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|NEWS FROM THE WORLD OF ONCOLOGY
|Year : 2020 | Volume
| Issue : 3 | Page : 363-365
News from the world of oncology
|Date of Submission||23-Jul-2020|
|Date of Decision||23-Jul-2020|
|Date of Acceptance||23-Jul-2020|
|Date of Web Publication||10-Aug-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. News from the world of oncology. Indian J Cancer 2020;57:363-5
| » Trends in Gender Differences in Publication Rates in Oncology Journals|| |
Gender equality has shown an upward trend over the past decades; however, these trends are yet to materialize in oncology publications. The current rates of women publishing scientific publications that serve as a benchmark for academic prowess and finesse in oncology are disproportionately lower compared to men.
A study conducted by Dalal et al., from University School of Medicine, Durham, North Carolina, USA (“Mind the gap: Gendered publication trends in oncology,” Cancer 2020,126(12):2859–865), highlighted the bibliometric analysis of five clinical specialty-oriented oncology journals indexed in the Web of Science. The analysis included 9189 articles published from 1990 to 2017.
The analyses included 5921 original research articles, 922 editorials, 1257 letters/notes, 807 papers from conference-related proceedings, and 282 review articles. These articles were selected from 1990, 2000, 2010, and 2017, each representing a publication year from each decade. The results showed that the female representation in terms of first authors improved from 17.7% in 1990 to 36.6% to 2017. However, this was not found to be adequate as women first, and senior authors were grossly outnumbered by their male counterparts irrespective of the type of articles published. The average citation counts for the authorship of 50 most cited articles per year also showed a male preponderance in the analyzed data. The probability of the first author being a male given a senior male author was significantly higher when compared to a woman being a senior author, where the probability of the first author is a male or female was not significantly different. The data analyzed also showed that female senior authors were more likely to work with male and female first authors on an equally likely basis compared to male senior authors who worked with more male first authors. This demonstrated that women when placed in leadership positions or when given senior author status often resulted with more equitable mentorship and collaboration. Dr. Nicole Dalal, MD, states “Addressing the observed gendered disparities in publishing in oncology will be essential to promoting women at all levels of oncologic practice and achieving workforce equality.”
The gender gap as per the authors is attributed to the “leaky pipeline” theory which postulates that women were more likely to spend time at home and bear significant childcare burden that impacts their career. The study concluded that fostering women in oncological research at different levels of academia may reap plentiful benefits in terms of collaboration and research output.
Ankeeta Menona Jacob, Mangalore
ORCID ID: https://orcid.org/0000-0002-9839-3556
| » Food and Drug Administration Approves Tumor-Agnostic Immune-Oncologic Drugs for High-Tumor Mutational Burden Cancers|| |
Mutations are genetic drivers of all malignancies. Targeted therapies for cancer are highly specific toward the driver mutations and clinically very effective. Immuno-oncological drugs (IO) are a recent addition to anticancer drugs, which are quite safe and show a durable response in a fraction of patients; however, we do not yet have definite predictors of response to IO. Some of the likely markers are programmed death-ligand 1, microsatellite instability (MSI), and tumor mutational burden (TMB). IO has received certain approvals on the basis of PDL-1 and MSI. On June 17, 2020, the U.S. Food and Drug Administration (FDA) approved pembrolizumab for adults and children with high-tumor mutational burden (TMB-H) tumors.
TMB indicates the number of accumulated mutations in a cancer over a period of its development and progression. Proteins coded by some of these mutations act as neoantigens, which are recognized as foreign bodies by CD8+ T cells, and are targeted by the immune system. Hence, tumors with high TMB are considered to be more immunogenic and responsive to IO.
The tumor agnostic efficacy of pembrolizumab in TMB-H patients was investigated in a prospectively planned retrospective analysis of 10 cohorts of patients in KEYNOTE-158 trial. It was a multicenter, open-label, nonrandomized trial in which 102 patients identified as having TMB ≥ 10 mutations per megabase and received pembrolizumab 200 mg intravenously every 3 weeks until unacceptable toxicity or disease progression. All the patients had various previously treated unresectable or metastatic TMB-H solid tumors. The overall response rate for these patients was 29% (95% Confidence Interval: 21, 39), with a 4% complete response rate and 25% partial response rate. The median duration of response was not reached, with 57% of patients having response durations ≥12 months and 50% of patients having response durations ≥24 months. Adverse effects were the same as noted in any other trial of pembrolizumab.
The recent FDA approval is applicable to TMB-H cancers that have progressed following prior treatment and who have no satisfactory alternative treatment options. Although pembrolizumab appears quite promising in this subset of patients, this relationship is not so straight forward, with two major concerning factors. First, the efficacy of IO in TMB-H tumors is imperfect across and within tumor types. Merkel cell carcinomas, renal cell cancers, and mesotheliomas have higher response rates to IOs than would be anticipated from their TMBs and lower response rates in some tumor types such as glioma and microsatellite stable colorectal cancer. Second, the determination and thresholds for TMB are likely to differ across tumor types and also across testing platforms; thus, no consistent pan-cancer testing approach has been validated. Nonetheless, FDA has also approved the FoundationOneCDx assay as a companion diagnostic for pembrolizumab.
In the opinion of Dr. Mudhasir Ahmad (Consultant Medical Oncologist, Fortis Hospital Noida, India), “Immunotherapy is a landmark success against cancer. The recent TMB based FDA approval opens up a newer avenue to use this modality in another subset of patients, making its applicability wider for the benefit of cancer affected population.”
HS Darling, Bangalore
ORCID ID: https://orcid.org/0000-0001-7557-0292
| » Consultations via Videoconference Significantly Reduce Anxiety in Caregivers of Cancer Patients|| |
A study funded by National Institutes of Health and conducted by Sara L. Douglas as lead author, under the aegis of American Society of Clinical Oncology (ASCO), was conducted to evaluate the efficacy of videoconferencing to allay the anxiety of remote caregivers of cancer patients. The study titled “Videoconference Intervention Significantly Reduces Anxiety and Distress among Remote Caregivers of People with Cancer” was published on May 13, 2020, on the official website of ASCO (https://www.asco.org). Sara L. Douglas is the Gertrude Perkins Oliva Professor in Oncology Nursing and Assistant Dean for Research at the Case Western Reserve University School of Nursing. Caregivers of cancer patients are always anxious for the well-being of their patients. Many of the caregivers live remotely from the patient and are sometimes the sole caregivers for the patients. Outbreak of COVID-19 has led people into social distancing and separation and has hence resulted in increased anxiety in caregivers of cancer patients.
This study evaluated the reduction in anxiety and stress levels by use of videoconferencing in 441 caregivers of cancer patients who lived more than 1 hour away from the patients. The caregivers were randomized into following three groups.
Group 1 had training sessions with a nurse practitioner or social worker along patient–oncologist visits via videoconference. The focus was on providing information and support. They also had access to a website with information specifically designed for distance caregivers.
Group 2 received virtual patient–oncologist visits and access to the same website.
Group 3 had access to the website only.
The average age of caregivers included in the study was 47 years. Seventy-one percent of caregivers were females. Sixty-three percent of caregivers were children of the patients. The average age of patients clocked at 65 years, 60% of them being females. Gastrointestinal and hematologic cancers formed 30% and 18% of all cases, respectively. Of patients with solid tumors, 59% had stage 4 disease. The duration of study was 4 months after which the caregivers were evaluated using a questionnaire.
Group 1 caregivers experienced 19.2% reduction in anxiety and 24.8% reduction in distress, while caregivers in group 2 had 17.3% improvements in anxiety scores and 19.8% improvements in distress scores when compared with group 3 patients.
The authors concluded that use of a simple technology like videoconferencing could significantly reduce the anxiety and distress levels of the caregivers. This can be used not just in times of COVID outbreak but otherwise also when caregivers live remotely and are unable to come for appointments of their patients.
Neha Chauhan, Bangalore
ORCID ID: https://orcid.org/0000-0003-4705-1959
ICMR releases guidelines on “Do Not Attempt Resuscitation” (DNAR)
The Indian Council of Medical Research (ICMR) Consensus Guidelines on “Do Not Attempt Resuscitation” were released in April 2020 and published in the Indian Journal of Medical Research 2020; 151:303–310 and simultaneously in National Medical Journal of India 2020; 33:e1–e6. They are based on recommendations of the core committee and several experts from various disciplines. The guidelines were finalized through virtual and real consultative meeting with a larger representative audience. The first hospital policies on orders not-to-resuscitate were published in the medical literature in 1976 and have been much debated since then.
The purpose of the document is to guide treating physicians on their decision concerning DNAR with the ultimate aim of preserving dignity in death and also to avoid prolonged suffering to the patient through nonbeneficial cardiopulmonary resuscitation (CPR) while continuing to provide other supportive care. It has been accepted that in some patients with specific medical conditions (debilitating chronic obstructive pulmonary disease, multiorgan failure, irreversible heart failure, advanced irreversible neurological disease, and advanced metastatic cancer), CPR does not alter the overall outcome of illness, rather it is likely to increase suffering and further deteriorate the quality of life. DNAR as an option has been practiced in many countries for such cases when the decision as a rule is taken by the treating physician who knows the patient's medical condition thoroughly, with information to the patient or her/his surrogate. While ordering DNAR on the patient's medical case record, every effort is made to treat the underlying disease and continue optimal medical care with compassion. This policy document describes the principles for DNAR, offers an algorithm and format for its implementation, and guidance on frequently asked questions. If done right as per the procedure laid for open communication, it would enhance mutual trust and respect between the treating physician and the patient/surrogate(s) respecting patient's autonomy and always on a case-to-case basis. It might as well involve team play with another physician, a psychologist or social worker, or a counselor or the hospital administrator depending on specific settings.
As mentioned in the guidelines, the discussions on DNAR should ideally take place when the patient is in her/his full senses, or if the patient is incompetent, i.e., not in a position to take such a decision, then allowing enough time for the family/surrogate(s) to grasp the situation, before the physician takes the decision.
ORCID ID: https://orcid.org/0000-0001-8670-3556