Publications by authors named "Narjust Duma"

56 Publications

Knowledge, Practice, and Attitudes of Physicians in Low- and Middle-Income Countries on Fertility and Pregnancy-Related Issues in Young Women With Breast Cancer.

JCO Glob Oncol 2022 Jan;8:e2100153

Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.

Purpose: Fertility and pregnancy-related issues are highly relevant for young (≤ 40 years) patients with breast cancer. Limited evidence exists on knowledge, practice, and attitudes of physicians from low- and middle-income countries (LMICs) regarding these issues.

Methods: A 19-item questionnaire adapted from an international survey exploring issues about fertility preservation and pregnancy after breast cancer was sent by e-mail between November 2019 and January 2020 to physicians from LMICs involved in breast cancer care. Descriptive analyses were performed.

Results: A total of 288 physicians from Asia, Africa, America, and Europe completed the survey. Median age was 38 years. Responders were mainly medical oncologists (44.4%) working in an academic setting (46.9%). Among responders, 40.2% and 53.8% reported having never consulted the available international guidelines on fertility preservation and pregnancy after breast cancer, respectively. 25.0%, 19.1%, and 24.3% of responders answered to be not at all knowledgeable about embryo, oocyte, or ovarian tissue cryopreservation, respectively; 29.2%, 23.6%, and 31.3% declared that embryo, oocyte, and ovarian tissue cryopreservation were not available in their countries, respectively. 57.6% of responders disagreed or were neutral on the statement that controlled ovarian stimulation can be considered safe in patients with breast cancer. 49.7% and 58.6% of responders agreed or were neutral on the statement that pregnancy in breast cancer survivors may increase the risk of recurrence overall or only in those with hormone receptor-positive disease, respectively.

Conclusion: This survey showed suboptimal knowledge, practice, and attitudes of physicians from LMICs on fertility preservation and pregnancy after treatment completion in young women with breast cancer. Increasing awareness and education on these aspects are needed to improve adherence to available guidelines and to promote patients' oncofertility counseling.
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http://dx.doi.org/10.1200/GO.21.00153DOI Listing
January 2022

Assessment of Regional Variability in COVID-19 Outcomes Among Patients With Cancer in the United States.

JAMA Netw Open 2022 01 4;5(1):e2142046. Epub 2022 Jan 4.

University of California, San Diego.

Importance: The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography.

Objective: To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer.

Design, Setting, And Participants: This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States.

Exposures: Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index.

Main Outcomes And Measures: The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time.

Results: Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58).

Conclusions And Relevance: In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.42046DOI Listing
January 2022

Women Oncologists' Perceptions and Factors Associated With Decisions to Pursue Academic vs Nonacademic Careers in Oncology.

JAMA Netw Open 2021 12 1;4(12):e2141344. Epub 2021 Dec 1.

Department of Medical Oncology, University of Wisconsin Hospital and Clinics, Madison.

Importance: Women outnumber men in US medical school enrollment, but they represent less than 40% of academic oncology faculty.

Objective: To identify the key factors associated with female oncologists' decision to pursue academic or nonacademic oncology practice and to characterize their perceptions about their current career.

Design, Setting, And Participants: This cross-sectional survey study was distributed through email and social media to female physicians in academic and nonacademic oncology practice in the United States. The survey was open for 3 months, from August 1 to October 31, 2020.

Main Outcomes And Measures: No single primary study outcome was established because of the cross-sectional nature of the survey. Data were collected anonymously and analyzed using t tests for continuous variables and χ2 tests for categorical variables.

Results: Among the 667 female respondents, 422 (63.2%) identified as academic oncologists and 245 (36.8%) identified as nonacademic oncologists. Approximately 25% of respondents reported that their spouse or partner (156 [23.5%]) and/or family (176 [26.4%]) extremely or moderately affected their decision to pursue academic practice. Academic oncologists perceived the biggest sacrifice of pursuing academics to be time with loved ones (181 [42.9%]). Nonacademic oncologists perceived the biggest sacrifice of pursuing academics to be pressure for academic promotion (102 [41.6%]). Respondents had different perceptions of how their gender affected their ability to obtain a chosen job, with 116 academic oncologists (27.6%) and 101 nonacademic oncologists (41.2%) reporting a positive or somewhat positive impact (P = .001). More than half of the women surveyed (54.6% academic oncologists [230]; 50.6% nonacademic oncologists [123]; P = .61) believed they were less likely to be promoted compared with male colleagues. Academic and nonacademic oncologists reported rarely or never having a sense of belonging in their work environment (33 [7.9%] and 5 [2.0%]; P < .001). Most respondents reported that they would choose the same career path again (301 academic oncologists [71.3%]; 168 nonacademic oncologists [68.6%]); however, 92 academic oncologists (21.9%) reported they were likely to pursue a career outside of academic oncology in the next 5 years.

Conclusions And Relevance: This survey study found that a spouse or partner and/or family were factors in the career choice of both academic and nonacademic oncologists and that female gender was largely perceived to adversely affect job promotion. Given that more than 20% of female academic oncologists were considering leaving academia, gender inequality is at high risk of continuing if the culture is not addressed.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.41344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8719237PMC
December 2021

COVID-19 and Cancer: A Review of the Registry-Based Pandemic Response.

JAMA Oncol 2021 12;7(12):1882-1890

Aurora Cancer Care, Advocate Aurora Health, Milwaukee, Wisconsin.

Importance: The COVID-19 pandemic has had consequences for patients with cancer worldwide and has been associated with delays in diagnosis, interruption of treatment and follow-up care, and increases in overall infection rates and premature mortality.

Observations: Despite the challenges experienced during the pandemic, the global oncology community has responded with an unprecedented level of investigation, collaboration, and technological innovation through the rapid development of COVID-19 registries that have allowed an increased understanding of the natural history, risk factors, and outcomes of patients with cancer who are diagnosed with COVID-19. This review describes 14 major registries comprising more than 28 500 patients with cancer and COVID-19; these ongoing registry efforts have provided an improved understanding of the impact and outcomes of COVID-19 among patients with cancer.

Conclusions And Relevance: An initiative is needed to promote active collaboration between different registries to improve the quality and consistency of information. Well-designed prospective and randomized clinical trials are needed to collect high-level evidence to guide long-term epidemiologic, behavioral, and clinical decision-making for this and future pandemics.
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http://dx.doi.org/10.1001/jamaoncol.2021.4083DOI Listing
December 2021

Professional Address during Obstetrics and Gynecology Grand Rounds Introductions: Setting the Stage, Setting the Standard.

J Surg Educ 2021 Nov-Dec;78(6):1930-1937. Epub 2021 Jul 19.

Department of Obstetrics and Gynecology University of Wisconsin, Madison, Wisconsin. Electronic address:

Objective: This study aimed to assess gender dynamics during Obstetrics and Gynecology (Ob/Gyn) Grand Rounds.

Design: This was an observational cohort study of Ob/Gyn Grand Rounds introductions at a large academic center. Ob/Gyn Grand Rounds introductions from December 2016 to February 2020 were included. Audio and video components of introductions for those with doctorate degrees were reviewed. Each named reference to the presenter and use of descriptors were collected. Statistical analyses included Fisher's exact test for categorical variables and Student's t-test for continuous variables.

Setting: This study was completed at the University of Wisconsin in the Department of Ob/Gyn PARTICIPANTS: Ob/Gyn Grand Rounds introducers who had complete audio and video components of introductions for those with doctorate degrees.

Results: Sixty-four Grand Rounds introductions were reviewed; 57 met inclusion criteria. The majority of introducers and presenters were women. Consistent use of "doctor" was similar by men and women introducers (50% vs. 29%, p = 0.427). Assistant professors were more likely to maintain professional address during introductions, compared to associate or full professors (86% vs. 0% vs. 10%, p < 0.001). Trainees were less likely than faculty to be addressed professionally at any time during introductions (42% vs. 81%, p = 0.017). Descriptors were used for men and women presenters, though men received more female-gendered descriptors than women (5 vs. 1, p = 0.011). Women introducers used productivity descriptors less often than men introducers (8 [15.1%] vs. 5 [55.6%] (p = 0.015)).

Conclusions: Use of professional address was associated with academic rank, but not gender. Men endorsed and received more descriptors emphasizing accomplishments, highlighting qualifications as an expert. Given the professional environment, all Grand Rounds presenters should be introduced using professional titles.
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http://dx.doi.org/10.1016/j.jsurg.2021.06.011DOI Listing
July 2021

Evidence to Date: Evaluating Pembrolizumab in the Treatment of Extensive-Stage Small-Cell Lung Cancer.

Clin Pract 2021 Jul 6;11(3):441-454. Epub 2021 Jul 6.

Division of Medical Oncology, Hematology and Palliative Care, University of Wisconsin, Madison, WI 53706, USA.

Small-cell lung cancer (SCLC) is an aggressive subtype of lung cancer characterized by a rapid initial response and early development of resistance to systemic therapy and radiation. The management of SCLC significantly changed for the first time in decades with the introduction of immune checkpoint inhibitors. Pembrolizumab, a humanized IgG4 isotype antibody, targets the programmed cell death protein 1 (PD-1) pathway to restore anti-tumor immunity. Prospective trials of pembrolizumab in patients with previously treated SCLC showed significant durability of responses. These results led to the U.S. Food and Drug Administration (FDA) granting pembrolizumab accelerated approval as second- or third-line monotherapy for patients with extensive-stage (ES) SCLC. In a recent clinical trial that included patients with previously untreated ES-SCLC, pembrolizumab in combination with platinum/etoposide met its progression-free survival endpoint, but overall survival (OS) did not cross the threshold for superiority. With the therapeutic landscape for SCLC rapidly evolving, we review prior experience and future directions of pembrolizumab in ES-SCLC.
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http://dx.doi.org/10.3390/clinpract11030059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293071PMC
July 2021

Sociodemographic disparities in the management of advanced lung cancer: a narrative review.

J Thorac Dis 2021 Jun;13(6):3772-3800

Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.

Treatment of advanced non-small cell lung cancer (NSCLC) has markedly changed in the past decade with the integration of biomarker testing, targeted therapies, immunotherapy, and palliative care. These advancements have led to significant improvements in quality of life and overall survival. Despite these improvements, racial and socioeconomic disparities in lung cancer mortality persist. This narrative review aims to assess and synthesize the literature on sociodemographic disparities in the management of advanced NSCLC. A narrative overview of the literature was conducted using PubMed and Scopus and was narrowed to articles published from January 1, 2010, until July 22, 2020. Articles relevant to sociodemographic variation in (I) chemoradiation for stage III NSCLC, (II) molecular biomarker testing, (III) systemic treatment, including chemotherapy, targeted therapy, and immunotherapy, and (IV) palliative and end of life care were included in this review. Twenty-two studies were included. Sociodemographic disparities in the management of advanced NSCLC varied, but recurring findings emerged. Across most treatment domains, Black patients, the uninsured, and patients with Medicaid were less likely to receive recommended lung cancer care. However, some of the literature was limited due to incomplete data to adequately assess appropriateness of care, and several studies were out of date with current practice guidelines. Sociodemographic disparities in the management of advanced lung cancer are evident. Given the rapidly evolving treatment paradigm for advanced NSCLC, updated research is needed. Research on interventions to address disparities in advanced NSCLC is also needed.
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http://dx.doi.org/10.21037/jtd-20-3450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264681PMC
June 2021

#LatinasInMedicine: Using the Hashtag to Build Community in Medicine.

J Grad Med Educ 2021 Jun 15;13(3):332-334. Epub 2021 Apr 15.

is a Research Fellow, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health.

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http://dx.doi.org/10.4300/JGME-D-20-01396.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207927PMC
June 2021

Work Patterns of Women Physicians During Vacation: A Cross-Sectional Study.

J Womens Health (Larchmt) 2021 Jun 24. Epub 2021 Jun 24.

Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, Wisconsin, USA.

Burnout and poor work-life integration (WLI) are prevalent among women physicians. Vacation may help alleviate burnout and improve WLI but working while on vacation may negate these potential benefits. Little is known about the work patterns of women physicians on vacation, and we attempted to further characterize it in this study. In this online cross-sectional study of 498 members of the Physician Women in Leadership Facebook Group, we collected demographic information, information regarding burnout/WLI, self-reported work patterns while on vacation, and perceived impact of working during vacation on burnout/WLI. We also asked about the impact of the COVID-19 pandemic on these behaviors. At baseline, 37.5% of respondents reported burnout and 58.4% reported lack of satisfaction with WLI. About 94.4% of respondents reported engaging in some level of work-related behavior while on vacation (primarily answering work-related emails and participating in work-related meetings), but 73.3% reported that such engagement was detrimental to their mental health and WLI. About 66.3% reported an increase in at least one work-related behavior on vacation during the COVID-19 pandemic. Respondents identified and/or endorsed multiple strategies to reduce work-related engagement on vacation, many involving good modeling by leadership and/or national associations. Engagement in work-related behavior while on vacation is almost universal among women physicians, but most feel that it has negative effects on mental health and WLI. Strategies to encourage reduced engagement should be developed/strengthened and endorsed/modeled by those in leadership.
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http://dx.doi.org/10.1089/jwh.2021.0100DOI Listing
June 2021

The Matilda Effect: Underrecognition of Women in Hematology and Oncology Awards.

Oncologist 2021 09 9;26(9):779-786. Epub 2021 Jul 9.

Department of Medicine, Division of Hematology, Medical Oncology and Palliative Care, Madison, Wisconsin, USA.

Background: The proportion of women in the field of hematology and oncology (H&O) has increased over recent decades, but the representation of women in leadership positions remains poor. In an effort to close the gender gap in academia, it is important to report on such inequities in hopes to close these gaps and improve career development.

Materials And Methods: We conducted a retrospective, observational study of published award recipients from 1994 to 2019 from the seven major H&O societies in the world. Gender was determined based on publicly available data. The χ and Cochran-Armitage tests were used for data analysis.

Results: Of the 1,642 awardees over the past 26 years, 915 met inclusion criteria. Award recipients were overwhelmingly men (77.9%) and non-Hispanic White (84.7%). Women awardees received 30.3% of the humanistic and education-related awards, whereas only receiving 16.0% of basic science awards (p < .01). Women represent 35.6% of all hematologists and oncologists but only received 24.0% of awards given to these physicians (p = .004). Black, Hispanic, and Asian awardees represented 3.7%, 3.3%, and 6.8% of the total awardees, respectively.

Conclusion: From 1994 to 2019, women were less likely to receive recognition awards from the seven major H&O societies studied compared with men. We also observed a considerably low proportion of minority awardees across all oncology subspecialties. Further studies examining how selection criteria favor either gender would be warranted in order to achieve equal representation in academic awards.

Implications For Practice: In this study, women and minority groups were found to be underrepresented amongst award recipients. Significant disparities were seen in disciplines that have been historically male predominant, such as basic sciences. As awards on an international level enhance academic resumes and assist with career advancement, it is important that awards are being given in an equitable manner. First steps to promote diversity and inclusion in academic medicine is reporting of gender and racial disparities in various areas of academia.
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http://dx.doi.org/10.1002/onco.13871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417845PMC
September 2021

COVID-19 and Global Oncology: A Year in Review.

JCO Glob Oncol 2021 05;7:797-801

Division of Medical Oncology, Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL.

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http://dx.doi.org/10.1200/GO.21.00078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457878PMC
May 2021

Baby Steps in the Right Direction: Toward a Parental Leave Policy for Gastroenterology Fellows.

Am J Gastroenterol 2021 11;116(11):2300

Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.

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http://dx.doi.org/10.14309/ajg.0000000000001331DOI Listing
November 2021

Videoconferencing Etiquette: Promoting Gender Equity During Virtual Meetings.

J Womens Health (Larchmt) 2021 04;30(4):460-465

Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.

Considerable evidence has demonstrated that gender influences interactions during in-person meetings, most commonly, negatively impacting women and persons of color. Pervasive gender stereotypes about roles that were (and are) occupied by men and women lead to implicit assumptions about competency in said roles. For example, women may receive more negative verbal interruptions or nonverbal cues that undermine their authority as a leader, a stereotypically male-typed role. The coronavirus pandemic has led to the rapid rise in videoconferencing in professional interactions; however, little is known about videoconferencing etiquette and how gender bias permeates to this new setting. Although there are many benefits to the use of this technology, it has the potential to reinforce gender bias rooted in cultural and societal norms, gender stereotypes, and traditional gender roles. The well-documented implicit biases that have been shown to favor men over women during in-person meetings may translate to further gender gaps in leadership during virtual meetings. It is also possible that videoconferencing could be used to reduce gender bias, but until we have research to shine a light on this topic, this article provides 10 tips for promoting gender equity during virtual meetings.
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http://dx.doi.org/10.1089/jwh.2020.8881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064948PMC
April 2021

It Can Wait.

Authors:
Narjust Duma

Oncologist 2021 05 21;26(5):439-440. Epub 2021 Apr 21.

Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.

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http://dx.doi.org/10.1002/onco.13773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100540PMC
May 2021

Evaluating Bias in Speaker Introductions at the American Society for Radiation Oncology Annual Meeting.

Int J Radiat Oncol Biol Phys 2021 06 26;110(2):303-311. Epub 2020 Dec 26.

Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.

Purpose: Introducing a physician without a professional title may reinforce bias in medicine by influencing perceived credibility. We evaluated differences in the use of professional titles in introductions of speakers at recent American Society for Radiation Oncology (ASTRO) Annual Meetings.

Methods And Materials: We reviewed recordings from the 2017 to 2019 ASTRO Annual Meetings and included complete introductions of speakers with a doctoral degree. Professional introduction was defined as "Doctor" or "Professor" followed by the speaker's full or last name. We collected use of professional introduction, introducer gender, speaker gender, and speaker professional and demographic variables. Identified speakers were sent surveys to collect self-reported demographic data. Analysis was performed using χ tests and multivariable logistic regression (MVA).

Results: Of 3267 presentations reviewed, 1226 (38%) met the inclusion criteria. Overall, 805 (66%) speakers and 710 (58%) introducers were men. Professional introductions were used in 74% (2017), 71% (2018), and 69% (2019) of the presentations. There was no difference in the use of professional introductions for male and female speakers (71% vs 73%; P = .550). On MVA, male introducers were associated with decreased use of professional address (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.26-0.49; P < .001). At the 2019 conference, professional introduction was less likely to be used (2019 vs 2017: OR, 0.68; 95% CI, 0.49-0.96; P = 0.026). Those who self-identified as Asian/Pacific Islander were twice as likely to receive a professional introduction compared with those who identified as white (OR, 1.95; 95% CI, 1.07-3.64; P = .033).

Conclusion: Male introducers were significantly less likely to introduce any speaker, regardless of gender, by their professional title, and overall use of professional introductions decreased from 2017 to 2019. Furthermore, no difference in professional introduction use by speaker gender was identified at the recent ASTRO meetings. Implementing speaker guidelines could increase the use of professional introductions and raise awareness of unconscious bias at future ASTRO meetings.
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http://dx.doi.org/10.1016/j.ijrobp.2020.12.027DOI Listing
June 2021

Assessing vitamin D and mammographic breast density in Alaskan women.

Clin Pract 2020 Oct 15;10(4):1253. Epub 2020 Oct 15.

Department of Internal Medicine, Mayo Clinic, Rochester, MN.

Vitamin D deficiency and high breast density may be associated with increased breast cancer risk. We examined a possible association between vitamin D levels and mammographic breast density in a population of Alaskan women. Patients seen in the Mayo Clinic-Alaska Native Medical Center telemedicine program from December 2014 to December 2017 were enrolled in the study. Pearson correlation was used to estimate the association between mammographic breast density and vitamin D levels. Of the 33 women enrolled, 70% of women self-identified as American Indian/Alaskan Native, 12% as White, 6% as Native Hawaiian/Pacific Islander and 12% as other. Nineteen (58%) participants were taking vitamin D supplementation. No correlation was identified between breast density and serum vitamin D levels overall (correlation= -0.03). Larger studies controlling for vitamin supplementation are needed, as this association could potentially impact breast cancer rates in populations at risk for vitamin D deficiency.
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http://dx.doi.org/10.4081/cp.2020.1253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579742PMC
October 2020

The HOLA COVID-19 Study: An International Effort to Determine How COVID-19 Has Impacted Oncology Practices in Latin America.

Cancer Cell 2020 11 13;38(5):605-608. Epub 2020 Oct 13.

Department of Medicine, Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, WI, USA. Electronic address:

Countries in Latin America and the Caribbean have become hotspots of the novel coronavirus (COVID-19) pandemic, exacerbating socioeconomic inequalities and overwhelming fragmented health systems. Studies from the United States and Europe have highlighted the disproportionate effects of COVID-19 on patients with cancer and the disruption it has caused on cancer care delivery. The HOLA COVID-19 Study aims to understand how cancer care in Latin American countries has been affected by the COVID-19 pandemic.
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http://dx.doi.org/10.1016/j.ccell.2020.10.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553055PMC
November 2020

Oncology training in Latin America: are we ready for 2040?

Lancet Oncol 2020 10;21(10):1267-1268

Department of Oncology, Division of Radiation Oncology, Queen's University, Kingston K7L 5P9, ON, Canada. Electronic address:

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http://dx.doi.org/10.1016/S1470-2045(20)30158-3DOI Listing
October 2020

Leveraging Social Media for Cardio-Oncology.

Curr Treat Options Oncol 2020 08 13;21(10):83. Epub 2020 Aug 13.

Departments of Cardiology & Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA.

Opinion Statement: As the world becomes more connected through online and offline social networking, there has been much discussion of how the rapid rise of social media could be used in ways that can be productive and instructive in various healthcare specialties, such as Cardiology and its subspecialty areas. In this review, the role of social media in the field of Cardio-Oncology is discussed. With an estimated 17 million cancer survivors in the USA in 2019 and 22 million estimated by 2030, more education and awareness are needed. Networking and collaboration are also needed to meet the needs of our patients and healthcare professionals in this emerging field bridging two disciplines. Cardiovascular disease is second only to recurrence of the primary cancer or diagnosis with a secondary malignancy, as a leading cause of death in cancer survivors. A majority of these survivors are anticipated to be on social media seeking information, support, and ideas for optimizing health. Healthcare professionals in Cardio-Oncology are also online for networking, education, scholarship, career development, and advocacy in this field. Here, we describe the utilization and potential impact of social media in Cardio-Oncology, with inclusion of various hashtags frequently used in the Cardio-Oncology Twitter community.
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http://dx.doi.org/10.1007/s11864-020-00775-3DOI Listing
August 2020

Targeting of the Hedgehog/GLI and mTOR pathways in advanced pancreatic cancer, a phase 1 trial of Vismodegib and Sirolimus combination.

Pancreatology 2020 Sep 14;20(6):1115-1122. Epub 2020 Jul 14.

Schulze Center for Novel Therapeutics, Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, MN, USA; Department of Medical Oncology, Department of Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA. Electronic address:

Background/objectives: Preclinical data indicated a functional and molecular interaction between Hedgehog (HH)/GLI and PI3K-AKT-mTOR pathways promoting pancreatic ductal adenocarcinoma (PDAC). A phase I study was conducted of Vismodegib and Sirolimus combination to evaluate maximum tolerated dose (MTD) and preliminary anti-tumor efficacy.

Methods: Cohort I included advanced solid tumors patients following a traditional 3 + 3 design. Vismodegib was orally administered at 150 mg daily with Sirolimus starting at 3 mg daily, increasing to 6 mg daily at dose level 2. Cohort II included only metastatic PDAC patients. Anti-tumor efficacy was evaluated every two cycles and target assessment at pre-treatment and after a single cycle.

Results: Nine patient were enrolled in cohort I and 22 patients in cohort II. Twenty-eight patients were evaluated for dose-limiting toxicities (DLTs). One DLT was observed in each cohort, consisting of grade 2 mucositis and grade 3 thrombocytopenia. The MTD for Vismodegib and Sirolimus were 150 mg daily and 6 mg daily, respectively. The most common grade 3-4 toxicities were fatigue, thrombocytopenia, dehydration, and infections. A total of 6 patients had stable disease. No partial or complete responses were observed. Paired biopsy analysis before and after the first cycle in cohort II consistently demonstrated reduced GLI1 expression. Conversely, GLI and mTOR downstream targets were not significantly affected.

Conclusions: The combination of Vismodegib and Sirolimus was well tolerated. Clinical benefit was limited to stable disease in a subgroup of patients. Targeting efficacy demonstrated consistent partial decreases in HH/GLI signaling with limited impact on mTOR signaling. These findings conflict with pre-clinical models and warrant further investigations.
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http://dx.doi.org/10.1016/j.pan.2020.06.015DOI Listing
September 2020

The Dragon.

Authors:
Narjust Duma

Oncologist 2020 10 18;25(10):903-904. Epub 2020 Aug 18.

Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.

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http://dx.doi.org/10.1634/theoncologist.2020-0567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543240PMC
October 2020

Unconscious Bias in Speaker Introductions at a Surgical Oncology Meeting: Hierarchy Reigns Over Gender.

Ann Surg Oncol 2020 Oct 25;27(10):3754-3761. Epub 2020 Jul 25.

Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.

Background: Recent reviews of medical conferences have shown that women were less likely to receive a formal introduction compared with men. We examined speaker introductions at the Society of Surgical Oncology (SSO) annual meeting to determine whether similar biases exist within our organization.

Methods: An observational study of video-archived speaker introductions at the 2018 and 2019 SSO annual meetings was conducted. Professional address was defined as professional title followed by full name or last name. Multivariable logistic regression was used to identify factors associated with form of address.

Results: There were 499 speaker introductions reviewed. Speakers included 290 (58%) men and 238 (49%) post-graduate trainees (residents and fellows). A non-professional form of address was used to introduce 148 (30%) speakers and was most often used for post-graduate trainees (33%). Full professors were more likely than junior faculty to introduce speakers with a non-professional form of address (37% of full professors vs 18% of assistant professors, p < 0.001). In multivariable regression analysis these findings persisted. Trainees were 2.8 times more likely to receive a non-professional form of address (p = 0.003). Use of a non-professional introduction did not significantly vary by the speaker's nor the introducer's gender.

Conclusions: Residents and fellows were more likely to receive a non-professional form of address, and the likelihood of this increased with rising seniority of the introducer. The manner of speaker introduction did not vary by gender in our organization. More research is needed to explore the influence of these disparities on academic advancement for the next generation of surgical oncologists.
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http://dx.doi.org/10.1245/s10434-020-08906-8DOI Listing
October 2020

Cancer Care for All? Tales of Caring for Undocumented Patients with Cancer.

Oncologist 2020 07 26;25(7):552-554. Epub 2020 May 26.

Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.

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http://dx.doi.org/10.1634/theoncologist.2020-0113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356780PMC
July 2020

Pulmonary Complications Secondary to Immune Checkpoint Inhibitors.

Int J Chronic Dis 2020 23;2020:4928648. Epub 2020 Apr 23.

Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA.

Background: Immune checkpoint inhibitors (ICI) have changed the landscape in the treatment of a number of cancers. Immune-related adverse events (irAEs) have emerged as a serious clinical problem with the use of ICI.

Methods: All oncology patients diagnosed with pulmonary complications secondary to ICI at Mayo Clinic Rochester from January 1, 2012 to December 31, 2018 were reviewed. Demographics, comorbidities, smoking, and oncologic history were analyzed.

Results: A total of 10 patients developed pulmonary complications secondary to ICI. Seven patients were men (70%), and the median age at diagnosis was 61.5 (IQR 55.8-69.3) years. All patients had stage IV disease. Melanoma was the most common malignancy. Seven (70%) patients had a positive smoking history, and 6 (60%) were obese (BMI > 30). Most cases were grade 2 pneumonitis (70%). One patient with grade 4 pneumonitis required endotracheal intubation and a prolonged course of systemic corticosteroids (>30 days). Eight (80%) patients received prior radiation therapy. The median time from initiation of ICI to pneumonitis diagnosis was 3.5 months.

Conclusion: Melanoma was the most common malignancy, the majority of patients had grade 2 pneumonitis and required treatment with steroids, and all patients affected by ICI-related pneumonitis had stage IV malignancy. Potential risk factors included smoking history, prior radiotherapy, obesity, and advance stage at the time of ICI initiation. Extrapulmonary irAEs are common in patients with pneumonitis.
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http://dx.doi.org/10.1155/2020/4928648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196156PMC
April 2020

Osimertinib-Induced Cardiomyopathy.

JACC Case Rep 2020 Apr 1;2(4):641-645. Epub 2020 Apr 1.

Division of Medical Oncology, University of Wisconsin, Madison, Wisconsin.

Osimertinib is the preferred treatment in patients with metastatic non-small cell lung cancer with epidermal growth factor receptor mutations. We report a case series of acute cardiomyopathy with heart failure exacerbation during osimertinib treatment. We suggest that cardiotoxicity from osimertinib is reversible and occurs at a dose of 80 mg/day. ().
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http://dx.doi.org/10.1016/j.jaccas.2019.12.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298525PMC
April 2020

Gender differences in publication rates in oncology: Looking at the past, present, and future.

Authors:
Narjust Duma

Cancer 2020 06 25;126(12):2759-2761. Epub 2020 Mar 25.

Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, Wisconsin.

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http://dx.doi.org/10.1002/cncr.32819DOI Listing
June 2020

It Is Time to Talk About Fertility and Immunotherapy.

Oncologist 2020 04 24;25(4):277-278. Epub 2020 Feb 24.

Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, Ospedale Policlinico San Martino, Genova, Italy.

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http://dx.doi.org/10.1634/theoncologist.2019-0837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160400PMC
April 2020
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