This study demonstrates the increase in e-billing by physicians at the UCSF for patient messages that are deemed to require more than 5 minutes of clinical work over a 7 day work week. Notably, with the adoption of billing for these visits the mean number of e-visits increased from a mean of 50 per week to over 235. What are your thoughts on this practice? Find the article here (https://jamanetwork.com/journals/jama/fullarticle/2800370).
When treating patients with nasopharyngeal cancer with definitive radiation therapy there is oftentimes question about whether treat the uninvolved contralateral neck as a way to reduce toxicity. The retrospective study of over 291 patients treated for node involved nasopharyngeal disease with unilateral (101 patients) and bilateral (190) radiation determined that regional control and overall survival outcomes are similar suggesting dose escalation. Find the article here (https://www.redjournal.org/article/S0360-3016(22)03694-X/fulltext).
This article suggests that in the treatment of advanced melanoma which utilizes doublet immunotherapy (Ipilimumab and Nivolumab) that treating grade 3 adverse effects with second-line immunosuppression, irrespective of the type, was associated with impaired progression-free survival and overall survival. We should consider alternative ways to combat these adverse events as a result. Find the article here (https://jamanetwork.com/journals/jamaoncology/article-abstract/2797850).
In radiotherapy, proton therapy in comparison to IMRT has the benefit of limiting toxicity by reducing the degree of exit dose, with the drawback of heightened entrance dose and subsequent skin toxicity. This study highlights this in the treatment of head and neck cancer treatment in patients with oral and oropharyngeal cancer. Specifically, a retrospective study demonstrated the utilization of proton therapy compared to IMRT doubled the rate of osteoradionecrosis of the mandible. Find the article here (https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2799626).
This article highlights women with breast cancer treated in high volume centers leads to better survival outcomes compared to those who are unable to, suggesting that policymakers should adopt this strategy to improve healthcare outcomes nationwide. Find the link here (https://ascopubs.org/doi/abs/10.1200/JCO.22.02012).
Patients with cervical cancer undergoing definitive radiation therapy are vulnerable to significant bowel related toxicity. This study demonstrates that adapting the delivery of radiation therapy during the course of treatment to the bowels confers significant dosimetric advantages in bowel sparing over a conventional non-adapted technique, with greater sparing seen with more frequent replanning schedules. This will help patients significantly from a symptom management standpoint acutely and chronically. Find the article here (https://www.practicalradonc.org/article/S1879-8500(22)00384-8/fulltext)
Definitive radiotherapy treatment for prostate cancer can oftentimes lead to endorsement of erectile dysfunction. Therefore, ways to reduce erectile dysfunction through modification of radiation has been discussed for some time. However, this Phase III randomized trial demonstrates that sparing erectile tissue with sophisticated IMRT planning does not demonstrate an effect on potency preservation outcomes at 2 years, though power to detect a difference was limited. Find the article here (https://www.redjournal.org/article/S0360-3016(22)03627-6/fulltext)
Post-prostatectomy in men with high risk prostate cancer the Decipher Genomic Classifier tool/scoring can be utilized to predict for adverse outcomes. In this study of over 265 tissue specimens that underwent testing it was found that the Genomic Classifier score demonstrates an association with distant metastases and overall survival. Find the article here (https://www.redjournal.org/article/S0360-3016(22)03688-4/fulltext)
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