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Observational evidence has established a relationship between obesity and cancer risk and outcomes. Interventional studies have demonstrated the feasibility and benefits of lifestyle change after cancer diagnosis, and guidelines recommend weight management and regular physical activity in cancer survivors; however, lifestyle interventions are not a routine part of cancer care. The ASCO Research Summit on Advancing Obesity Clinical Trials in Cancer Survivors sought to identify the knowledge gaps that clinical trials addressing energy balance factors in cancer survivors have not answered and to develop a roadmap for the design and implementation of studies with the potential to generate data that could lead to the evidence-based incorporation of weight management and physical activity programs into standard oncology practice. Recommendations highlight the need for large-scale trials evaluating the impact of energy balance interventions on cancer outcomes, as well as the concurrent conduct of studies focused on dissemination and implementation of interventions in diverse populations of cancer survivors, including answering critical questions about the degree of benefit in key subgroups of survivors. Other considerations include the importance of incorporating economic metrics into energy balance intervention trials, the need to establish intermediate biomarkers, and the importance of integrating traditional and nontraditional funding sources. Establishing lifestyle change after cancer diagnosis as a routine part of cancer care will require a multipronged effort to overcome barriers related to study development, funding, and stakeholder engagement. Given the prevalence of obesity and inactivity in cancer survivors in the United States and elsewhere, energy balance interventions hold the potential to reduce cancer morbidity and mortality in millions of patients, and it is essential that we move forward in determining their role in cancer care with the same care and precision used to test pharmacologic and other interventions.

In 2013, the Institute of Medicine (IOM) concluded that cancer care in the United States is in crisis. Patients and their families are not receiving the information that they need to make informed decisions about their cancer care. Many patients do not have access to palliative care and too few are referred to hospice at the appropriate point in their disease trajectory. Simultaneously, there is a growing demand for cancer care with increases in new cancer diagnoses and the number of patients surviving cancer. Furthermore, there is a workforce shortage to care for this growing and elderly population. The IOM's report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, outlined recommendations to improve the quality of cancer care. This article provides an overview of the IOM report and highlights the recommendations that are most relevant to practicing clinicians who care for patients with cancer across the continuum. The implementation of the recommendations in clinical practice will require better patient-clinician communication, improved care coordination, targeted clinician training, effective dissemination of evidence-based guidelines and strategies for eliminating waste, and continuous quality assessment and improvement efforts.

A recent report from the Institute of Medicine titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, identifies improvement in information technology (IT) as essential to improving the quality of cancer care in America. The report calls for implementation of a learning healthcare IT system: a system that supports patient-clinician interactions by providing patients and clinicians with the information and tools necessary to make well informed medical decisions and to support quality measurement and improvement. While some elements needed for a learning healthcare system are already in place for cancer, they are incompletely implemented, have functional deficiencies, and are not integrated in a way that creates a true learning healthcare system. To achieve the goal of a learning cancer care delivery system, clinicians, professional organizations, government, and the IT industry will have to partner, develop, and incentivize participation.

Background Since the onset of COVID-19, oncology practices across the US have integrated telemedicine (TM) and remote patient monitoring (RPM) into routine care and clinical trials. The extent of provider experience and comfort with TM/RPM in treatment trials, however, is unknown. We surveyed oncology researchers to assess experience and comfort with TM/RPM. Methods Between April 10 and June 1, 2022, we distributed email surveys to US-based members of the American Society of Clinical Oncology (ASCO) whose member records indicated interest or specialization in clinical research. We collected respondent demographic data, clinical trial experience, workplace characteristics, and comfort and experience with TM/RPM use across trial components in phase I and phase II/III trials. TM/RPM was defined as clinical trial-related healthcare and monitoring for patients geographically separated from trial site. Results There were 141 surveys analyzed (5.1% response rate). Ninety percent of respondents had been Principal Investigators, 98% practiced in a norural site. Most respondents had enrolled patients in phase I (82%) and phase II/III trials (99%). Across all phases and trial components, there was a higher frequency of researcher comfort compared to experience. Regarding remote care in treatment trials, 75% reported using TM, RPM, or both. Among these individuals, 62% had never provided remote care to trial patients before the pandemic. Conclusion COVID-19 spurred the rise of TM/RPM in cancer treatment trials, and some TM/RPM use continues in this context. Among oncology researchers, higher levels of comfort compared with real-world experience with TM/RPM reveal opportunities for expanding TM/RPM policies and guidelines in oncology research. [ABSTRACT FROM AUTHOR]

69 Background: Clinical trials are part of standard cancer care. Yet, a quarter of oncology fellows in a 2023 survey reported feeling underprepared to conduct research after training and nearly half did not identify research as important to their practice. In a 2024 survey, we explore the impact of exposure to research activities in fellowship on intentions to conduct research post-training. Methods: Fellows who took the 2024 ASCO Medical Oncology In-Training Exam (ITE) were invited to an optional IRB-exempted post-exam survey to measure (1) research exposure during training and (2) anticipated research participation once in practice. Responses of moderate and great amount are combined as frequent (vs. never, rarely, occasionally as not frequent). Rates of frequent research engagement in future practice are compared by frequent/not frequent research exposure during fellowship, expected practice setting, and program year using chi-squared analysis. Results: Of the 1884 US medical oncology fellows taking the ITE, 1491 (79%) participated in this study, 33% 1st year, 37% 2nd year, 39% 3rd year. 891 (60%) expect their first post-training role to be in academics, 527 (35%) in a non-academic practice, and 67 (5%) in other settings. Anticipated engagement in enrollment and management of participants on clinical trials post-training was associated with exposure to those activities in fellowship and with expected practice setting. Overall, 827 (63%) anticipate frequent participation in research once in practice. 531 (76%) of 701 with frequent exposure in training compared to 296 (37%) of 790 with not frequent exposure anticipate frequent participation in practice (p<0.001). 610 (78%) of fellows expecting to practice in an academic setting vs. 192 (40%) in a non-academic setting anticipate frequent future participation in practice (p<0.001). For research leadership activities (writing clinical research protocols, applying for clinical research grants, serving as principal investigator), 622 (49%) anticipate frequent participation once in practice. 390 (79%) of 519 with frequent vs. 229 (29%) of 855 with not frequent exposure to leadership activities during fellowship anticipate frequent future engagement (p<0.001). 523 (67%) of fellows expecting to practice in an academic setting vs. 76 (16%) in a non-academic setting anticipate frequent leadership engagement after training (p<0.001). Anticipated future participation did not vary by program year for either type of research activity. Conclusions: Findings show an urgent need to increase exposure to research during fellowship training to improve participation in clinical trials by practicing oncologists. This is a critical component of improving patient access to research. [ABSTRACT FROM AUTHOR]

63 Background: ASCO and Association of Community Cancer Centers (ACCC) released a statement on increasing racial/ethnic equity, diversity, and inclusion (EDI) in cancer trials (1). It included recommendations for clinical practices and research sites to 1) screen every patient for trial eligibility; and 2) routinely collect and analyze screening and enrollment data by patient demographic characteristics, including race/ethnicity. Most of the 62 sites that completed a 2021 pilot study reported that screening data were not readily available by patient race/ethnicity (2). ASCO conducted a follow-up study about challenges, resource needs, and effective strategies for collecting and analyzing these data. Methods: Semi-structured interviews were conducted with research team members from sites that completed the 2021 pilot study. Sites were purposefully selected based on pilot study data quality and insights, diversity of patient population, and site type, size, and region. Sites completed a pre-interview questionnaire on site characteristics and screening and enrollment processes before participating in a 1-hour interview focused on challenges and effective strategies for collecting and analyzing screening and enrollment data, by race/ethnicity. Anticipated themes and relationships, stemming from the pilot study findings, informed a conceptual framework. Up to 20 interviews were planned and halted sooner when there was theme saturation. Results: Thirteen research sites participated in the study, representing academic centers (62%) and community-based practices/health systems (38%) with racially/ethnically diverse patient populations (median 31% non-white; range 11% to 63%). 53 research team members participated in the interviews (typically 4 per site), including investigators (23%), directors/managers (56%), and coordinators (21%). Aggregated responses were interpreted through content analysis and concepts were quantified for both frequency and extensiveness. Several barriers to patient screening, data collection, and analysis were cited, including lack of standardized procedures and documentation, dedicated staff and time, quality and/or accessible data on race/ethnicity and/or screening, and integrated technology that facilitates screening and documentation. Conclusions: Collecting and analyzing screening and enrollment data are critical to identifying and mitigating racial/ethnic disparities in trial access and EDI. Many sites do not systematically screen every patient for a trial and/or document outcomes. Lack of resources, including dedicated staff and time and integrated technology, make it difficult for them to do so in systematic and reliable ways. Greater investment in resources will help to facilitate routine screening of every patient and ensure underrepresented populations are not being overlooked for trials. 1. Oyer et al, JCO, 2022. 2. Pressman et al, JCO, 2022. [ABSTRACT FROM AUTHOR]

43 Background: The Supreme Court decision in Dobbs v. Jackson Women's Health Organization (2022) allows states to ban or limit abortion without health exceptions for pregnant persons. Notably, about 1 out of every 1000 pregnant persons has cancer and abortion is utilized in up to 28% of pregnant patients with cancer. To investigate the impact of this court decision on oncology practice, we studied perceptions among oncology fellows of the effect of abortion restrictions on quality care and whether they anticipate care implications to influence their decisions on future practice location. Methods: Fellows who took the 2024 ASCO Medical Oncology In-Training Exam (ITE) were invited to take an optional post-ITE survey assessing perceived (1) effect of abortion policies on ability to provide 9 key aspects of quality cancer care, including care access and delays, trust, and professional well-being and (2) impact of abortion restrictions on quality care in decisions of future practice location. Agreement (Agree, Strongly Agree) and impact on future practice location (Somewhat likely, Very likely) were compared by respondent gender and abortion policies (banned/under legal contention vs legal) in their own or neighboring state using chi-squared analysis. Results: Of 1884 US medical oncology fellows who took the ITE, 1254 (67%, inc. 49% male, 46% female) participated in this survey; 34% trained in states with bans, 44% in states adjacent to states with bans, and 22% in and adjacent to states where abortion is legal. Overall, 33% of fellows report that abortion restrictions affected their ability to deliver at least one aspect of quality care, including 22% reporting limited availability/delays of drugs and 28% reporting poorer job satisfaction. For all 9 aspect of quality care, agreement was strongly associated with local abortion status (p<0.001). For example, 37% of fellows in abortion-restricted states report reduced patient trust and relationship quality vs. 20% among those in states adjacent to bans vs. 18% among those in and adjacent to legal states (p<0.001). Over half (51%) of fellows report that they are likely to consider the impact of local abortion policies on quality care when deciding future practice location (28% were neutral, 21% unlikely to consider). More fellows training in states where abortion is legal report being likely to consider the impact of local abortion policies on care in future practice location decisions (55%) than those training in abortion-restricted states (45%) (p<0.001). More women (58%) than men (45%) report being likely to consider the impact of local abortion policies on quality care in future practice location (p<0.001). Conclusions: Findings provide early insights into the impact of abortion restrictions both on key aspects of quality care as well as the geographic distribution of future oncologists. [ABSTRACT FROM AUTHOR]