Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement

2015 ◽  
Vol 33 (32) ◽  
pp. 3826-3833 ◽  
Author(s):  
Arti Hurria ◽  
Laura A. Levit ◽  
William Dale ◽  
Supriya G. Mohile ◽  
Hyman B. Muss ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Trials ◽  
Clinical Oncology ◽  
Age Distribution ◽  
Evidence Base ◽  
Institute Of Medicine ◽  
Patients With Cancer ◽  
Treatment Plans ◽  
American Society ◽  
Journal Policies

The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants.

Clinical Cancer Advances 2010: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology

2010 ◽  
Vol 28 (36) ◽  
pp. 5327-5347 ◽  
Author(s):  
Mark G. Kris ◽  
Steven I. Benowitz ◽  
Sylvia Adams ◽  
Lisa Diller ◽  
Patricia Ganz ◽  
...  
Keyword(s):  
United States ◽  
Cancer Research ◽  
Clinical Trials ◽  
Clinical Oncology ◽  
The United States ◽  
Cooperative Group ◽  
Institute Of Medicine ◽  
Group Program ◽  
American Society ◽  
The Right

A MESSAGE FROM ASCO'S PRESIDENT Like many health professionals who care for people with cancer, I entered the field because of specific patients who touched my heart. They still do. In an effort to weave together my personal view of what the American Society of Clinical Oncology (ASCO) stands for and the purpose the organization serves, my presidential theme this year is “Patients. Pathways. Progress.” Patients come first. Caring for patients is the most important, rewarding aspect of being an oncology professional. At its best, the relationship between doctor and patient is compassionate and honest—and a relationship of mutual respect. Many professional organizations have an interest in cancer, but no other society is so focused on the entire spectrum of cancer care, education, and research. Nor is any other society as particularly interested in bringing new treatments to our patients through clinical trials as ASCO is. Clinical trials are the crux for improving treatments for people with cancer and are critical for continued progress against the disease. “Pathways” has several meanings. Some pathways are molecular—like the cancer cell's machinery of destruction, which we have only begun to understand in recent years. But there are other equally important pathways, including the pathways new therapies follow as they move from bench to bedside and the pathways patients follow during the course of their diseases. Improved understanding of these pathways will lead to new approaches in cancer care, allowing doctors to provide targeted therapies that deliver improved, personalized treatment. The best pathway for patients to gain access to new therapies is through clinical trials. Trials conducted by the National Cancer Institute's Cooperative Group Program, a nationwide network of cancer centers and physicians, represent the United States' most important pathway for accelerating progress against cancer. This year, the Institute of Medicine released a report on major challenges facing the Cooperative Group Program. Chief among them is the fact that funding for the program has been nearly flat since 2002. ASCO has called for a doubling of funding for cooperative group research within five years and supports the full implementation of the Institute of Medicine recommendations to revitalize the program. ASCO harnesses the expertise and resources of its 28,000 members to bring all of these pathways together for the greater good of patients. Progress against cancer is being made every day—measurable both in our improved understanding of the disease and in our ability to treat it. A report issued in December 2009 by the National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries found that rates of new diagnoses and rates of death resulting from all cancers combined have declined significantly in recent years for men and women overall and for most racial and ethnic populations in the United States. The pace of progress can be and needs to be hastened. Much remains to be done. Sustained national investment in cancer research is needed to bring better, more effective, less toxic treatments to people living with cancer. Pathways to progress continue in the clinic as doctors strive to find the right treatments for the right patients, to understand what represents the right treatments, and to partner with patients and caregivers for access to those treatments. This report demonstrates that significant progress is being made on the front lines of clinical cancer research. But although our nation's investment in this research is paying off, we must never forget the magnitude of what lies ahead. Cancer remains the number two killer of Americans. Future progress depends on continued commitment, from both ASCO and the larger medical community. George W. Sledge Jr, MD President American Society of Clinical Oncology

Clinical Cancer Advances 2013: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology

2014 ◽  
Vol 32 (2) ◽  
pp. 129-160 ◽  
Author(s):  
Jyoti D. Patel ◽  
Lada Krilov ◽  
Sylvia Adams ◽  
Carol Aghajanian ◽  
Ethan Basch ◽  
...  
Keyword(s):  
Cancer Research ◽  
Clinical Trials ◽  
Clinical Oncology ◽  
Cancer Survival ◽  
Annual Report ◽  
Quality Care ◽  
Patients With Cancer ◽  
The Past ◽  
Clinical Cancer ◽  
American Society

A MESSAGE FROM ASCO'S PRESIDENTSince its founding in 1964, the American Society of Clinical Oncology (ASCO) has been committed to improving cancer outcomes through research and the delivery of quality care. Research is the bedrock of discovering better treatments—providing hope to the millions of individuals who face a cancer diagnosis each year.The studies featured in “Clinical Cancer Advances 2013: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology” represent the invaluable contributions of thousands of patients who participate in clinical trials and the scientists who conduct basic and clinical research. The insights described in this report, such as how cancers hide from the immune system and why cancers may become resistant to targeted drugs, enable us to envision a future in which cancer will be even more controllable and preventable.The scientific process is thoughtful, deliberate, and sometimes slow, but each advance, while helping patients, now also points toward new research questions and unexplored opportunities. Both dramatic and subtle breakthroughs occur so that progress against cancer typically builds over many years. Success requires vision, persistence, and a long-term commitment to supporting cancer research and training.Our nation's longstanding investment in federally funded cancer research has contributed significantly to a growing array of effective new treatments and a much deeper understanding of the drivers of cancer. But despite this progress, our position as a world leader in advancing medical knowledge and our ability to attract the most promising and talented investigators are now threatened by an acute problem: Federal funding for cancer research has steadily eroded over the past decade, and only 15% of the ever-shrinking budget is actually spent on clinical trials. This dismal reality threatens the pace of progress against cancer and undermines our ability to address the continuing needs of our patients.Despite this extremely challenging economic environment, we continue to make progress. Maintaining and accelerating that progress require that we keep our eyes on the future and pursue a path that builds on the stunning successes of the past. We must continue to show our policymakers the successes in cancer survival and quality of life (QOL) they have enabled, emphasizing the need to sustain our national investment in the remarkably productive US cancer research enterprise.We must also look to innovative methods for transforming how we care for—and learn from—patients with cancer. Consider, for example, that fewer than 5% of adult patients with cancer currently participate in clinical trials. What if we were able to draw lessons from the other 95%? This possibility led ASCO this year to launch CancerLinQ, a groundbreaking health information technology initiative that will provide physicians with access to vast quantities of clinical data about real-world patients and help achieve higher quality, higher value cancer care.As you read the following pages, I hope our collective progress against cancer over the past year inspires you. More importantly, I hope the pride you feel motivates you to help us accelerate the pace of scientific advancement.Clifford A. Hudis, MD, FACPPresidentAmerican Society of Clinical Oncology

scholarly journals Global Practice and Efficiency of Multidisciplinary Tumor Boards: Results of an American Society of Clinical Oncology International Survey

2015 ◽  
Vol 1 (2) ◽  
pp. 57-64 ◽  
Author(s):  
Nagi S. El Saghir ◽  
Raghid N. Charara ◽  
Firas Y. Kreidieh ◽  
Vanessa Eaton ◽  
Kate Litvin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Clinical Oncology ◽  
The United States ◽  
Management Change ◽  
Patients With Cancer ◽  
Tumor Boards ◽  
Treatment Plans ◽  
American Society ◽  
E Mail

Purpose Multidisciplinary tumor boards (MDTBs) are universally recommended, but recent literature has challenged their efficiency. Methods The American Society of Clinical Oncology (ASCO) conducted a survey of a randomly selected cohort of international ASCO members. The survey was built on SurveyMonkey and was sent via e-mail to a sample of 5,357 members. Results In all, 501 ASCO members practicing outside the United States responded, and 86% of them participated in MDTBs at their own institutions. Those who attended represented a variety of disciplines in 70% to 86% of all MDTBs. The majority of MDTBs held weekly specialty and/or general meetings. Eighty-nine percent of 409 respondents attended for advice on treatment decisions. Survey respondents reported changes of 1% to 25% in treatment plans for 44% to 49% of patients with breast cancer and in 47% to 50% of patients with colorectal cancer. They reported 25% to 50% changes in surgery type and/or treatment plans for 14% to 21% of patients with breast cancer and 12% to 18% of patients with colorectal cancer. Of the 430 respondents 96% said overall benefit to patients was worth the time and effort spent at MDTBs, and 96% said that MDTBs have teaching value. Mini tumor boards held with whatever types of specialists were available were considered valid. In all, 94.8% (425 of 448) said that MDTBs should be required in institutions in which patients with cancer are treated. Conclusion MDTBs are commonplace worldwide. A majority of respondents attend them to obtain recommendations, and they report changes in patient management. Change occurred more frequently with nonmedical oncologists and with physicians who had less than 15 years in practice. MDTBs helped practitioners make management decisions. Mini tumor boards may improve time efficiency and are favored when the full team is not available. Suggestions for improving MDTBs included making them more efficient, better selection and preparation of cases, choosing an effective team leader, and improving how time is used, but more research is needed on ways to improve the efficiency of MDTBs.

scholarly journals How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology

2020 ◽  
pp. OP.20.00442
Author(s):  
William Dale ◽  
Grant R. Williams ◽  
Amy R. MacKenzie ◽  
Enrique Soto-Perez-de-Celis ◽  
Ronald J. Maggiore ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Online Survey ◽  
Task Force ◽  
Statistical Significance ◽  
Geriatric Oncology ◽  
Perceived Barriers ◽  
Patients With Cancer ◽  
Change Behavior ◽  
American Society

PURPOSE: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers’ practices using GA. Therefore, ASCO’s Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO’s Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%). CONCLUSION: Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.

scholarly journals Recommendations for Obesity Clinical Trials in Cancer Survivors: American Society of Clinical Oncology Statement

2015 ◽  
Vol 33 (33) ◽  
pp. 3961-3967 ◽  
Author(s):  
Jennifer A. Ligibel ◽  
Catherine M. Alfano ◽  
Dawn Hershman ◽  
Rachel M. Ballard ◽  
Suanna S. Bruinooge ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cancer Survivors ◽  
Clinical Oncology ◽  
American Society

Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer: 2007 Update of an American Society of Clinical Oncology Practice Guideline

2007 ◽  
Vol 25 (12) ◽  
pp. 1596-1605 ◽  
Author(s):  
D. Andrew Loblaw ◽  
Katherine S. Virgo ◽  
Robert Nam ◽  
Mark R. Somerfield ◽  
Edgar Ben-Josef ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Clinical Oncology ◽  
Specific Antigen ◽  
Survival Advantage ◽  
Controlled Trials ◽  
Moderate Increase ◽  
Specific Mortality ◽  
American Society ◽  
Androgen Blockade

Purpose To update the 2004 American Society of Clinical Oncology (ASCO) guideline on initial hormonal management of androgen-sensitive, metastatic, recurrent, or progressive prostate cancer (PCa). Methods The writing committee based its recommendations on an updated systematic literature review. Recommendations were approved by the Expert Panel, the ASCO Health Services Committee, and the ASCO Board of Directors. Results Seven randomized controlled trials (four new), one systematic review, one meta-analysis (new), one Markov model, and one delta-method 95% CI procedure for active controlled trials (new) informed the guideline update. Recommendations Bilateral orchiectomy or luteinizing hormone–releasing hormone agonists are recommended initial androgen-deprivation treatments (ADTs). Nonsteroidal antiandrogen monotherapy merits discussion as an alternative; steroidal antiandrogen monotherapy should not be offered. Combined androgen blockade should be considered. In metastatic or progressive PCa, immediate versus symptom-onset institution of ADT results in a moderate decrease (17%) in relative risk (RR) for PCa-specific mortality, a moderate increase (15%) in RR for non–PCa-specific mortality, and no overall survival advantage. Therefore, the Panel cannot make a strong recommendation for early ADT initiation. Prostate-specific antigen (PSA) kinetics and other metrics allow identification of populations at high risk for PCa-specific and overall mortality. Further studies must be completed to assess whether patients with adverse prognostic factors gain a survival advantage from immediate ADT. For patients electing to wait until symptoms for ADT, regular monitoring visits are indicated. For patients with recurrence, clinical trials should be considered if available. Currently, data are insufficient to support use of intermittent androgen blockade outside clinical trials.

scholarly journals American Society of Clinical Oncology/American Society of Hematology Clinical Practice Guideline Update on the Use of Epoetin and Darbepoetin in Adult Patients With Cancer

2010 ◽  
Vol 6 (6) ◽  
pp. 317-320 ◽  
Author(s):  
J. Douglas Rizzo ◽  
Melissa Brouwers ◽  
Patricia Hurley ◽  
Jerome Seidenfeld ◽  
Mark R. Somerfield ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Oncology ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Adult Patients ◽  
Patients With Cancer ◽  
Clinical Questions ◽  
American Society ◽  
Esa Therapy

This guideline update addresses two clinical questions: (1) What are the defining features of patients with a malignancy who are appropriate candidates for ESA treatment? (2) For patients who are appropriate candidates for treatment with ESAs, what are the optimal approaches to ESA therapy?

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