had no significant impact on HRQoL outcomes.

One key limitation of the analysis was incomplete follow-up with HRQoL questionnaires. Over time, response rates declined, with a 60% expected response rate at 5 years.

“Addition of concomitant chemotherapy or use of neoadjuvant chemotherapy has no significant impact on HRQoL, further supporting the routine use of 5-FU and mitomycin C in this setting,” Dr. Huddart and coauthors concluded.

Cancer Research UK funded the study. The authors reported having no conflicts of interest.

SOURCE: Huddart RA et al. Eur Urol. 2019 Dec 13. doi: 10.1016/j.eururo.2019.11.001.

Chemoradiotherapy impairs health-related quality of life (HRQoL) after the initiation of treatment in patients with muscle-invasive bladder cancer, according to an exploratory analysis of trial data.

However, HRQoL scores improved to pretreatment levels within 6 months, and improvements were maintained at 5-year follow up.

“[We] planned a prospective assessment of patient-reported outcomes within BC2001, using the Functional Assessment of Cancer Therapy–Bladder (FACT-BL) questionnaire,” wrote Robert A. Huddart, MBBS, MRCP, FRCR, PhD, of the Institute of Cancer Research, England, and colleagues. Their report is in European Urology.

The exploratory analyses of HRQoL data included 452 patients from the phase 3 BC2001 trial. The objective of the analysis was to evaluate the impact of chemoradiotherapy on HRQoL in trial participants.

The BC2001 trial randomized patients to either radiotherapy (standard or reduced high-dose volume radiotherapy) and/or chemotherapy (radiotherapy or chemoradiotherapy) comparison groups. The primary outcome was the change in bladder cancer subscale (BLCS) scores from baseline to 12 months.

At trial baseline, study subjects were enrolled into the optional substudy, which involved completion of the FACT-BL questionnaire. Follow-up assessment was conducted at various time points after the start of radiotherapy.

After analysis, the researchers found that HRQoL scores deteriorated at end of treatment (BLCS: –5.06; 99% confidence interval, –6.12 to –4.00; overall FACT-BL: –8.22; 99% CI, –10.76 to –5.68), but improved to baseline levels at 6 months, and were maintained thereafter.

“Two-thirds of patients report stable or improved HRQoL on long-term follow-up,” they reported. “There [was] no evidence of impairment in HRQoL resulting from the addition of chemotherapy,” the researchers said.

In addition, the team found that pretrial administration of neoadjuvant chemotherapy had no significant impact on HRQoL outcomes.

One key limitation of the analysis was incomplete follow-up with HRQoL questionnaires. Over time, response rates declined, with a 60% expected response rate at 5 years.

“Addition of concomitant chemotherapy or use of neoadjuvant chemotherapy has no significant impact on HRQoL, further supporting the routine use of 5-FU and mitomycin C in this setting,” Dr. Huddart and coauthors concluded.

Cancer Research UK funded the study. The authors reported having no conflicts of interest.

SOURCE: Huddart RA et al. Eur Urol. 2019 Dec 13. doi: 10.1016/j.eururo.2019.11.001.

Chemoradiotherapy impairs health-related quality of life (HRQoL) after the initiation of treatment in patients with muscle-invasive bladder cancer, according to an exploratory analysis of trial data.

However, HRQoL scores improved to pretreatment levels within 6 months, and improvements were maintained at 5-year follow up.

“[We] planned a prospective assessment of patient-reported outcomes within BC2001, using the Functional Assessment of Cancer Therapy–Bladder (FACT-BL) questionnaire,” wrote Robert A. Huddart, MBBS, MRCP, FRCR, PhD, of the Institute of Cancer Research, England, and colleagues. Their report is in European Urology.

The exploratory analyses of HRQoL data included 452 patients from the phase 3 BC2001 trial. The objective of the analysis was to evaluate the impact of chemoradiotherapy on HRQoL in trial participants.

The BC2001 trial randomized patients to either radiotherapy (standard or reduced high-dose volume radiotherapy) and/or chemotherapy (radiotherapy or chemoradiotherapy) comparison groups. The primary outcome was the change in bladder cancer subscale (BLCS) scores from baseline to 12 months.

At trial baseline, study subjects were enrolled into the optional substudy, which involved completion of the FACT-BL questionnaire. Follow-up assessment was conducted at various time points after the start of radiotherapy.

After analysis, the researchers found that HRQoL scores deteriorated at end of treatment (BLCS: –5.06; 99% confidence interval, –6.12 to –4.00; overall FACT-BL: –8.22; 99% CI, –10.76 to –5.68), but improved to baseline levels at 6 months, and were maintained thereafter.

“Two-thirds of patients report stable or improved HRQoL on long-term follow-up,” they reported. “There [was] no evidence of impairment in HRQoL resulting from the addition of chemotherapy,” the researchers said.

In addition, the team found that pretrial administration of neoadjuvant chemotherapy had no significant impact on HRQoL outcomes.

One key limitation of the analysis was incomplete follow-up with HRQoL questionnaires. Over time, response rates declined, with a 60% expected response rate at 5 years.

“Addition of concomitant chemotherapy or use of neoadjuvant chemotherapy has no significant impact on HRQoL, further supporting the routine use of 5-FU and mitomycin C in this setting,” Dr. Huddart and coauthors concluded.

Cancer Research UK funded the study. The authors reported having no conflicts of interest.

SOURCE: Huddart RA et al. Eur Urol. 2019 Dec 13. doi: 10.1016/j.eururo.2019.11.001.