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Background: From 2007 to 2017, sorafenib was the sole systemic therapy for hepatocellular carcinoma (HCC), but nine new therapies were approved from 2017 to 2022. No studies have yet examined population‐level treatment patterns for HCC since these approvals. Methods: For this retrospective cohort, Surveillance, Epidemiology, and End Results (SEER)–Medicare data were used to identify patients who had HCC diagnosed between 2014 and 2019 with claims through 2020. The authors examined patient characteristics, comorbidities, and receipt of local (e.g., transplantation, resection, embolization) and systemic (e.g., sorafenib, lenvatinib, atezolizumab plus bevacizumab) therapies. Cohort characteristics, treatment patterns, and overall survival (OS) were analyzed, and χ2 tests and t‐tests were used to compare treatments between the 2014–2017 and 2018–209 cohorts. Adjusted Cox models were used to compare median OS between treatment groups. Results: Among 11,766 patients (men, 69.2%; White, 76.9%; median age, 71 years), 60.5% received treatment within 1 year, which remained stable over time (2014–2017, 60.4%; 2018–2019, 61.0%; p =.84). The use of local therapy also remained stable (2014–2017, 52.1%; 2018–2019, 52.8%; p =.43), whereas the use of systemic therapy slightly decreased (2014–2017, 17.0%; 2018–2019, 15.2%; p =.01). First‐line systemic treatments shifted significantly, with sorafenib use dropping from 84.5% (2014–2017) to 41.3% (2018–2019). The median OS among patients who received no treatment, systemic therapies first, or local therapies first was 2.2, 12.0, and 23.6 months, respectively. Patients who were diagnosed in 2019 had better OS (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.74–0.86) as did those who received systemic therapy first (HR, 0.33; 95% CI, 0.18–0.61), but survival was worse for those who received local therapy first (HR, 1.41; 95% CI, 1.08–1.84) compared with those who were diagnosed in 2014. Conclusions: Local therapy patterns remained stable, but novel therapies replaced sorafenib as the preferred first‐line treatment, improving survival. Between 2017 and 2022, nine new systemic therapies were approved for hepatocellular carcinoma. Local therapies patterns remained stable, whereas systemic therapies saw a shift from sorafenib to newer therapies as first‐line treatments. This change in treatment patterns was associated with better overall survival for patients who were diagnosed in 2019 compared with those who were diagnosed in 2014. [ABSTRACT FROM AUTHOR]

This study examined the association of county-level jail and state-level prison incarceration rates and cancer mortality rates in the United States. Incarceration rates (1995-2018) were sourced from national data and categorized into quartiles. County- and state-level mortality rates (2000-2019) with invasive cancer as the underlying cause of death were obtained from the National Vital Statistics System. Compared with the first quartile (lowest incarceration rate), the second, third, and fourth quartiles (highest incarceration rate) of county-level jail incarceration rate were associated with 1.3%, 2.3%, and 3.9% higher county-level cancer mortality rates, respectively, in adjusted analyses. Compared with the first quartile, the second, third, and fourth quartiles of state-level prison incarceration rate were associated with 1.7%, 2.5%, and 3.9% higher state-level cancer mortality rates, respectively. Associations were more pronounced for liver and lung cancers. Addressing adverse effects of mass incarceration may potentially improve cancer outcomes in affected communities. [ABSTRACT FROM AUTHOR]

George et al. show that patients have a 4‐ to 8‐fold variation in whether they receive systemic therapy at the end of life that is attributable to their oncologist. This editorial discusses how interventions around goals of care and nudging oncologists' behavior may ensure care is centered around patient preferences. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced cancer undergoing chemotherapy experience significant symptoms and declines in functional status, which are associated with poor outcomes. Remote monitoring of patient-reported outcomes (PROs; symptoms) and step counts (functional status) may proactively identify patients at risk of hospitalization or death. Objective: The aim of this study is to evaluate the association of (1) longitudinal PROs with step counts and (2) PROs and step counts with hospitalization or death. Methods: The PROStep randomized trial enrolled 108 patients with advanced gastrointestinal or lung cancers undergoing cytotoxic chemotherapy at a large academic cancer center. Patients were randomized to weekly text-based monitoring of 8 PROs plus continuous step count monitoring via Fitbit (Google) versus usual care. This preplanned secondary analysis included 57 of 75 patients randomized to the intervention who had PRO and step count data. We analyzed the associations between PROs and mean daily step counts and the associations of PROs and step counts with the composite outcome of hospitalization or death using bootstrapped generalized linear models to account for longitudinal data. Results: Among 57 patients, the mean age was 57 (SD 10.9) years, 24 (42%) were female, 43 (75%) had advanced gastrointestinal cancer, 14 (25%) had advanced lung cancer, and 25 (44%) were hospitalized or died during follow-up. A 1-point weekly increase (on a 32-point scale) in aggregate PRO score was associated with 247 fewer mean daily steps (95% CI –277 to –213; P <.001). PROs most strongly associated with step count decline were patient-reported activity (daily step change –892), nausea score (–677), and constipation score (524). A 1-point weekly increase in aggregate PRO score was associated with 20% greater odds of hospitalization or death (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4; P =.01). PROs most strongly associated with hospitalization or death were pain (aOR 3.2, 95% CI 1.6-6.5; P <.001), decreased activity (aOR 3.2, 95% CI 1.4-7.1; P =.01), dyspnea (aOR 2.6, 95% CI 1.2-5.5; P =.02), and sadness (aOR 2.1, 95% CI 1.1-4.3; P =.03). A decrease in 1000 steps was associated with 16% greater odds of hospitalization or death (aOR 1.2, 95% CI 1.0-1.3; P =.03). Compared with baseline, mean daily step count decreased 7% (n=274 steps), 9% (n=351 steps), and 16% (n=667 steps) in the 3, 2, and 1 weeks before hospitalization or death, respectively. Conclusions: In this secondary analysis of a randomized trial among patients with advanced cancer, higher symptom burden and decreased step count were independently associated with and predictably worsened close to hospitalization or death. Future interventions should leverage longitudinal PRO and step count data to target interventions toward patients at risk for poor outcomes. Trial Registration: ClinicalTrials.gov NCT04616768; https://clinicaltrials.gov/study/NCT04616768 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-054675 [ABSTRACT FROM AUTHOR]

The article discusses the role of linchpin oncologists in cancer care networks and their impact on patient outcomes. Linchpin oncologists are defined as those who are central to patient care in their local referral network. The study found that patients treated by linchpin oncologists had higher mortality rates for lung cancer and colorectal cancer, but the relationship varied depending on the specialty of the linchpin oncologist. The article raises questions about the characteristics of communities with linchpin oncologists and the potential factors contributing to worse outcomes. Further research is needed to determine the causal relationship between linchpin oncologists and patient outcomes. [Extracted from the article]

The article presents the discussion on Serious Illness Conversations (SICs) which being structured conversations between clinicians and patients about prognosis, treatment goals, and end-of-life preferences. Topics include inadequate documentation of the wishes in the electronic health record (EHR) leading to a disparity between patient and family preferences for less aggressive care; and evaluation of a health system initiative posing minimal risk to clinicians and patients.