Cancer Centers in the News

The following links highlight some of the most up-to-date news from the 27 NCCN Member Institutions. The media coverage below includes major national news outlets, industry magazines, medical journals, and press releases.

The news is listed in reverse chronological order for ease of use.

04/13/2017
Are Oncologists Jumping the Gun with the 21-Gene Assay?

University of Colorado Cancer Center Study uncovers discrepant decision-making for use of 21-gene assay in women with cancer:

  • Testing occurs in high-risk population, despite current evidence
  • Non-concordance with NCCN Guidelines® recommendations
  • Racial and socio-economic disparities found in testing use

[FORT WASHINGTON, PA — April 13, 2017] The 21-gene recurrence score (RS) assay, Oncotype DX™ (ODx), determines a score that estimates the likelihood of distant recurrence of disease in women with early-stage estrogen receptor-positive (ER+) breast cancer; this score is used to assess the benefit of adjuvant chemotherapy. RS testing is not recommended for women with intermediate- or high-risk, node-positive breast cancer because significant evidence exists that patients in that population benefit from adjuvant chemotherapy. That said, a recent study out of the University of Colorado Cancer Center finds that oncologists are indeed using the RS assay in patients with high-risk disease and, in some cases, foregoing adjuvant chemotherapy as a result.

The study, “The 21-Gene Recurrence Score (RS) Assay for Node-Positive Early Breast Cancer and Impact of RxPONDER Trial on Chemotherapy Decision-Making,” led by Jagar Jasem, MD, MPH, and Peter Kabos, MD, was published in the April issue of JNCCN – Journal of the National Comprehensive Center Network.

Dr. Jagar Jasem

“To our knowledge, this is the largest study that deals with the current trends of the RS assay use in the node-positive breast cancer population in the United States,” said Dr. Jasem.

For this study, Jasem et al used the National Cancer Data Base (NCDB) to evaluate more than 80,000 node-positive early breast cancer cases diagnosed between 2010 and 2012.

Ongoing study and current recommendations

The study indicates that, prior to trial results being published, oncologists are already adopting the inclusion criteria of the ongoing RxPONDER (Rx for Positive Node, Endocrine Responsive Breast Cancer) trial, which looks at low to intermediate RS scores and compares patients treated with hormone therapy alone to those treated with hormone therapy in combination with chemotherapy.

Dr. Peter Kabos

“The adoption of new modalities while prospective studies are ongoing is not new for the oncology field, with mixed results. For many years, use of high-dose chemotherapy intensification followed by autologous bone marrow or stem cell rescue was used and adopted as a standard of care before the completion of prospective randomized trials that were ultimately negative,” said Dr. Kabos.

The University of Colorado researchers found that RS assay is an independent predictor of less chemotherapy recommendation in node-positive early breast cancer. This suggests that oncologists are using the RxPONDER cut-off when making recommendations for patients, despite a lack of evidence. It also suggests that doctors are treating patients according to tumor biology, rather than tumor size or stage.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer—the recognized standard of cancer care in the United States—recommend adjuvant chemotherapy in patients with node-positive breast cancer.

Who, where, and why?

In breaking down the data, researchers noticed trends showing that race, treatment setting, and insurance coverage influenced whether or not patients received ODx testing, and whether they were treated with chemotherapy.

Black women with breast cancer have higher mortality rates and higher-risk cancers, including triple-negative breast cancer, compared with other patient populations. Despite that, Dr. Jasem’s study revealed that black women were significantly less likely to receive RS testing compared with women of other races. [Gross, et al, reported similar results in the March issue of JNCCN: https://www.nccn.org/about/news/newsinfo.aspx?NewsID=853]

"Black women may be less likely to get tested because oncologists tend to treat them with chemotherapy regardless of the test result,” the authors noted. “Our study, similar to others, documented a higher-risk disease in this patient population, which together with patient preference may play a role in final decision making. However, there are no data currently available that suggest differential use of the test or chemotherapy based on racial factors alone.”

When observing site of care, the researchers found that, compared with patients treated at community centers, patients at academic or comprehensive cancer centers were more likely to receive RS assay testing, but no discrepancies were noted regarding chemotherapy recommendations among all patients tested.

As a key indicator of socioeconomic status, insurance coverage played a major role in RS assay testing recommendations. The study showed that insured patients were more likely to have the RS test compared to uninsured patients, and the privately insured more than the governmentally insured. Furthermore, in the absence of testing, insured patients were significantly more likely to be recommended chemotherapy than uninsured.

“The results of well-designed clinical trials often inform clinical practice. As pointed out by Jasem and colleagues, clinicians not infrequently follow their instincts, rather than wait for the data from a trial. This practice may have unintended consequences including recommending adjuvant chemotherapy, or not, inappropriately—denying benefit to some and exposing unnecessary toxicity to others,” said William J. Gradishar, MD, Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Chair of the NCCN Guidelines® panel for Breast Cancer,

To access the study free of charge until July 31, 2017, visit JNCCN.org or JNCCN360.org.

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About JNCCN – Journal of the National Comprehensive Cancer Network
More than 24,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp

JNCCN 360 is a new online resource for oncology professionals featuring up-to-date news, literature, trials, clinical perspectives on current therapies, and much more. Visit JNCCN360.org

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world’s leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news.

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03/30/2017
NCCN Presents Awards for Service to Patients and Contributions to the Alliance
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03/29/2017
Patient, provider, caregiver: Physicians share lessons learned when the tables are turned

From left to right: Dr. Wakelee, Dr. Kalanithi, Dr. Carlson.

[FORT WASHINGTON, PA – March 29, 2017] — What happens when a young physician at the precipice of a stellar career is diagnosed with cancer and faces the same uncertainty about end-of-life as have his patients?

The late neurosurgeon Paul Kalanithi, MD, offered eloquent insight into the heartbreaking challenges he faced, in his New York Times bestselling memoir, When Breath Becomes Air. Kalanithi died in March 2015 at age 37 following a diagnosis of Stage IV lung cancer.

In the first time addressing a public forum together, Kalanithi’s widow, Lucy Kalanithi, MD, Clinical Assistant Professor of Medicine at Stanford School of Medicine; and Paul’s treating oncologist, Heather Wakelee, MD, Associate Professor of Medicine at Stanford Cancer Institute, spoke about their experiences on March 24, 2017 during the National Comprehensive Cancer Network® (NCCN®) 22nd Annual Conference: Improving the Quality, Effectiveness, and Efficiency of Cancer Care™. 

More than 1,600 attendees convened at the Rosen Shingle Creek in Orlando, FL, to hear about the latest updates in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), as well as issues in supportive care and patient management.  

Before the audience of fellow physicians as well as nurses, pharmacists, and other oncology stakeholders and industry leaders, the two recalled the moments that most influenced their lives and the way they practice medicine.

“Paul faced his cancer in a very, very brave manner,” said Wakelee, who had worked with Paul Kalanithi at Stanford but didn’t get to know him until he was her patient. “What he captures in the book is the essence of what we try to do to help our patients with cancer.  Even though he was dying since the time I met him, he really lived.”

“He was a master of putting into words the ambiguity inherent in medicine,” said Robert W. Carlson, MD, CEO of NCCN, who served as moderator of the panel.  Dr. Carlson noted that Dr. Paul Kalanithi grieved the loss of his neurosurgical career even as he understood how all–consuming a medical career could be. His father, also a physician, was often an absent parent during Paul’s youth; and Paul’s medical training had put a strain on his marriage.

Dr. Kalanithi and Dr. Carlson speak at the NCCN Keynote.

Dr. Lucy Kalanithi recounted that a reviewer wrote that Paul had put his life on hold during his neurosurgical residency, and just as he was about to learn how to live, he had to learn how to die. “But he didn’t put his life on hold -- that was his life,” Lucy Kalanithi said.  “That is the privilege of medicine…life and work are very intertwined. It’s part of the meaning of your life.”

Dr. Carlson asked Dr. Lucy Kalanithi whether the experience of Paul’s illness had changed the way she approaches her patients.

“One thing I do is acknowledge the caregiver and family members,” Lucy Kalanithi said. “I have a much deeper understanding of this when I go into a room…I remember Heather saying, ‘how’s the new pain medicine working out for you guys?’ It was plural, and that’s what it was like in real life.”

Dr. Wakelee also noted the importance of caring for the whole family. “When I’m working with medical students and fellows in training, we talk about the importance of continued communication not just with the patient, but with the families.”

“The family doesn’t always come in and I don’t get to know them,” Dr. Wakelee added. “That can be a disservice. An important part of our job is to help that family after the patient has passed to look back and know we did what we could to help them, and the patient was able to live with the time they had.”

Dr. Carlson asked Dr. Wakelee whether it is different to treat a fellow physician.

“Having patients who have medical knowledge certainly makes our job a little bit easier.  With Paul, I knew he would understand where I was coming from,” she said. She contrasted the physician’s approach to knowledge with that of other professional patients she sees.

“We understand that there are things we do not know…how long someone’s going to live, whether something’s going to work or not,” said Dr. Wakelee. In Silicon Valley, we have a lot of engineers and others who look at the world from a different perspective. They are taught differently….if you think about it the right way, you’ll get to "the truth". Biology is different from engineering, she explained.  “We have to take what we know and understand that no matter how hard we push the science and think about things, we will not always arrive at “the truth” ..so to have someone in medicine who understands that…I knew he was going to be able to reflect on the facts and understand it and understand that there are “unknowns",” she said.

Dr. Carlson then asked Dr. Lucy Kalanithi about a passage in the book in which Paul describes his difficulty navigating his transition to a patient. “Death is a one-time event but living with a terminal illness is an evolving process,” Dr. Carlson said. “How was he able to accomplish it?”

“The metaphor of the shifting landscape or sandstorm that wipes all your assumptions away is very apt,” Dr. Lucy Kalanithi responded. The decision-making is tied up in the prognosis…we had a sense of worst case, best case, and most likely scenarios…He looked at best case, which is why he went back to neurosurgery. You have to keep adjusting that as things keep changing, but also living with the total uncertainty is incredibly hard.”

“That is one of the challenges that we as care providers have,” Dr. Wakelee added.  “I have a lot of discussions around that balance. We don’t know. I could quote an average but I don’t think that’s helpful. When [Paul] was first diagnosed he wanted me to tell him how much time he had, [but] that would be me saying something I don’t know.  When people come to me crestfallen because a provider told them they have one year, that’s a disservice, as well.”

When we give patients a specific number, that’s all they remember.  The focus needs to be on all the rest of it.”  The job of the physician is to help the patient make the most of the time they do have, and when patients can do that, it’s inspiring, Dr. Wakelee said.

“One of the reasons I went into oncology was being able to witness how many patients were able to really live…that really fascinated me.”

At the core, being a good communicator is key to getting there.

“In health care we get to meet a huge diversity of patients,” Dr. Wakelee said. “It’s our job to figure out how to communicate best with each person.  Everyone is looking at the world differently and you have to understand where they’re coming from.”

Dr. Carlson noted that in Paul Kalanithi’s case, he faced an existential dilemma between thinking about the future and focusing on the urgency of the moment.

“Time stood still and sped up at the same time, especially when he was getting really sick,” Lucy Kalanithi said. “He said that time used to feel linear and now it feels like a space. There was this sense of time standing still that came out of the [realization] that the future is not guaranteed, and that's especially poignant when you have a newborn. [There was this feeling that] this is our family right now and this is all we have and how great is that. At the same time, Paul was really goal directed the whole time. As a chief resident, your identity is wrapped up in your future….when he was diagnosed he said the future he imagined had evaporated. That really messes up your identity; he kept having to reshape his identity.”

In Dr. Paul Kalanithi’s case, literature was the key to helping him regain his sense of self and make sense of his unexpected journey.  After a chest x-ray showed nodules in his lungs, he headed to the hospital with books including Cancer Ward by Aleksandr Solzhenitsyn, Mere Christianity by C. S. Lewis, and Being and Time, by Martin Heidegger. “To contemplate [it], he had to put words back on it,” Dr. Lucy Kalanithi said. “That transition was so intense.”

Later, his own writing drove him.

“The act of Paul writing kept him rooted and participating in the world by producing something that would probably outlive him. The book saved him in a way,” Dr. Lucy Kalanithi said.

And Paul’s book gave Lucy the opportunity to reflect on his words with others across the country who have suffered similar losses.  

“Doing a book tour for Paul was incredibly helpful,” she said. “I didn’t know if I would like it…but it’s been helpful to talk about it … grief can be incredibly isolating.”

Dr. Lucy Kalanithi expressed her delight at the opportunity to have a conversation with Dr. Wakelee in front of an audience of their peers. “I can’t believe we’re sitting here together,” she said. “I wish Paul were here to see us. It’s awesome.”

Photo credit: JAR Studio

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03/29/2017
NCCN Annual Conference Sheds Light on Treatment Disparities, Significance of the Doctor-Patient Relationship, Supportive Care Issues, and the Latest Guidelines Updates

More than 1,600 oncology professionals attended the NCCN 22nd Annual Conference in Orlando, Florida

[FORT WASHINGTON, PA – March 29, 2017] The National Comprehensive Cancer Network® (NCCN®) hosted its 22nd Annual Conference: Improving the Quality, Effectiveness, and Efficiency of Cancer Care™ on March 23 – 25, 2017 at the Rosen Shingle Creek in Orlando, Florida.

Best practices from the field

Ruben Mesa, MD, Mayo Clinic Cancer Center, presents the new NCCN Guidelines for Myeloproliferative Neoplasms. 

Key to the content of the NCCN Annual Conference were presentations from esteemed NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) panel members about the latest best practices in the management of patients with cancer, as well as NCCN Guidelines® updates for various diseases, including Bladder, Breast, Colorectal, Kidney, Lung, and Pancreatic Cancers, as well as Chronic Lymphocytic Leukemia, Gynecologic Malignancies, Hodgkin Lymphoma, Neuroendocrine Tumors, Non-Hodgkin’s Lymphomas, Soft Tissue Sarcoma, and the latest NCCN Guideline—Myeloproliferative Neoplasms.

In addition to disease-specific presentations, NCCN experts discussed front-line supportive care and screening issues, including, but not limited to, genetic testing, smoking cessation, and management of immunotherapy-related toxicities.

Kenneth Offit, MD, MPH, of Memorial Sloan Kettering Cancer Center, discussed personalized medicine during his presentation, Multi-Gene Testing for Hereditary Cancer: When, Why, and How. Dr. Offit noted that practitioners could reduce deaths by up to 60% by paying attention to known risk genetic and lifestyle risk factors for cancer. He discussed specific genetic mutations linked to both common and rare forms of cancer. Dr. Offit indicated that 5-40% of results from multi-gene panels  may report genomic variants  that are difficult to interpret, and highlighted the importance of  providers referring patients to registries such as  PROMPT (Prospective Registry of Multiplex Testing) to improve accuracy of cancer risk estimation. He also presented the 2017 NCCN Guidelines, which have begun to incorporate data to guide screening based on age-specific risks of genes included on multi-gene panels. 

Smoking Cessation in Patients with Cancer: Treatment Advances and the Oncologist’s Role, was presented by Paul Cinciripini, PhD, of The University of Texas MD Anderson Cancer Center. Dr. Cinciripini noted that smoking rates have leveled off at 15% of the U.S. population; however, those who smoke are among the most vulnerable with the least resources. Furthermore, smoking is highly correlated with mental illness, he said. Because smoking has negative effects on treatment, patients should be offered both counseling and medical intervention to aid in their smoking cessation, he said, noting that consistent engagement with the patient is the most important avenue for intervention.

Stephanie Andrews, MS, ANP-BC, of Moffitt Cancer Center, discussed the management of adverse events for immunotherapy and how to identify them. Her presentation, When to Hold and When to Fold, noting that enthusiasm for immunotherapy agents should be tempered by a healthy respect for their power. Ms. Andrews discussed the importance of considering three key areas at the onset of symptoms: disease progression, unrelated events, and immune-related adverse events, and explained that patient education is key to early recognition. NCCN has devised a teaching and monitoring tool for immunotherapy available at NCCN.org and is in the process of developing clinical practice guidelines in collaboration with ASCO specifically for the management of immunotherapy-related toxicities in patients with cancer.

Addressing disparities in cancer care

From left to right: Dr. Goodman, Dr. Allen, Dr. Chen, Ms. Filipic, Dr. Mitchell, Ms. Pettit Nassi. 

This year’s conference opened with a timely expert roundtable about disparities in oncology care. Moderated by Clifford Goodman, PhD, the session featured the following panelists: Shauntice Allen, PhD, University of Alabama at Birmingham Comprehensive Cancer Center; Moon S. Chen, Jr, PhD, MPH, University of California Davis Comprehensive Cancer Center; Anne Filipic, Enroll America; Edith Mitchell, MD, Sidney Kimmel Cancer Center at Jefferson; and Phyllis Pettit Nassi, MSW, Huntsman Cancer Institute at the University of Utah.

Dr. Chen noted that cancer is the leading cause of death among Asian, Latino, and American Indian communities, and there is an opportunity to make real gains by applying current medical knowledge to these populations.

Dr. Mitchell spoke of overcoming biases in order to deliver what the individual needs. “With older patients, we have conscious and unconscious biases,” she said.  “For patients of a certain age it may be assumed they won’t want treatment, but it’s not the chronological age that matters. Assessment must include the physiological age and comorbidities. Similarly, biases occur with religious and racial/ethnic populations. It’s frequently assumed that African Americans won’t participate in clinical trials but patients actually want to participate. Therefore, as providers, we must focus on our own biases.”

“As cancer centers, we have to accept the challenges,” Ms. Pettit Nassi said. “Huntsman is the catchment for five states. Once you make the commitment and...go beyond just collecting the data and getting the grants….it can be done. The doctors get out of the silo. You have to go and see. See with your eyes, you will see how you can make a difference. If we don’t start bringing clinical trials out into the rural and frontier areas we’re going to miss whole populations.”

Panelists challenged attendees to share their opinions with lawmakers so that their voices can be heard.

A summary of the roundtable is available on NCCN.org/news.

Patient, provider, caregiver

From left to right: Dr. Wakelee, Dr. Kalanithi, Dr. Carlson. 

During Friday’s highly anticipated keynote session moderated by NCCN Chief Executive Officer Robert W. Carlson, MD; Lucy Kalanithi, MD, widow of the late Paul Kalanthi, MD, author of When Breath Becomes Air, joined Paul’s oncologist, Heather Wakelee, MD, Stanford Cancer Institute, for the first time in public. Together, they recalled the moments with Paul that most influenced their lives and the way they practice medicine.

“Paul faced his cancer in a very, very brave manner,” said Wakelee, who had worked with Paul Kalanithi at Stanford but didn’t get to know him until he was her patient. “What he captures in the book is the essence of what we try to do to help our patients with cancer.  Even though he was dying since the time I met him, he really lived.”

“Time stood still and sped up at the same time, especially when [Paul] was getting really sick,” Dr. Lucy Kalanithi said. “He said that time used to feel linear and now it feels like a space. There was this sense of time standing still that came out of the [realization] that the future is not guaranteed, and that's especially poignant when you have a newborn. [There was this feeling that] this is our family right now and this is all we have and how great is that. At the same time, Paul was really goal directed the whole time. As a chief resident, your identity is wrapped up in your future…when he was diagnosed he said the future he imagined had evaporated. That really messes up your identity; he kept having to reshape his identity.”

A summary of the keynote is available on NCCN.org/news.

On-site announcements

On Thursday, March 23, NCCN launched its latest resource, the NCCN Radiation Therapy Compendium™.  The radiation therapy recommendations contained in the Compendium are derived directly from the library of NCCN Guidelines, and the Compendium provides guidance on all RT modalities recommended within the NCCN Guidelines, including Intensity Modulated Radiation Therapy (IMRT), Intra-Operative Radiation Therapy (IORT), Stereotactic Radiosurgery (SRS)/Stereotactic Body Radiotherapy (SBRT)/Stereotactic Ablative Radiotherapy (SABR), Image-guided Radiotherapy (IGRT), Low dose-rate brachytherapy (LDR)/High dose-rate brachytherapy (HDR), Radioisotope, and Particle Therapy. More information about the NCCN Radiation Therapy Compendium™ is available at NCCN.org/RTcompendium.

NCCN Foundation Board Officers, from left to right: Jack Gentile, Secretary; Dr. Heather Kopecky, Vice-Chair;  Gena Cook, Chair; Ray Lynch, Treasurer.

On Friday, March 24, Gena Cook, Co-Founder and Chief Executive Officer, Navigating Cancer, and Heather Kopecky, PhD, MBA, Senior Client Partner, Korn Ferry, were been named Chair and Vice-Chair, respectively, of the NCCN Foundation® Board of Directors.  More information is available at NCCN.org/news.

The 2017 NCCN Young Investigator Award recipients were named during the opening remarks of the Conference on Friday, March 24. Following are this year’s awardees:

NCCN Foundation Young Investigator Awards provide grants of $150,000 over a two-year period for research initiatives focused on assessing and improving outcomes in cancer care. More information is available at NCCN.org/news.

Additional on-site activities

In conjunction with the NCCN 22nd Annual Conference general session, NCCN hosted its annual Nursing Program: Advancing Oncology Nursing™, the NCCN Fellows Recognition Program: New Horizons in Quality Cancer Care™, and various lunch and dinner symposia.

2015 NCCN Foundation Young Investigator Awardees, from left to right: Dr. Morgan, Dr. El-Jawahri, Dr. Veenstra, and Dr. Blachly. Not pictured: Dr. Johnson.  

The NCCN General Poster Session featured more than 95 original studies focused on clinical oncology, pre-clinic oncology, epidemiology/risks, correlative/genomic, best practices in implementation and use of clinical practice guidelines, quality improvement, outcomes and health services research, and BIOinformatics/information technology sciences.

The poster session included research presented by the 2015 NCCN Foundation Young Investigator Awardees:

The NCCN 23rd Annual Conference will be held March 22 – 24, 2018, at the Rosen Shingle Creek in Orlando, Florida.

Certain 2017 conference sessions will be recorded and archived as part of NCCN’s continuing education program. Stay tuned for further updates.

More information about the NCCN Annual Conference is available at NCCN.org/conference.

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03/28/2017
NCCN Foundation Awards Grants to Four Young Investigators

NCCN Foundation Young Investigator Awards provide grants of $150,000 over a two-year period for research initiatives focused on assessing and improving outcomes in cancer care.

[FORT WASHINGTON, PA – March 24, 2017] The NCCN Foundation® has awarded grants to four young investigators from National Comprehensive Cancer Network® (NCCN®) Member Institutions. These awardees, who are dedicated to advancing and discovering new treatments for cancer,  enhancing quality, and improving patient education, represent the seventh series of NCCN Foundation Young Investigator Awards—a program initiated in 2011. The grants will provide $150,000 in funding over a two-year period to each awardee, beginning in July 2017.

“The NCCN Foundation is excited to award these funds to support career development of the next generation of innovators at the forefront of their field.  These researchers are guiding the course of treatment innovation and advancement for all people with cancer,” said Marcie R. Reeder, MPH, Executive Director, NCCN Foundation.

Following are the 2017 NCCN Foundation Young Investigator Award recipients:


Kemi Doll, MD, MSCR

Saad Kenderian, MB, CMB


Florian Muller, PhD


Elizabeth Stewart, MD

The awardees responded to a Request for Proposals issued by the NCCN Foundation to the NCCN Member Institutions and were nominated by their institutions. All submissions were reviewed by a multidisciplinary panel of oncology experts; the awardees were selected based on several key components, including scientific merit and study design.  The studies will be managed and overseen by the NCCN Oncology Research Program (ORP).

Since its inception in 2011, NCCN Foundation has provided funding to 35 U.S. researchers through the Young Investigator Awards. On March 23 and 24, 2017, NCCN featured abstracts from the fifth series of Young Investigator Awards recipients during the NCCN 22nd Annual Conference General Poster Session in Orlando, Florida.

The 2017 NCCN Foundation Young Investigator Awards were made possible through support from AbbVie Inc., Amgen Inc., Merck & Co. Inc., Novartis Pharmaceuticals Corporation, Takeda Oncology, and Pfizer Inc.

For more information about the NCCN Young Investigator Awards, visit NCCNFoundation.org.

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About NCCN Foundation
NCCN Foundation® was founded by the National Comprehensive Cancer Network® (NCCN®) to empower people with cancer and advance oncology innovation. NCCN Foundation supports people with cancer and their caregivers at every step of their treatment journey by delivering unbiased expert guidance from the world’s leading cancer experts through the library of NCCN Guidelines for Patients® and other patient education resources. NCCN Foundation is also committed to advancing cancer treatment by funding the nation’s promising young investigators at the forefront of cancer research, initiating momentum in their careers and furthering the betterment of patients through their groundbreaking innovations. For more information about NCCN Foundation, visit http://www.nccnfoundation.org.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world’s leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news.

 

 

 

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03/28/2017
Panelists Urge Attendees to Break Down Silos and Address Biases in Cancer Care

NCCN Conference Roundtable Addresses Health Disparities

Dr. Goodman speaks to expert panelists during the NCCN Annual Conference opening roundtable.

[Fort Washington, PA – March 28, 2017] Eliminating cancer disparities and reducing differences in incidence and mortality rates among minority populations must be addressed through research in prevention, screening, clinical trials, equal access to quality care, palliative and hospice care, and survivorship programs, according to panelists who spoke March 23, 2017 at the National Comprehensive Cancer Network® (NCCN®) 22nd Annual Conference: Improving the Quality, Effectiveness, and Efficiency of Cancer Care™ at the Rosen Shingle Creek Conference Center in Orlando. Moreover, the panelists agreed that recognizing the needs of minorities and underserved communities in delivering cancer care are most important aspects that must be addressed as related to race and ethnicity, cultural, linguistic, socioeconomic, age, gender, and other individual factors to impact disparities.

Participants in the opening NCCN Roundtable: Addressing Health Disparities in Cancer Care from Diagnosis to Survivorship, spoke before an audience of physicians, nurses, pharmacists, and other oncology stakeholders and industry leaders from among 1,600 conference attendees who convened to hear the effects of health policy on underserved populations, and psychosocial issues that impact patient quality of life.  

Moderator Clifford Goodman, PhD, Senior Vice President of The Lewin Group, opened the session by introducing the panelists and expressing his own concerns about health care disparities on the day when Congress was expected to vote on the American Health Care Act (AHCA).  “The vote taken today could put already disadvantaged populations at greater risk,” Dr. Goodman said.  The vote, however, has been postponed indefinitely.  

 

From left to right: Dr. Goodman, Dr. Allen, Dr. Chen, Ms. Filipic, Dr. Mitchell, Ms. Pettit Nassi.

The panelists included Shauntice Allen, PhD, Assistant Professor in the School of Public Health at the University of Alabama at Birmingham Comprehensive Cancer Center, who lives with metastatic breast cancer; Moon S. Chen Jr., PhD, MPH, of the University of California Davis Comprehensive Cancer Center; Anne Filipic of Enroll America, a non-profit organization dedicated to maximizing the number of Americans enrolled in health coverage made available through the Affordable Care Act; Edith Mitchell, MD, a retired Air Force General, Clinical Professor of Medicine and Medical Oncology Director of the Center to Eliminate Cancer Disparities, and the Associate Director, Diversity Affairs of the Sidney Kimmel Cancer Center at Thomas Jefferson University; and Phyllis Pettit Nassi, MSW, Associate Director of Research & Science, Special Populations, at the Huntsman Cancer Institute at The University of Utah, enrolled in the Otoe-Missouri Tribe and a member of the Cherokee Nation.  

Dr. Goodman began by asking the panelists to describe what health care disparities look like in America.

The absence of honest conversations about differences in class, culture, and social experiences lead to differences in how people are treated for cancer and informed about their choices, Dr. Allen said.

Dr. Chen added that cancer is the leading cause of death among Asian, Latino, and American Indian communities and there is an opportunity to make real gains by applying current medical knowledge to these populations.

Dr. Mitchell noted that some cancers impact minority communities experience disproportionate share of the cancer burden, and these differences must be addressed through the application of genomic research to relevant populations. Triple negative breast cancer, for example, occurs more frequently in younger women, and African Americans have twice the rate of triple negative breast cancer than the general population, with a 15% higher death rate. African Americans also have a 20% higher incidence of colon cancer and a 40% higher death rate, and develop cancers at a younger age. Therefore, screening for this population should begin earlier, at age 45, she explained.

Dr. Goodman then asked about how disparities arise and the prospects for improving care.

Dr. Mitchell spoke of overcoming biases in order to deliver what the individual needs. “With older patients, we have conscious and unconscious biases,” she said.  “For patients of a certain age it may be assumed they won’t want treatment, but it’s not the chronological age that matters. Assessment must include the physiological age and comorbidities. Similarly, biases occur with religious and racial/ethnic populations.  It’s frequently assumed that African Americans won’t participate in clinical trials but patients actually want to participate. Therefore, as providers, we must focus on our own biases.”

Ms. Pettit Nassi said that biases greatly impact the American Indian and Alaskan native health service systems, which have financial and geographic barriers. “On the Navajo reservation, when they see a Native American they think diabetes...it’s conditioned; it’s socialized within the system.”

Language barriers also create biases that impact health care delivery, Dr. Chen added.

“[Part] of the evidence is who gets recruited for clinical trials,” he said.  If the provider cannot speak the patient’s language there is a hesitation. There’s a predisposition that this person would not accept a clinical trial.” 

The term “clinical trial” itself can be confusing or intimidating to patients because “clinical” is an ambiguous term, and the word, “trial” in English could also mean “experiment” or “court case”, something that could have negative connotations.  Panelists agreed.

“There’s a lack of understanding of what clinical trials are and what they can do,” said Dr. Allen, who participated in a clinical trial. “I was surprised by the time commitment I had to make to the study, and the strict eligibility requirements.” She continued that she understands the importance of rigor, noted that there are patients out there waiting for tumors to grow larger or hoping to move on from a line of treatment so they can be eligible for particular  trials.

The panelists explained that it is financial toxicity – the burden of the health care expense – that is arguably the most significant impediment to care, and it hits medically underserved and minority communities especially hard.

“The provider without resources is not looking for preventive screening, Indian Health Service is forced to operate on ‘life and limb services because of lack of funding,” Ms. Pettit Nassi said, describing the American Indian population. “Their hands are tied in that the care they’re looking to provide is imminent. They can’t look at the future. Patients have asked for mammogram or colonoscopy and they don’t do it in small tribes.” The entire health budget for the year can be used up with one cancer diagnosis, she explained. “Part of the saying in Indian country is ‘don’t get sick after June, because you won’t get treatment.’”

“What we’re forgetting,” Ms. Pettit Nassi added, is that “the providers out in the community… they’re on the frontier. Often, they don’t have the same resources. I’m told, ‘we don’t look for cancer because if we don’t treat it, we don’t look for it.’”

Ms. Filipic told of similar sentiments uncovered in her research. “We conducted focus groups during the first open enrollment period,” she said.  “There was one woman who hadn’t done research [into health insurance.] She said, ‘You don’t go shoe shopping if you can’t afford to buy shoes.’ The lower income communities of color …assume they can’t afford it so they don’t even check out their options. We need to understand what is driving their decisions, but if you don’t address cost up front, you won’t be able to [address the other concerns].”

Dr. Allen noted that for people who have to decide between a medical bill, child care, or a car payment, access to clinical trials is an opportunity to receive high-quality care at little or no cost.

But financial toxicity and out of pocket expenses for travel, parking, lost wages for the patient and caregiver in health care are also factors for individuals who make a salary and have insurance and access to care, Dr. Mitchell said.

“I’ve been a big promoter of health care networks knowing their populations and the issues and needs that exist in the community and getting the community involved,” she said. “There may be other resources in the community to provide free mammograms.”

For example, Dr. Mitchell said, Jefferson has expanded chemotherapy administration to evenings on weekdays and weekends.  This accommodate teachers, hourly workers, working parents and others who can’t afford to miss work.

Prevention also has a role to play in reducing health care disparities in cancer, Dr. Chen said, noting that smoking cessation programs and greater use of the HPV vaccine could make a significant impact. 

Dr. Goodman then asked whether the burden for addressing disparities should rest on cancer care providers.

It’s a tough question, Ms. Filipic acknowledged, but one that providers might be best positioned to coordinate with the network of resources. “We’ve talked about the importance of cultural competence when it comes to care, but it applies to financial issues as well,” she said.  “Just because someone can enroll in coverage doesn’t mean they are aware.  Many people want to sit down with someone and talk about their options. Who are the trusted sources in the community who can get the word out?”

The panelists spoke about the importance of breaking down silos to get all participants in the health care arena involved in addressing health disparities.

There are resources that help health care institutions build the community network, Dr. Mitchell said, including volunteer groups, churches, and primary care physicians who can help define the needs.

“As cancer centers, we have to accept the challenges,” Ms. Pettit Nassi said. “Huntsman is the catchment for five states. Once you make the commitment and...go beyond just collecting the data and getting the grants….it can be done. The doctors get out of the silo. You have to go and see. See with your eyes, you will see how you can make a difference. If we don’t start bringing clinical trials out into the rural and frontier areas we’re going to miss whole populations.”

In wrapping up, many of the panelists urged those in attendance to make their voices heard in Congress and at the state level as lawmakers shape health policy.

“Apply what you learn about the community to what we know about prevention, screening and treatment and work with the community to address the individual needs of the community,” Dr. Mitchell said. “If you have an opinion regarding what is happening in Washington today, call your congressional representative today…so your voice can be heard.”

Photo credits: JAR Studio

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03/17/2017
Dealing with Distress (CancerConnect.com)
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03/16/2017
Cancer & Distress: A Guide to Coping (The Huffington Post)
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03/16/2017
Racial Disparities in Genetic Testing of Women with Breast Cancer (MedicalResearch.com)
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03/16/2017
New Supportive Care Resources from NCCN Help Patients with Cancer Confront Distress

New NCCN Guidelines for Patients®: Distress available on NCCN.org/patients

[FORT WASHINGTON, PA – March 16, 2017] — All patients with cancer experience some level of distress associated with their cancer diagnosis and the effects of the disease and its treatment—regardless of the stage of disease. Not only does distress effect a patient’s mental and psychosocial well-being, but because distress is a risk factor for non-adherence, uncontrolled distress can have a significant impact on a patient’s overall survival.

And yet – many patients don’t feel comfortable talking about their anxiety, family problems, or other issues with their oncologist. 

Empowering Patients through Education

To empower patients confronting distress after a cancer diagnosis, the National Comprehensive Cancer Network® (NCCN®) has published the NCCN Guidelines for Patients® and NCCN Quick Guide™ for Distress through funding from the NCCN Foundation® and Good Days, a patient advocacy organization providing financial assistance to patients so that they do not have to choose between access to medicine they need and affording everyday living. These resources are available free of charge at NCCN.org/patients and on the NCCN Patient Guides for Cancer mobile app.

“NCCN was a pioneer in understanding the central role of distress in overall patient management in oncology,” said Jimmie C. Holland, MD, the Wayne E. Chapman Chair in Psychiatric Oncology at Memorial Sloan Kettering Cancer Center and Founding Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Distress Management. “We are proud to continue that tradition through the publication of these patient tools that will further assist patients in identifying the symptoms of distress and empower them to seek help to manage them.”

In addition to her role with NCCN, Dr. Holland, a pioneer in psycho-oncology, is the Founding President of the American Psychosocial Oncology Society (APOS), which brings together professionals from all disciplines working in psychosocial oncology so that patients affected by cancer have access to quality psychosocial care to optimize health outcomes. APOS has endorsed the NCCN Guidelines for Patients®: Distress.

Meeting National Requirements

In 2015, the American College of Surgeons (ACS) began to require cancer centers to have in place a process for distress screening in all patients diagnosed with cancer. Many had already been relying on the widely-used NCCN Distress Thermometer, which was first created in 1997 as part of the NCCN Guidelines for Distress Management. Similar to the pain scale used in various areas of medicine, the distress thermometer allows patients to self-identify their stress level from zero to 10, with 10 being an extreme level of distress. Under the guidelines, patients reporting above a “4” should be referred to supportive care that will best serve their needs.  

As described in the NCCN Guidelines for Patients®: Distress, the NCCN Distress Thermometer,  which meets the ACS Commission on Cancer’s requirements, is presented with a “problem list” where patients can identify sources of distress from the following categories:

  • Practical Problems
  • Family Problems
  • Emotional Problems
  • Spiritual/Religious Concerns
  • Physical Problems

“In patients with cancer, distress encompasses far more than anxiety about treatment and prognosis,” says Dr. Holland. “Encouraging patients to identify and express the sources of distress in their lives will ultimately improve their psychosocial and physical well-being. My hope is that one day, all oncologists will post the NCCN Distress Thermometer in their examination rooms just as ophthalmologists have the eye chart.  Discussion of distress should be a routine part of the patient visit.”   

Today, the NCCN Distress Thermometer is accessible in the NCCN Quick Guide™ sheet for Distress

“The moment a patient is diagnosed with cancer, distress is likely to begin to surface,” says Clorinda Walley, Executive Director of Good Days. “As an advocacy organization that works directly with patients, Good Days regularly supports individuals who not only need financial resources, but require the right information that will aid their specific health care situation. The NCCN Guidelines for Patients: Distress empowers cancer patients so that they may construct a holistic path to wellness.”

A Full Library of Patient Resources

NCCN Guidelines for Patients, patient-friendly adaptations of the NCCN Guidelines, are easy-to-understand resources based on the same clinical practice guidelines used by health care professionals around the world to determine the best way to treat a person with cancer. Each resource features unbiased expert guidance from the nation’s leading cancer centers designed to help people living with cancer understand and discuss their treatment options with their providers.

NCCN Guidelines for Patients and NCCN Quick Guide™ sheets—one-page summaries of key points in the patient guidelines—are written in plain language and include patient-friendly tools, such as questions to ask your doctor, a glossary of terms, and medical illustrations of anatomy, tests, and treatment.  NCCN Guidelines for Patients and NCCN Quick Guide™ sheets DO NOT replace the expertise and clinical judgment of the clinician.

NCCN currently offers NCCN Guidelines for Patients for the following: Brain, Breast, Colon Distress, Esophageal, Kidney, Non-Small Cell Lung, Ovarian, Pancreatic, Prostate, and Stomach Cancers; Acute Lymphoblastic Leukemia; Adolescents and Young Adults with Cancer; Chronic Lymphocytic Leukemia; Chronic Myelogenous Leukemia; Hodgkin Lymphoma; Lung Cancer Screening; Malignant Pleural Mesothelioma; Melanoma; Multiple Myeloma; Myelodysplastic Syndromes; Nausea and Vomiting; Non-Hodgkin’s Lymphomas; Soft Tissue Sarcoma; and Waldenström’s Macroglobulinemia.

The NCCN Guidelines for Patients and NCCN Quick Guide™ sheet for Distress are available to download for free from NCCN.org/patients and on the NCCN Patient Guides for Cancer mobile app.

NCCN Guidelines for Patients®: Distress will be available at the following Conferences this month:

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About NCCN Foundation

NCCN Foundation® was founded by the National Comprehensive Cancer Network® (NCCN®) to empower people with cancer and advance oncology innovation. NCCN Foundation supports people with cancer and their caregivers at every step of their treatment journey by delivering unbiased expert guidance from the world’s leading cancer experts through the library of NCCN Guidelines for Patients® and other patient education resources. NCCN Foundation is also committed to advancing cancer treatment by funding the nation’s promising young investigators at the forefront of cancer research, initiating momentum in their careers and furthering the betterment of patients through their groundbreaking innovations. For more information about NCCN Foundation, visit http://www.nccnfoundation.org.

 

About Good Days       

Good Days is a national, independent 501(c)(3) non-profit charitable organization that provides financial assistance to patients so that they do not have to choose between access to medicine they need and affording everyday living. Since 2003, Good Days has provided more than 800,000 grants and helped more than 500,000 people with access to healthcare resources. For more information about Good Days, visit http://www.mygooddays.org

 

About American Psychosocial Oncology Society (APOS)

APOS is the only multidisciplinary organization in the United States dedicated to researching and treating the psychosocial aspects of cancer. For more information go to www.apos-society.org.

 

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world’s leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news

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03/15/2017
Yale Study Published in JNCCN Uncovers Racial Disparities in Treatment of Women with Breast Cancer

Researchers at Yale Cancer Center/Smilow Cancer Hospital found that black and Hispanic women in Connecticut are significantly less likely to undergo gene expression profiling than white women.

[FORT WASHINGTON, PA — March 15, 2017] In a simple definition, cancer is a disease of the cells, which is caused by gene mutations. For a proportion of patients, including women with hormone receptor positive (HR+) breast cancer, gene expression profiling has a substantial impact on treatment decision-making by determining which patients might—or might not—respond to particular treatment options.

Gene expression profiling tests are readily available, yet researchers recently found that white women with breast cancer are far more likely to receive a particular test—Oncotype Dx™ (ODx)—than black or Hispanic women with the same diagnosis. The study, Racial and Ethnic Disparities in Oncotype Dx™ Test Receipt in a State-Wide Population-Based Study,” led by Cary P. Gross, MD, Yale University School of Medicine and a member of Yale Cancer Center, is published in the March issue of JNCCN – Journal of the National Comprehensive Cancer Network.

“Observed racial and ethnic disparities in Oncotype DX testing are particularly concerning given its potential to guide treatment decisions for women with early stage breast cancer. Unequal access to genetic testing has the potential to further exacerbate disparities in treatment quality, survival, and quality of life,” said Dr. Gross.

Testing Within vs. Outside of the Guidelines

According to lead author Brigette Davis, MPH, the study built on existing research in two ways: identifying racial disparities in a state-wide, population-based analysis; and identifying the use of ODx among women for whom the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommend it, as well as among women for whom NCCN Guidelines® did not recommend testing.  This distinction is important, Ms. Davis says, “because evidence-based guidelines are intended to remove subjectivity from clinical decision-making; utilization outside of these guidelines further highlights how nonclinical factors may impact outcomes and costs for patients and payers.”

The team looked at a cohort of more than 8,000 women across the state of Connecticut who were diagnosed with HR+ breast cancer between 2011 and 2013. Among those women, Dr. Gross and colleagues performed a retrospective analysis of race, ethnicity, and ODx receipt, dividing the population among those who did and did not qualify for ODx testing according to the NCCN Guidelines for Breast Cancer.

Among the population, more than 80% of the patients were white, 6.3% were black, and 7.4% were Hispanic. Researchers found that for the NCCN Guidelines-recommended group, white patients were more likely to receive ODx testing than black and Hispanic women: 51.4% vs. 44.6% and 47.7%. Even after further adjusting for tumor and clinical characteristics, researchers observed significantly lower ODx use among black and Hispanic women compared with white women in the recommended group. Significant testing variation between the white, black, and Hispanic patients were also noted in the non-Guidelines-recommended group: 21.2% vs. 9.0% and 9.7%, respectively.

“Understanding and mitigating racial barriers to gene expression testing in women with breast cancer is imperative to narrowing disparities in breast cancer outcomes,” said Dr. Gross. “Our study reinforces the notion that at the same time the scientific community is discovering exciting new ways to help prevent or treat breast cancer, our broader community of clinicians and policy makers must ensure that these breakthroughs are accessible for all patients who need them, regardless of the color of their skin, their nation of origin, or the size of their bank account.” 

Overuse of Oncotype DX Testing

In addition to racial disparities, the study uncovered significant use of ODx outside NCCN Guidelines recommendations—confirming earlier concern about overuse of genetic profiling in patients with breast cancer. As outlined in the study, between 2011 and 2013, the NCCN Guidelines for Breast Cancer did not recommend ODx for patients with higher-risk disease, yet more than 18%—or 1,100 women—received ODx testing.

Amy E. Cyr, MD, of Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine and a member of the NCCN Guidelines Panel for Breast Cancer noted, “Papers like this are important to make us aware of our practice patterns; I expect that most physicians do not perceive that they use these tests differently when caring for minority women. Stricter adherence to treatment guidelines should reduce such racial disparity. We cannot address disparity in outcomes without addressing disparity in treatment patterns.”

“Reports such as this Yale study of racial and ethnic disparities regarding Oncotype testing are important for the medical community to receive and digest,” said Benjamin O. Anderson, MD, of Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance and Vice-Chair of the NCCN Guidelines Panel for Breast Cancer. “Patients who have a complete understanding—without fear—of their treatment options, are more likely to seek and receive the care they need. As clinicians who educate each patient about their care, the solution is very much in our hands.”

This study was funded by the American Cancer Society.

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About JNCCN – Journal of the National Comprehensive Cancer Network
More than 24,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp

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03/15/2017
Antibody Fights Pediatric Brain Tumors in Preclinical Testing (Stanford Medicine)
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03/15/2017
New Driver, Target in Advanced Mucosal Melanoma (University of Colorado Cancer Center)
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03/15/2017
As Drug Costs Soar, People Delay or Skip Cancer Treatments (NPR Shots Blog)
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03/14/2017
Finding Positive in the Negative (Massachusetts General Hospital Cancer Center)
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03/07/2017
NCCN “Just Bag It!” Campaign Shoots for 100 Adopters by End of Annual Conference

[FORT WASHINGTON, PA - March 7, 2017] – By the time its annual conference concludes on March 25, 2017, the National Comprehensive Cancer Network® (NCCN®) is aiming to have 100 reported medical centers and practices that deliver chemotherapy committed to Just Bag It: The NCCN Campaign for Safe Vincristine HandlingNCCN will register new  adopters prior to and during the NCCN 22nd Annual Conference: Improving the Quality, Effectiveness, and Efficiency of Cancer Care™ March 23-25  in Orlando, FL, and report progress toward the goal on Twitter: #NCCNac17 and #NCCNJustBagIt.

As part of its mission to improve the quality, effectiveness, and efficiency of cancer care so that patients can live better lives, NCCN launched the Just Bag It! campaign November 10, 2016 to encourage health care providers across the United States and the world, to adopt a policy to always dilute and administer vincristine in a mini IV-drip bag to prevent a deadly medical error.

Prior to the launch in November, all 27 NCCN Member Institutions had adopted policies in line with these Guidelines, which are also recommended by the Institute for Safe Medication Practices, the Joint Commission, the World Health Organization, and the Oncology Nursing Society.

By the end of February, more than 30 additional centers had confirmed with NCCN their adherence to the campaign, which NCCN is waging through social media and its 27 Member Institutions. 

Vincristine is a chemotherapy agent, widely used in patients with Leukemia or Lymphoma, which should be administered intravenously—directly into the patient’s vein. When it enters the blood, it is highly effective at blocking the growth of cancer by preventing cells from separating. However, vincristine is a neurotoxin that causes peripheral neuropathy when given intravenously and profound neurotoxicity if given into the spinal fluid, which flows around the spinal cord and brain.

Many patients who receive vincristine have a treatment regimen that includes other chemotherapy drugs that are administered intrathecally, or injected into the spinal fluid with a syringe. If vincristine is administered mistakenly into the spinal fluid, it is uniformly fatal, causing ascending paralysis, neurological defects, and eventually death.

In 2005, NCCN Chief Executive Officer Robert W. Carlson, MD, a medical oncologist, witnessed such a tragedy with a 21-year-old patient with Non-Hodgkin’s Lymphoma named Christopher Wibeto. Wibeto was transferred to Dr. Carlson’s care after receiving incorrectly administered vincristine at another hospital. Dr. Carlson watched the young man go from having a treatable condition to deteriorating and dying over the course of four days. Motivated by this tragic experience, Dr. Carlson spearheaded a national effort to address this deadly error when he arrived at NCCN, enlisting the help of its Best Practices Committee, which is dedicated to improving cancer treatment protocols.

To ensure that vincristine is always administered properly, NCCN has issued guidelines and updated NCCN Chemotherapy Order Templates (NCCN Templates®) advising health care providers to always dilute and administer vincristine in a mini IV-drip bag and never use a syringe to administer the medication. This precaution renders it impossible to accidentally administer the medication into the spinal fluid and greatly decreases the chances of improper dosage.

“Every medical center, hospital, and oncology practice that makes the commitment to ‘Just Bag It’ takes an important step toward patient safety and ensures that this error will never happen again,” Dr. Carlson said. “Christopher’s memory inspires us to never give up telling his story and remaining vigilant for this cause.”  

Surveys issued by the Institute for Safe Medication Practices (ISMP) show that over time, more hospitals have adopted a policy to always bag vincristine. According to ISMP data, the number of hospitals that have fully implemented the policy across their practice nearly doubled between February 2014 and February 2016. Earlier surveys indicated a similar increase between 2005 and 2012. Still, only about half of all respondents indicated that they have implemented the policy in all treatment settings, indicating that there is a long way to go.

With 125 known cases of accidental death in the United States and abroad since the inception of vincristine use in the 1960s, this error is relatively rare. Still, it is unique in its level of mortality. Improvements in practice over the years, including manufacturer- and pharmacist-issued warning labels, have reduced the number of deaths, but the error continues to occur.

For more information about Just Bag It: The NCCN Campaign for Safe Vincristine Handling, or to report that a medical facility has adopted a vincristine policy, visit www.NCCN.org/JustBagIt.

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03/06/2017
Major Pharmaceutical Companies Collaborate in Groundbreaking NCCN Project

The NCCN Oncology Research Program has awarded grants for its first-ever multi-industry collaborative project, soliciting investigator-initiated proposals to research the effectiveness of Boehringer-Ingelheim’s afatinib in combination with other drugs to treat lung and head and neck cancers.

[FORT WASHINGTON, PA – March 6, 2017] The National Comprehensive Cancer Network® (NCCN®) Oncology Research Program (ORP) has funded three studies in its first multi-industry collaborative research project in which Boehringer Ingelheim Pharmaceuticals, Inc. and Eli Lilly and Company (Lilly) are collaborating with NCCN to study combination therapeutic agents in lung cancer and head and neck cancers.

The following studies were awarded funding through NCCN ORP:

Boehringer Ingelheim awarded NCCN ORP a $2-million research grant to support NCCN investigator-initiated pre-clinical, clinical, and correlative studies of combination therapies containing afatinib1 in the treatment of lung and head and neck cancers. NCCN and Boehringer Ingelheim collaborated with Lilly for access to necitumumab2.

Proposals of other afatinib combination therapies were also accepted. Submissions were peer reviewed by the NCCN Afatinib Combination Scientific Review Committee. The funded concepts were selected based on several criteria, including scientific merit, existing data, and the types of studies necessary to further evaluate the efficacy of afatinib.

“In facilitating this innovative research initiative, NCCN ORP indeed leads the way in laying the groundwork for future collaborative clinical research endeavors,” said Susan Most, RN, MBA, Director, Clinical Operations, NCCN ORP. “The study of the effectiveness of combination therapies in oncology requires collaboration among various stakeholders, and NCCN applauds Boehringer Ingelheim and Lilly in their combined efforts to advance cutting edge research to improve the lives of people with lung and head and neck cancers.”

For more information about NCCN ORP, visit NCCN.org/ORP.

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About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the nation’s leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news.

About Boehringer Ingelheim
Boehringer Ingelheim Pharmaceuticals, Inc., based in Ridgefield, CT, is the largest U.S. subsidiary of Boehringer Ingelheim Corporation. Boehringer Ingelheim is one of the world’s 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, the company operates globally with 145 affiliates and about 50,000 employees. Since its founding in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel treatments for human and veterinary medicine.

Boehringer Ingelheim is committed to improving lives and providing valuable services and support to patients and families. Our employees create and engage in programs that strengthen our communities. To learn more about how we make more health for more people, visit our Corporate Social Responsibility Report.

For more information please visit www.us.boehringer-ingelheim.com, or follow us on Twitter @BoehringerUS.

About Lilly Oncology
For more than 50 years, Lilly has been dedicated to delivering life-changing medicines and support to people living with cancer and those who care for them. Lilly is determined to build on this heritage and continue making life better for all those affected by cancer around the world. To learn more about Lilly's commitment to people with cancer, please visit www.LillyOncology.com.

About Eli Lilly and Company
Lilly is a global healthcare leader that unites caring with discovery to make life better for people around the world. We were founded more than a century ago by a man committed to creating high-quality medicines that meet real needs, and today we remain true to that mission in all our work. Across the globe, Lilly employees work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to communities through philanthropy and volunteerism. To learn more about Lilly, please visit us at www.lilly.com and www.lilly.com/newsroom/social-channels.


1Afatinib is FDA approved under the brand name Gilotrif for the first-line treatment of patients with metastatic NSCLC whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) substitution mutations as detected by an FDA-approved test.

2 Necitumumab is FDA approved under the brand name Portrazza. Portrazza, in combination with gemcitabine and cisplatin, is approved for the first-line treatment of people with metastatic squamous NSCLC. Portrazza is not indicated for treatment of nonsquamous NSCLC.

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02/15/2017
Payers Weigh the Implications of Multigene Testing Coverage in New UCSF Study

A recent study from the UCSF Center for Translational and Policy Research on Personalized Medicine and the UCSF Helen Diller Family Comprehensive Cancer Center identified opportunities to address the barriers to coverage of hereditary cancer panels, as published in JNCCN.

(FORT WASHINGTON, PA – February 15, 2017) Innovation in precision medicine has introduced an amalgam of testing options, of which hereditary cancer panels—multigene tests—are a major component. Additionally, the importance of inherited cancer genomics was further bolstered by Former President Barack Obama’s Precision Medicine Initiative in 2015. Controversy lay, however, in the lack of formal insurance coverage policy for such tests. To expose the major roadblocks to coverage, researchers from the UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS) and the UCSF Helen Diller Family Comprehensive Cancer Center, interviewed 11 major U.S. payers covering 160 million lives.

The results of their study, “Payer Coverage for Hereditary Cancer Panels: Barriers, Opportunities, and Implications for the Precision Medicine Initiative,” are available in the February issue of JNCCN – Journal of the National Comprehensive Cancer Network.

“We believe that understanding payers’ coverage decision-making is imperative to ensuring future patient access to potentially transformative modalities and informing genetic research,” said lead author Julia R. Trosman, PhD, Adjunct Assistant Professor, TRANSPERS, UCSF Department of Clinical Pharmacy; Adjunct Assistant Professor, Northwestern University Feinberg School of Medicine; and Director at the Center for Business Models in Healthcare, an independent research organization. “We focused on private payers, as they collectively cover two-thirds of the insured U.S. population, and their coverage decisions affect public payer policy. The 11 major payers involved in our study collectively cover over 160 million enrollees in the U.S.”

Researchers also believe that payers’ hereditary cancer panel coverage considerations have implications on the Precision Medicine Initiative and its efforts to assemble more than one million volunteers to contribute genomic, clinical, and lifestyle data to advance genetic science. Based on the findings from the study, the paper discusses how the Precision Medicine Initiative design can incorporate payer feedback to ensure patient access.

A majority of payers noted that novel hereditary cancer panel features present a unique appeal to patients and clinicians, but 100 percent of those interviewed cited that the panels do not fit within current coverage frameworks and lack necessary evidence, while more than 90 percent noted that the hereditary cancer panels represented departed from pedigree/family-history–based testing toward genetic screening.

Payers shared not only barriers to hereditary cancer panel coverage, but also opportunities to address them. For instance, participants shared insight into how evidentiary requirements for the plans can be met, noting that, in many cases, randomized controlled trials may not be required. Rather, observational and pooled studies and registry data may be acceptable to confirm statistical significance.  Some also suggested that coverage and evidence evaluation frameworks could potentially be modified to align with panel features and benefits.

In addition to clinical and evidentiary concerns, more than 80 percent of those interviewed expressed concern about patient engagement and understanding of the ramifications of such panels. Despite completion of the informed consent form, it remains a challenge to ensure that patients understand the emergent state of evidence for many genes in panels and express their wishes regarding being re-contacted in the future when new evidence becomes available.

“We hope that our findings bring attention to the topic of insurance coverage for cancer panels and contribute to a productive dialogue among various stakeholders on framing an approach to address payers’ concerns,” stated Dr. Trosman. “Many previous studies on reimbursement for genomic technologies, including our own, were focused on barriers to coverage. We are encouraged that the present study also identified opportunities that could be pursued to mitigate barriers.”

Identified within the article are three target areas where the Precision Medicine Initiative design can incorporate payer feedback, and, therefore, strengthen its impact on patients and genetic science: address insurance coverage barriers to secure access to future Precision Medicine Initiative discoveries; incorporate payers’ evidentiary requirements to the Precision Medicine Initiative research agenda to increase relevance of research to future coverage decisions; and leverage payer recommendations and experience to keep patients informed and engaged.

"This study represents another step forward in understanding the discordant needs between health care providers and payers with regard to coverage of hereditary cancer panels. Many of the barriers to coverage cited by the payers interviewed in this study, including gaps in evidence on gene penetrance and questionable actionability are shared by the genetics community. The concern of the payers that availability of hereditary cancer panels will lead to 'indiscriminant genetic screening,' however, is likely unfounded. Instead, considerable effort on the part of the genetics community has been, and continues to be, devoted to evolving counseling models and encouraging patient participation in testing decisions to deal with the inherent uncertainties involved with genetic risk. On the other hand, it is promising that the payers support the need for pre- and post-test counseling, and they are open to the development of novel models to address the current barriers to coverage," said Mary B. Daly, MD, Fox Chase Cancer Center, Chair, NCCN Guidelines Panel for Genetic/Familial High-Risk Assessment: Breast and Ovarian.

Complimentary access to the study, “Payer Coverage for Hereditary Cancer Panels: Barriers, Opportunities, and Implications for the Precision Medicine Initiative,” is available until May 31, 2017 at JNCCN.org.

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About JNCCN – Journal of the National Comprehensive Cancer Network
More than 24,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp

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02/10/2017
Deep-Learning Algorithm Matches Dermatologists’ Ability to Identify Skin Cancer (Stanford Cancer Institute)
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02/09/2017
Scientists Identify Aggressive Pancreatic Cancer Cells and Their Vulnerability (The University of Texas MD Anderson Cancer Center)
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