Princess Margaret Cancer Foundation

OBJECTIVES: Suicide rates are elevated in individuals with cancer, although suicidal intention is not typically assessed in cancer centers. We evaluated in a large comprehensive cancer center the utility of an electronic Distress Assessment and Response Tool (DART), in which suicidal intention is assessed with a single item. METHODS: Patients attending cancer clinics completed DART as part of routine care. DART includes measures of physical symptoms, depression, anxiety, social difficulties, and practical concerns. Medical variables were obtained from the Princess Margaret Cancer Registry, the data warehouse of cancer patient statistics. A Generalized Estimating Equation (GEE) model was used to assess factors associated with suicidal intention. RESULTS: Between September 2009 and March 2012, 4822/5461 patients (88.3%) who completed DART consented to the use of their data for research. Amongst the latter, 280 (5.9%) of the 4775 patients who answered the question reported suicidal ideation, which was related to physical and psychological distress, and social difficulties (ps < 0.0001). Amongst those with ideation who responded to the intention question, 20/186 (10.8%) reported suicidal intention. Of respondents with more severe suicidal ideation, 12/49 (24.5%) reported suicidal intention. Using a GEE model, suicidal intention in those with ideation was significantly associated with male sex, difficulty making treatment decisions, and with everyday living concerns. CONCLUSIONS: Suicidal ideation is reported on an electronic distress screening tool (DART) by almost 6% of cancer patients, of whom almost 11% report suicidal intention and 33% decline to indicate intention. DART demonstrated utility in identifying patients who may be at highest risk of completed suicide and who require urgent clinical assessment.

An MRI-guided radiation therapy linear accelerator was designed and tested for clinical implementation. The main investigation was related to the magnetic field coupling effects between the MR magnet and the therapy equipment, RF noise Isolation and overall system design for safe and streamlined clinical operation. The study involved numerical simulations of the magnetic field environment, which included the MR, accelerator and patient transfer system at full physical scale. Experimental measurements were performed to quantify the MR imaging field, fringe field mapping, magnetic field pull forces, and residual field effects on the optimal performance of the therapy accelerator's x-ray beam. The theoretical and experimental results were found to be in a good agreement. Currently, the system is in its final stage of assessment for tumor site specific workflows leading to its clinical release.

PURPOSE: Biliary tract cancer (BTC) is the leading cause of death in patients with primary sclerosing cholangitis (PSC). PSC-related BTC is poorly understood, and the risks and benefits of conventional and immunotherapy treatments are unknown. We aimed to characterize clinical outcomes and genomes of PSC-related BTCs. EXPERIMENTAL DESIGN: This was a retrospective cohort study of patients with BTC with underlying PSC treated at MD Anderson Cancer Center (N = 46) and Princess Margaret Cancer Centre (N = 16), which were contrasted to patients with non-PSC-related BTC (N = 146). We compared outcomes between PSC and non-PSC, and PSC treated with and without immunotherapy. A combination of targeted sequencing (N = 139), whole-genome sequencing (WGS; N = 27), and WGS with paired RNA sequencing (N = 33) delineated the genomic and transcriptomic landscape of PSC-associated BTCs. RESULTS: In PSC-related BTC, the addition of immunotherapy to chemotherapy was associated with improved first-line progression-free survival (PFS; N = 22 vs. 11; median PFS, 12.2 vs. 4.7 months; P = 0.01). Immune-related adverse events were rare (N = 2, 12.5%) and improved after treatment discontinuation. Classic actionable genomic alterations, including IDH1 mutations and FGFR2 fusions, were absent in PSC-related BTCs. PSC tumors had a 2.6-fold higher tumor mutational burden (P = 3.28e-05) compared with non-PSC tumors. Transcriptomic profiling revealed a subset of PSC tumors displaying RNA signatures of immunotherapy response. CONCLUSIONS: Immunotherapy in PSC-associated BTCs seemed safe, with a potential signal of effectiveness. Given the sample size and retrospective design, these results are hypothesis-generating. Together, these results demonstrate the unique biology underlying PSC-associated BTCs, highlighting the need for prospective trials and the development of specialized treatment strategies.

Despite initiatives to enhance diversity in clinical trials (CTs), disparities persist in hematologic malignancy (HM) studies. We reviewed 1,230 US-based phase II-III HM CTs (2000-2023) including 149,434 participants and compared enrollment to SEER benchmarks. Race was reported in 59% of trials and ethnicity in 40%, with significant improvement over time. Trials initiated in 2016 or later were more likely to report race (OR 36.3) and ethnicity (OR 8.0) than those before 2008. Compared with NIH-sponsored studies, institutional (OR 0.34) and industry trials (OR 0.52) had lower odds of reporting demographics. Black and Hispanic individuals were consistently underrepresented, most notably in multiple myeloma (7.0% vs. 20.0% expected) and acute lymphoblastic leukemia (21.5% vs. 36.9% expected). NIH-funded trials enrolled more Black participants than other sponsor types. These findings emphasize the need for enforceable mandates on race and ethnicity reporting, as well as representation targets, to ensure equitable access and generalizability.