Supplementary Figure 1: Number of cancer cases and deaths across indications in 2020, Millions

PDF file, 72K, Determination of the patient population selected for analysis.

PURPOSE:Next-generation sequencing (NGS) is recommended for patients with metastatic prostate cancer (PC). Nationwide, testing rates are low. Whether PC disease characteristics and courses differ between those with and without NGS testing is unknown. We identified predictors of testing, explored likely reasons for lack of testing, and compared survival between those with and without testing. METHODS:We retrospectively reviewed patients with metastatic PC initially seen between 2020 and 2022 at Johns Hopkins. Clinical data and reasons for nontesting were abstracted from the electronic medical record. We conducted a logistic regression assessing predictors of NGS testing, adjusting for age, Gleason grade, marital status, and metastatic diagnosis year. We used Cox regression to compare overall survival, defined from the time patients had both a metastatic diagnosis and a visit at our institution until death/last follow-up, between those tested and not tested. We adjusted for age, Gleason grade, initial metastasis (M) stage, comorbidities, and time from metastatic diagnosis to first visit. RESULTS:Of the 435 patients, 257 (59%) had NGS testing. Older patients were less likely to have testing (adjusted odds ratio [aOR], 0.96 [95% CI, 0.94 to 0.98]). Unmarried patients were less likely to have testing (aOR, 0.62 [95% CI, 0.38 to 1.01]). Patients with Gleason Grade Group 5 were more likely to undergo testing than patients with Groups 1-3 (aOR, 1.86 [95% CI, 1.14 to 3.04]). Among those without testing, 139 (78%) had at least one potential reason for lack of testing in the medical record. The most common reason for nontesting was patient/disease factors (37%). CONCLUSION:Older and unmarried men with metastatic PC were less likely to obtain NGS testing, whereas those with high Gleason grade were more likely. Interventions are needed to improve testing rates.

OBJECTIVES:Low-dose CT (LDCT) screening is critical for early lung cancer detection. We assessed diagnostic uncertainty following positive LDCTs in the National Lung Screening Trial (NLST). We defined this pathway as an "Potential missed diagnostic opportunity" for participants eventually diagnosed with lung cancer. METHODS:This is a secondary analysis of the NLST trial, examining potential missed diagnostic opportunity among screen-detected participants who were diagnosed with lung cancer in the LDCT arm. Potential missed diagnostic opportunity (PMDO) defined as no lung cancer diagnosis following a positive LDCT, which was then followed by a subsequent annual positive LDCT that did lead to lung cancer diagnosis. RESULTS:Of 1,089 lung cancers diagnosed in the LDCT arm, 58 % (630 individuals) were adherent screen-detected at risk for a PMDO (605 [55 %] using Lung-RADS). Overall, 37.3 % (235 of 630) experienced ≥1 PMDO (33.1 % using Lung-RADS). Among the 235 participants who experienced a PMDO, only 1.7 % (four individuals) received a diagnostic resection or biopsy, and 35.7 % (84 individuals) had little to no diagnostic procedures following their first positive LDCT. Once diagnosed, the group that experienced PMDO tended to have earlier stage lung cancer and longer survival rates compared to those without such events. CONCLUSIONS:While LDCT is a vital screening tool, a substantial proportion of lung cancer patients experience a period of diagnostic uncertainty after an initial positive screen. This pathway highlights a critical area for process improvement. Understanding the clinical decision-making during these periods is essential to fully optimize the benefits of early detection.

Supplementary Figure 2: Number of cancer cases and deaths across geography in 2020, Millions

Supplementary Table 1: Authors and affiliations

171 Background: Since 2020, guidelines recommend somatic next-generation sequencing (NGS) in patients with metastatic (M1) prostate cancer. Nationwide, genetic testing rates are low with known disparities in access. Whether prostate cancer disease characteristics and courses differ between those with and without testing are unknown. In this study, we determined the NGS testing rate in M1 prostate cancer at a single academic center and assessed social and clinical features by NGS testing status. In those without NGS testing, we reported the most likely reasons for lack of testing. Finally, we compared survival among those with and without testing. Methods: Retrospective chart review of M1 patients with prostate cancer seen as a new visit between 2020-2022 with at least one follow-up. Sociodemographics, comorbidities, prostate cancer clinical features, and vital status were obtained from the electronic medical record (EMR). Reasons for lack of NGS testing were assessed through chart review. A multivariable (MV) logistic regression assessed predictors of NGS testing (covariates: age, Gleason grade group, marital status, M1 diagnosis year). Survival analysis was conducted from the date of first visit with M1 disease to the date of death/last follow-up (covariates: age, Gleason grade group, M stage at initial diagnosis, NCI comorbidity index, days from M1 diagnosis date to first visit date). Results: 258 (59%) of 435 patients had NGS ordered. Patients who were older and not married were less likely to have NGS testing, which remained in MV analysis [age: odds ratio (95% confidence interval) = 0.96 (0.94-0.98); unmarried vs. married/partnered 0.62 (0.38-1.00)]. (Table 1). The most common likely underlying reason for no NGS testing ordered were perceived patient/disease factors (28%), no tissue available (16%), and shared care with another oncologist (18%). There was no clear reason in 22% of patients. Those with testing ordered had worse survival than those without [adjusted hazard ratio (95% confidence interval) = 1.43 (1.03-1.99)]. Conclusions: NGS testing remains underutilized in men with metastatic prostate cancer, particularly among older and unmarried individuals. Those without NGS testing had longer survival, contrary to what is seen in other diseases. Future research is needed to develop and assess interventions to improve NGS testing rates. Multivariable analysis of predictors of ordering next-generation sequencing (NGS) in metastatic (M1) prostate cancer (N=419). Variables Odds Ratio 95% confidence interval p-value Age at M1 diagnosis 0.96 0.94-0.98 <0.01 Gleason score at initial diagnosis 0.07 Group 1-3 1 ref Group 4 1.59 0.84-3.01 Group 5 1.78 1.09-2.91 Gleason score never performed 2.20 1.05-4.59 Marital Status 0.05 Married/partnered 1 ref Not married/partnered 0.62 0.38-1.00 Year of M1 diagnosis 0.07 2019 or earlier 1 ref 2020-2022 0.62 0.36-1.05

Objectives: In the United States, under-represented racial/ethnic groups lack ample enrollment in clinical trials, yielding ungeneralizable trial results. Barriers to increasing minority enrollment include decreased awareness of clinical trials, lack of access, financial burden and toxicity, medical system mistrust, and discordant physician-patient demographics. The ongoing Spine Patient Optimal Radiosurgery Treatment for Symptomatic MEtastatic Neoplasms (SPORTSMEN) clinical trial (NCT05617716 on clinicaltrials.gov) has a study design to actively accrue minority patients. We present our protocol addressing key targets to increase minority enrollment on this randomized, phase II clinical trial. Methods: Adults with evidence of symptomatic spine metastases are eligible. Baseline demographics (including race/ethnicity) are reported for statistical analysis. Our protocol seeks to minimize barriers to minority enrollment and targets 5 key areas including clinical trial design, access to care, financial toxicity, community engagement, and patient-centered care. Results and Conclusions: Increasing clinical trial diversity is a challenge that must be addressed with meaningful intent to present robust level I data that broadens the understanding of treatment response in all demographics. Our protocol takes a patient-centered approach to achieve the objective of concordant racial/ethnic representation in a randomized clinical trial.

On October 12, 2023, Franklyn G. Prendergast, MD, PhD, died of pancreatic cancer. He was a force in science and medicine and a trailblazer in civil rights. He rose from humble beginnings in Jamaica to be a distinguished physician/scientist and a very successful administrator in one of the nation's most distinguished medical centers.Along the way, he became an idol to young minorities and women in medicine and science. His success disproved naysayers who believed Black people did not have the potential to lead. When counseling young minority physicians and scientists, Prendergast would caution that even today there are some who think of themselves as enlightened who have difficulty accepting minorities and women in leadership.Prendergast graduated with honors from the medical school at the University of the West Indies (Jamaica) in 1968. He was then selected as a Rhodes Scholar and attended Lincoln College, University of Oxford. In 1971, he came to the United States to work at Mayo Clinic as an internal medicine resident. In 1977, he earned a PhD in biochemistry from the joint program at the Mayo Graduate School and University of Minnesota. He immediately joined the Mayo Clinic faculty, specializing in protein chemistry. He became a professor of pharmacology, biochemistry, and molecular biology in 1986 and chair of the Department of Biochemistry and Molecular Biology in 1987. He was then named Director for Research for Mayo Clinic in 1989. The following year, he was appointed to the Mayo Board of Governors and the Mayo Foundation. He became the director of the Mayo Clinic Cancer Center in 1995. In 2006, he stepped down as director of the comprehensive cancer center and organized the Mayo Center for Individualized Medicine. He retired from Mayo in 2014.Prendergast also received several honorary doctorates. Among them, from Purdue University and his alma mater, the University of the West Indies. He also received Distinguished Alumni Awards from the University of the West Indies, University of Minnesota, and Mayo Clinic. Prendergast served on the Board of Directors of several companies, among them Eli Lilly, Neubase Therapeutics, Cyclica, Morphimmune, and Medbio. He is especially remembered as a member of the NCI Board of Scientific Advisors and the National Cancer Advisory Board.The National Cancer Institute (NCI) initiated the Cancer Centers Program as a result of President Richard Nixon's National Cancer Act of 1971. Mayo Clinic was one of the first institutions to obtain NCI designation in 1973. By 1995, there were 38 NCI-designated cancer centers. Their directors were and are a prestigious and influential cohort. They have been called "the Senators of American oncology." Until 1995, all directors of NCI-designated cancer centers were White, and almost all were male. That is when Franklyn Prendergast was named leader of the NCI-designated clinical cancer center at Mayo. In 2000, he took the Mayo Cancer Center from an NCI-designated clinical cancer center to the even more prestigious recognition as an NCI-designated comprehensive cancer center. Thus, Prendergast is not just the first Black person to lead an NCI-designated cancer center, he is the first Black director to take a cancer center to the "comprehensive designation."As director of the Mayo Clinic Comprehensive Cancer Center, Prendergast was known for mentorship and "managing by walking around." He would often run into a young scientist in the hallway, stop, and mention that he had been thinking about them and that he had some idea that he wanted to run past them. One now distinguished senior investigator said, "As an early career researcher, this made a huge difference for me to know that the cancer center director remembered my name and took an interest in me."Indeed, one should not underestimate the importance of men and women like Prendergast who demonstrated what Black people and other minorities could do with competence. His opening of minds and his widespread acceptance created opportunities for others. One prominent Black physician/scientist/administrator who directs an NCI-designated comprehensive cancer center said, "We Black doctors think of Frank as our Jackie Robinson."Prendergast was a role model who encouraged young men and women of all races/ethnicities to pursue careers in science and medicine at mainstream institutions. Prendergast was a bit of an enigma in Rochester, Minnesota. When asked by a young Black physician about it being unusual for a Jamaican to settle in Rochester, Minnesota, he said, "It's easy once you get used to the fact that they put white cream sauces on everything." He then laughed and said, "I am talking about more than just food."In a 2021 graduation speech given at the Mayo Clinic Graduate School of Biomedical Sciences, Prendergast summed up his philosophy of leadership after a life in medicine and decades in one of the nations most distinguished medical institutions. He stressed the importance of mentorship and of creating opportunities for young physicians and scientists. He thanked by name those who were his mentors along the way, freely giving their knowledge, time, and experience. In speaking of his experiences in medicine, he said that one should understand the significance of tradition. "Respect for tradition is one thing, but slavish adherence to tradition quite another. Tradition is vital, but there comes the time when we have to examine the precepts and meaning of a tradition or set of traditions and be willing to change them boldly in the face of new realities." Going further, he said that one should understand the role of dissent in an institution, emphasizing that "opinions that differ inculcate and engender the habit of critical analysis and review." He admonished the graduates and faculty to "teach the art of genuinely solicitous and respectful commentary" and strongly encouraged them to "be involved!"Prendergast is survived by his wife Debbra and his adult children Sean and Kathryn.

Summary: Despite exponentially increased industry investment in oncology research and development with more than $80 billion spent annually, patient enrollment in clinical trials remains below 5% globally. Our multistakeholder international cancer coalition envisions ecosystem transformation with capacity building through a global “hub-and-spoke” network model to expand access to and accelerate clinical trials, thus ending cancer as a major cause of death in this lifetime.

Population data support use of race (a sociopolitical demographic) in development of prostate cancer risk profiles and screening algorithms. This is "benevolent racial profiling." We should aspire to develop more scientific and objective precision medicine tools to assess risk of clinically significant prostate cancer, such as germline gene testing and assessment of environmental exposures.

1584 Background: Fewer than 5% of patients with cancer enroll in a clinical trial, partly due to the significant financial and logistical burden on patients, especially among underserved populations. The COVID-19 pandemic marked a significant shift in the adoption of remote technologies and decentralized trial operations by major pharmaceutical companies. We sought to determine the current global state of adoption of these technologies, understand factors that are driving or preventing adoption of them, and highlight aspirations and direction for industry to enable more patient-centric trials. Methods: The multi-stakeholder Bloomberg New Economy International Cancer Coalition composed of patient advocacy, industry, government regulators, and academic medical centers developed a survey directed to global biopharmaceutical companies of the Coalition with a focus on registrational clinical trials. The survey was organized into three main sections: 1) Impact of different remote monitoring and data collection technologies on patient-centricity; 2) Adoption of these technologies in oncology and all therapeutic areas; 3) Barriers/facilitators to adoption. Results: Administered from October 1 to December 31, 2022, a total of 8 companies completed the survey (response rate: 100%), representing 33% of oncology market by revenues in 2021. Across nearly all remote monitoring and data collection technologies, adoption in oncology trials lags that of all trials. In the current state, eDiary/eCOA is the most utilized technology with 56% and 51% adoption for all trials and oncology trials, respectively, whereas visits in local physician networks is the least adopted at 12% and 7%, respectively. Looking forward, the difference between the current and aspired adoption rate in 5 years for oncology is large, with respondents expecting a 40% or greater absolute adoption increase in 8 out of the 11 technologies (Table). Furthermore, respondents identified digitally enabled recruitment, local or mobile imaging capabilities, and local physician networks as those technologies that would be most impactful for improving patient centricity in the long term. Conclusions: This survey is the first by a coalition of global stakeholders to determine the current state and future aspirations for the use of remote technologies in oncology clinical trials. These efforts may galvanize momentum towards greater adoption of enabling technologies supporting a new paradigm of trials that are more accessible, less burdensome, and more inclusive.[Table: see text]

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AbstractA better understanding of breast cancer subtypes is allowing their use as prognostic markers. For some time, it has been documented that black women with breast cancer have a poorer prognosis than white women of the same stage. Advances in immunohistochemistry and the appreciation of breast cancer subtypes are enabling investigators to study the distribution of these subtypes among populations. Clin Cancer Res; 16(24); 5920–2. ©2010 AACR.

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Abstract Background: Black-White racial disparities in cancer mortality in the US are well-documented. Oncologist density, as a measure of oncology care access, has the potential to improve cancer outcomes. Given the estimated shortage of oncologists over the next decade, understanding how oncologist density might influence cancer disparities is of considerable importance. We hypothesized that greater oncologist density was associated with smaller racial disparities in cancer mortality. Methods: An ecological study of 1,048 US counties was performed. Oncologist density (per 100,000 population) was calculated where oncologists were identified from the 2013 National Plan and Provider Enumeration System. Using the age-standardized cancer mortality rate between 2014-2018 from State Cancer Profiles, the Black:White cancer mortality rate ratio was calculated for each county. Linear regression was constructed to assess the association of oncologist density with (1) Black-White cancer mortality rate ratio, and (2) cancer mortality rates overall, and separately among Black and White people. Results: The mean Black:White cancer mortality rate ratio across US counties was 1.13. Every five additional oncologists per 100,000 population was associated with 0.02 increase in the Black:White cancer mortality rate ratio (95% confidence interval [CI]: 0.007 to 0.03) in the multivariable model. The role of oncologist density on cancer mortality was different between Black and White people. Every five additional oncologists per 100,000 population was associated with a 1.59 decrease per 100,000 population in cancer mortality rates among White people (95% CI: -2.96 to -0.23), whereas oncologist density was not associated with cancer mortality rates among Black people. Conclusions: Greater oncologist density was associated with larger Black-White racial disparities in cancer mortality. Greater oncologist density was associated with significantly lower cancer mortality among White patients, but not among Black patients. Increasing oncologist density alone could exacerbate mortality disparities, thus attention to ensuring equitable care is critical. Citation Format: Yuehan Zhang, Kathryn M. Leifheit, Otis W. Brawley, Roland Thorpe, Darrell Gaskin, Lorraine Dean. Does greater oncologist density reduce estimates of Black-White disparities in cancer mortality [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-177.