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The article focuses on activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and SLACK Incorporated.

Background: Prostate cancer (PCa) incidence and survival rates continue to rise among African American men. An estimated 161,360 new cases were expected to occur in 2017. With increased survival rates, individuals are living longer, thus increasing the risk of experiencing adverse physical and psychosocial longterm effects of the cancer and its treatment. This study explores how minorities affected by PCa can become more informed and active in the decision-making process in the context of a support community. Methods: An online registry was created by researchers from the Center for Cancer Research & Therapeutic Development. The registry captures participants' demographics and clinical disease information throughout the PCa continuum. The registry was made available online at www.pcregistry.cau.edu, required registration and informed consent, and included mechanisms to maintain confidentiality. A voluntary response sample was utilized. Conceptual framework from Andersen's version of the Behavioral Model of Health Services Utilization and Wilson and Cleary's Model of Health-Related Quality of Life were used as the basis for the survey. Key consultants were engaged as community relations advisory board members. Comprehensive recruitment strategies were employed yielding a response rate of over 1000 registered survivors, surpassing the goal of 500. Conclusion: The PCa registry targets a specific group of survivors, exploring subsets that may be underserved or high-risk for distress. The registry is not linked to treatment location, thus respondents are more compelled to share their experience. A comprehensive database system provides ongoing information on health and issues facing ethnic PCa survivors and identifies gaps to determine areas of future research while developing a consensus on implications survivors may face. [ABSTRACT FROM AUTHOR]

Background: Cancer care delivery approaches to address financial toxicity among cancer patients are not well- established, especially in rural communities. Objectives: To identify healthcare staff perspectives of financial toxicity experienced by cancer patients and to examine staff- and systems-level cancer care delivery approaches for addressing financial toxicity, with a focus on rural cancer survivors in Kentucky. Methods: We conducted key informant interviews using a semistructured interview guide with cancer center staff who provided financial navigation and/or assistance to oncology patients and their caregivers at 15 cancer centers in Kentucky. Results: Findings from this study revealed several key factors related to the availability and accessibility of cancer care delivery approaches at patient, staff, and system levels for reducing financial toxicity and improving access to care for rural and urban cancer survivors. Participants perceived high financial toxicity among cancer patients, especially in rural regions, related to the high cost of cancer care, as well the patients' limited ability to engage in cost-of-care conversations, low cost-related health literacy, and challenges in navigating cancer care. The availability of trained financial navigators/counselors dedicated solely to assisting the cancer patient population was limited, as was the use of standardized and proactive screening methods for financial toxicity. While in-house and external financial assistance programs were frequently tapped into, there were limitations in the navigators' ability to provide cost estimates based on insurance coverage and in assisting patients with applying for health insurance. Gaps in cancer care delivery approaches to reduce financial toxicity of patients included enhanced transportation options, additional financial navigation staff, early assessment of patient financial barriers and concerns, increased cost transparency, and enhanced cost-of-care conversations between patients and clinicians. Conclusion: Establishing sustainable oncology-designated financial navigation roles is imperative to expanding patient support and improving health and financial outcomes of cancer patients. Future research is needed to gather evidence that informs programs targeted at mitigating financial toxicity of cancer patients in rural communities. [ABSTRACT FROM AUTHOR]

Background: A patient navigator is a health professional who partners with patients, serving as an advocate and guide, prioritizing a patient's needs when working through the obstacles of the healthcare system to achieve optimal outcomes. Oncology patients undergoing treatment may have oncology nurse navigators as part of the care team. Navigators have the potential to improve outcomes in patients, and emergency department utilization may potentially be affected by nurse navigators. Objective: The purpose of this study is to determine if oncology patients who were assigned nurse navigators utilized the emergency department differently than patients who did not have a nurse navigator. Methods: We conducted a retrospective analysis of emergency visits from 2 acute care facilities in a Western state over 3 years, comparing frequency of emergency department visits and descriptive characteristics of navigated with non-navigated oncology patients. Results: Statistical comparison controlling for differences indicated navigated patients utilized the emergency department more frequently. We identified characteristics of navigated patients as having advanced- stage cancers, higher number of comorbidities, being single, and having chemotherapy as part of the cancer treatment. Conclusion: Navigated patients showed a higher frequency of emergency department utilization. Insights from measuring navigated patients' emergency department use helped us define parameters to quantify the impact of oncology nurse navigator (ONN) programs. Consideration in deciding which clinical outcomes to measure should be based on the availability of accurate data provided by ONNs. Analyzing the data from emergency department visits among navigated and non-navigated oncology patients highlights opportunities for high(er)-risk and vulnerable cancer patients to be identified and supported earlier in their cancer process. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has brought significant changes to the delivery of healthcare while increasing care needs in certain areas. To decrease the risk of transmitting the novel coronavirus to patients and healthcare workers, care providers have had to make major changes in their practice, such as increased use of telemedicine services. Many cancer centers also had to modify their cancer care while adopting telemedicine in a very short time. Objectives: To present the 4-week journey that our comprehensive cancer center underwent to implement telemedicine service during the pandemic, lessons learned from the process, and future directions for telemedicine use in cancer care. Methods: The telemedicine implementation process used in our cancer center was consistent with the steps suggested by the American Medical Association. The main steps included a needs assessment, identification and purchase of software and hardware, development of workflow and documentation mechanisms, preparation of clinicians and other team members, and patient education, as well as follow-up of implementation services, such as volume statistics, patient satisfaction surveys, and opportunities for improvement. Results: During the first 6 months of telemedicine service, the number of outpatient visits via televisit increased significantly, from 0 to 2156 visits by the end of September 2020. Feedback from patient satisfaction surveys was positive. The most appreciated aspect of telemedicine visits for patients was the ability to connect with their providers from home. No major complaints from patients or resistance from providers and staff were reported. Telemedicine service in our center has been undergoing continuous enhancements, and the service coverage has been increasing, including survivorship care appointments, social work interventions, caregiver support, and advance care planning. Conclusion: Telemedicine is likely here to stay, with increasing capacity in the current eHealth ecosystem. Further efforts must be made to generate evidence for its effectiveness in improving patient outcomes and experiences while establishing best practice approaches. [ABSTRACT FROM AUTHOR]

Background: There are limited training opportunities for healthcare professionals focused on the supportive care needs of sexual and gender minority (SGM) patients. SGM prostate cancer survivors have unique physical, psychosocial, and sexual needs that often go unaddressed due to lack of provider understanding of those needs. Methods: To inform the development of a training and companion materials for healthcare professionals to fill this gap, the authors conducted formative research to assess the needs of target learners and SGM patients. Formative research included a survey and focus group of oncology social workers, and interviews with SGM prostate cancer survivors. Results: Survey respondents indicated SGM patients deserved the same quality care as heterosexual, cis-gender patients; however, one-third indicated they were not well informed regarding health needs of SGM people. Focus group themes included differing social support structures for SGM people and the need for healthcare professional training. Patient interviews indicated a need for SGM-specific training of healthcare professionals. Conclusion: There is a need for ongoing education and training among healthcare professionals to meet the needs of SGM prostate cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Sapanisertib is a potent ATP‐competitive, dual inhibitor of mTORC1/2. Ziv‐aflibercept is a recombinant fusion protein comprising human VEGF receptor extracellular domains fused to human immunoglobulin G1. HIF‐1α inhibition in combination with anti‐angiogenic therapy is a promising anti‐tumor strategy. This Phase 1 dose‐escalation/expansion study assessed safety/ tolerability of sapanisertib in combination with ziv‐aflibercept in advanced solid tumors. Methods: Fifty‐five patients with heavily pre‐treated advanced metastatic solid tumors resistant or refractory to standard treatment received treatment on a range of dose levels. Results: Fifty‐five patients were enrolled and treated across a range of dose levels. Forty were female (73%), median age was 62 (range: 21–79), and ECOG PS was 0 (9, 16%) or 1 (46, 84%). Most common tumor types included ovarian (8), colorectal (8), sarcoma (8), breast (3), cervical (4), and endometrial (4). Median number of prior lines of therapy was 4 (range 2–11). Sapanisertib 4 mg orally 3 days on and 4 days off plus 3 mg/kg ziv‐aflibercept IV every 2 weeks on a 28‐day cycle was defined as the maximum tolerated dose. Most frequent treatment‐related grade ≥2 adverse events included hypertension, fatigue, anorexia, hypertriglyceridemia, diarrhea, nausea, mucositis, and serum lipase increase. There were no grade 5 events. In patients with evaluable disease (n = 50), 37 patients (74%) achieved stable disease (SD) as best response, two patients (4%) achieved a confirmed partial response (PR); disease control rate (DCR) (CR + SD + PR) was 78%. Conclusion: The combination of sapanisertib and ziv‐aflibercept was generally tolerable and demonstrated anti‐tumor activity in heavily pre‐treated patients with advanced malignancies. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint blockade has shown mixed results in advanced/recurrent gynecologic malignancies. Efficacy may be improved through costimulation with OX40 and 4‐1BB agonists. The authors sought to evaluate the safety and efficacy of avelumab combined with utomilumab (a 4‐1BB agonist), PF‐04518600 (an OX40 agonist), and radiotherapy in patients with recurrent gynecologic malignancies. Methods: The primary end point in this six‐arm, phase 1/2 trial was safety of the combination regimens. Secondary end points included the objective response rate (ORR) according to Response Evaluation Criteria in Solid Tumors and immune‐related Response Evaluation Criteria in Solid Tumors, the disease control rate (DCR), the duration of response, progression‐free survival, and overall survival. Results: Forty patients were included (35% with cervical cancer, 30% with endometrial cancer, and 35% with ovarian cancer). Most patients (n = 33; 83%) were enrolled in arms A–C (no radiation). Among 35 patients who were evaluable for efficacy, the ORR was 2.9%, and the DCR was 37.1%, with a median duration of stable disease of 5.4 months (interquartile range, 4.1–7.3 months). Patients with cervical cancer in arm A (avelumab and utomilumab; n = 9 evaluable patients) achieved an ORR of 11% and a DCR of 78%. The median progression‐free survival was 2.1 months (95% CI, 1.8–3.5 months), and overall survival was 9.4 months (95% CI, 5.6–11.9 months). No dose‐limiting toxicities or grade 3–5 immune‐related adverse events were observed. Conclusions: The findings from this trial highlight that, in heavily pretreated patients with gynecologic cancer, even multidrug regimens targeting multiple immunologic pathways, although safe, did not produce significant responses. A DCR of 78% in patients with cervical cancer who received avelumab and utomilumab indicates that further research on this combination in select patients may be warranted. In a phase 1/2 trial of heavily pretreated patients who had recurrent gynecologic cancers, avelumab in combination with a 4‐1BB agonist, an OX40 agonist, and/or radiation was safe and had a similar rate of immune‐related adverse events compared with single‐agent immune checkpoint blockade. The combination of multiple immune‐modulating agents, however, did not result in increased efficacy. [ABSTRACT FROM AUTHOR]

Background: Patient navigators play a critical role in working across interdisciplinary cancer teams and guiding patient care throughout the cancer continuum. Training for cancer patient navigators is needed to increase navigator capacity to improve health outcomes, especially given the current climate of provider shortages and high healthcare costs. Objective: The objective of the study was to evaluate the efficacy of the competency-based online Oncology Patient Navigator Training: The Fundamentals, designed by The George Washington University Cancer Center to increase confidence among participants in training learning objectives, which align with patient navigator competencies. Methods: We analyzed pre- and postlesson data from 671 learners who completed the training from 2015 to 2017 to assess changes in confidence across learning objectives. Questions were asked on a 5-point Likert scale (strongly disagree to strongly agree). We calculated summary statistics and compared pre- and postlesson scores using paired t tests. Results: Learners reported statistically significant (P <.001) improvements in confidence across all objectives, increasing from an average mean of 3.6 to 4.3. Learners who completed this training also reported high intention to implement new strategies/skills/information into practice (87.7%). Discussion: The Oncology Patient Navigator Training: The Fundamentals was found to be efficacious in improving participant confidence, and learners intended to apply their training in practice. Further research on how effectively the training prepares participants for certification and for ability to perform navigation duties in practice is warranted. Conclusion: This fundamental training for patient navigators increased learners' confidence on competency-based learning objectives. [ABSTRACT FROM AUTHOR]

Introduction: Immune checkpoint inhibitor (ICI) pneumonitis causes substantial morbidity and mortality. Estimates of real-world incidence and reported risk factors vary substantially. Methods: We conducted a retrospective review of 419 patients with advanced non-small cell lung cancer (NSCLC) who were treated with anti-PD-(L)1 with or without anti-CTLA-4 therapy. Clinical, imaging, and microbiological data were evaluated by multidisciplinary adjudication teams. The primary outcome of interest was grade ≥2 (CTCAEv5) pneumonitis. Clinicopathologic variables, tobacco use, cancer therapies, and preexisting lung disease were assessed for univariate effects using Cox proportional hazards models. We created multivariate Cox proportional hazards models to assess risk factors for pneumonitis and mortality. Pneumonitis, pneumonia, and progression were modeled as time-dependent variables in mortality models. Results: We evaluated 419 patients between 2013 and 2021. The cumulative incidence of pneumonitis was 9.5% (40/419). In a multivariate model, pneumonitis increased the risk for mortality (HR 1.6, 95% CI, 1.0-2.5), after adjustment for disease progression (HR 1.6, 95% CI, 1.4-1.8) and baseline shortness of breath (HR 1.5, 95% CI, 1.2-2.0). Incomplete resolution was more common with more severe pneumonitis. Interstitial lung disease was associated with higher risk for pneumonitis (HR 5.4, 95% CI, 1.1-26.6), particularly in never smokers (HR 26.9, 95% CI, 2.8-259.0). Conclusion: Pneumonitis occurred at a high rate and significantly increased mortality. Interstitial lung disease, particularly in never smokers, increased the risk for pneumonitis. This article examines the predisposing risk factors and incidence of pneumonitis in patients with non-small cell lung cancer undergoing immune checkpoint inhibitor therapy and explores the potential modifying effects of smoking history and preexisting lung disease. [ABSTRACT FROM AUTHOR]

Background: In lung cancer, overexpression of nuclear export proteins can result in inactivation of critical tumor suppressor proteins and cell‐cycle regulators. Selective suppression of nuclear export proteins has immunomodulatory activities. Here, clinical safety and early efficacy data are presented on the combination of pembrolizumab and an oral selective nuclear export inhibitor, selinexor, for the treatment of metastatic non–small cell lung cancer (mNSCLC). Methods: The primary objective of this prospective investigator‐initiated study was to determine the safety and tolerability of selinexor in combination with pembrolizumab in patients with mNSCLC. Secondary objectives included determination of objective tumor response rate, disease control rate, and progression‐free survival duration. Results: A total of 17 patients were included in the final analysis. Fifteen (88%) received more than two lines of prior systemic therapy and 10 (59%) had prior exposure to anti–PD‐1/programmed death‐ligand 1 (PD‐L1) therapy. The median age was 67.5 years. Ten patients had grade ≥3 adverse events related to selinexor treatment. Responses to treatment occurred in patients who did and did not undergo previous anti–PD‐1/PD‐L1 therapy and in patients with activating driver mutations. The median overall survival and progression‐free survival were 11.4 months (95% CI, 3.4–19.8 months) and 3.0 months (95% CI, 1.7–5.7 months), respectively. The overall response rate was 18% and the 6‐month disease control rate was 24%. Conclusions: Selinexor in combination with pembrolizumab demonstrated promising antitumor activity in patients with mNSCLC, including those who had previously received anti–PD‐1/PD‐L1 therapy. The therapy‐related toxic effects were consistent with the prior safety data for both drugs, and no overlapping toxic effects were observed. Trial registration: ClinicalTrials.gov identifier: NCT02419495. Plain language summary: New strategies to prevent or reverse resistance to immune checkpoint inhibitors are under investigation. Selective inhibitors of nuclear export proteins, such as selinexor, can induce restoration of tumor‐suppressing pathways and induce potent immunomodulatory activities.This article contains the clinical safety and early efficacy data on the combination of pembrolizumab and selinexor in treatment of metastatic non–small cell lung cancer. New strategies to prevent or reverse resistance to immune checkpoint inhibitors are under investigation. This article contains the clinical safety and early efficacy data on the combination of pembrolizumab and the first‐in‐class oral selective nuclear export inhibitor selinexor in the treatment of metastatic non–small cell lung cancer. [ABSTRACT FROM AUTHOR]

For a searchable version of these abstracts, please visit www.acrabstracts.org. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has significantly changed the way we treat patients and educate healthcare professionals (HCPs). In summer 2020, the International League against Epilepsy (ILAE) implemented a virtual CME program with three integrated program elements addressing challenges in patient treatment as well as challenges caused by the forced transition to a virtual environment. Despite the highly competitive environment with exponential increase of webinars offered to HCPs, the program achieved high participation and satisfaction rates. Over 60% of participants indicated a change in their clinical practice after the interventions. With our outcomes evaluation, we aimed to better understand how well such an integrated program resonates with the learner and if it can make a difference in a highly competitive environment by supporting educators to become more adaptive and responsive to learner needs. Our pilot project was shown to be well accepted, achieving high satisfaction and perceived impact by the learner. In the light of an upcoming "digital fatigue" and a wish to return to face-to-face, we reiterate the value of the digital approach and recommend continuing along this successful path as we believe that taking a learner on a digital educational journey has been successful in a highly competitive and challenging environment. [ABSTRACT FROM AUTHOR]

Background: Recent meta-analytic evidence indicates that survivorship care plans (SCPs) may not yield improvements in cancer survivors' patient-reported outcomes. Objective: We sought to investigate the prevalence of SCP receipt and explore associations between SCPs and patient-reported psychosocial and health behavior outcomes in a sample of cancer survivors enriched with individuals with a family history of cancer. Methods: Using a cross-sectional survey, we evaluated receipt of SCPs and/or treatment summaries and psychosocial and behavioral health outcomes in 123 survivors of cancer. Results: Most (93%) of the sample had a family history of cancer; only 31% (n = 38) received some form of written care plan (SCP/treatment summary). Receipt of a care plan was associated with significantly lower psychological distress (F [1, 104] = 8.316, P = .005) and higher coping self-efficacy (F [1, 104] = 6.627, P = .011), but it was unrelated to patient satisfaction, quality of life, cancer-related distress, and other health behaviors. Discussion: Results suggest that SCPs are infrequently provided and not uniformly implemented, even among high-risk patients. Similar to a recent systematic review, findings provide initial support for the association between written care plans and psychological distress and coping self-efficacy. Although these constructs have implications for cancer survivors' communication with providers, psychosocial adjustment, and seeking/understanding medical information, attention to how high-risk survivors respond to SCPs and adhere to recommended follow-up care is important. Conclusion: Results of the current study contribute to the growing literature about SCPs. Future work will need to identify whether high-risk cancer survivors benefit from SCPs over time. [ABSTRACT FROM AUTHOR]

Individuals living with mental health disorders served by the public mental health system often face comorbid medical conditions that affect their quality of life and lifespan. The effect of physical limitations on the engagement in daily activities among individuals living with mental health disorders has not been extensively researched. Adults attending community wellness centers (N = 53) in a northeastern United State were included in a descriptive study exploring the impact of physical limitations on daily activities. The activities most frequently affected were: walking or moving around, sleeping, and finding a job. The physical limitations affecting these three activities were lack of energy and pain. Health care professionals, including mental health nurses and occupational therapy practitioners, are in an ideal position to collaborate by evaluating and offering treatment interventions that address physical limitations to positively affect occupational functioning and recovery. [ABSTRACT FROM AUTHOR]

A Continuing Medical Education (CME) quiz concerning.