A Pan-Canadian Framework for Cancer Survivorship Research

BackgroundComplementary therapies are being increasingly used by cancer survivors. As a channel for customers to share their feelings, outcomes, and perceived knowledge about the products purchased from e-commerce platforms, Amazon consumer reviews are a valuable real-world data source for understanding cancer survivorship care needs.ObjectiveIn this study, we aimed to highlight the potential of using Amazon consumer reviews as a novel source for identifying cancer survivorship care needs, particularly related to symptom self-management. Specifically, we present a publicly available, manually annotated corpus derived from Amazon reviews of health-related products and develop baseline natural language processing models using deep learning and large language model (LLM) to demonstrate the usability of this dataset.MethodsWe preprocessed the Amazon review dataset to identify sentences with cancer mentions through a rule-based method and conducted content analysis including text feature analysis, sentiment analysis, topic modeling, cancer type, and symptom association analysis. We then designed an annotation guideline, targeting survivorship-relevant constructs. A total of 159 reviews were annotated, and baseline models were developed based on deep learning and large language model (LLM) for named entity recognition and text classification tasks.ResultsA total of 4703 sentences containing positive cancer mentions were identified, drawn from 3349 reviews associated with 2589 distinct products. The identified topics through topic modeling revealed meaningful insights into cancer symptom management and survivorship experiences. Examples included discussions of green tea use during chemotherapy, cancer prevention strategies, and product recommendations for breast cancer. Top 15 symptoms in reviews were also identified, with pain being the most frequent symptom, followed by inflammation, fatigue, etc. The annotation labels were designed to capture cancer types, indicated symptoms, and symptom management outcomes. The resulting annotation corpus contains 2067 labels from 159 Amazon reviews. It is publicly accessible, together with the annotation guideline through the Open Health Natural Language Processing (OHNLP) GitHub. Our baseline model, Bert-base-cased, achieved the highest weighted average F1-score, that is, 66.92%, for named entity recognition, and LLM gpt4-1106-preview-chat achieved the highest F1-score for text classification tasks, that is, 66.67% for “Harmful outcome,” 88.46% for “Favorable outcome” and 73.33% for “Ambiguous outcome.”ConclusionsOur results demonstrate the potential of Amazon consumer reviews as a novel data source for identifying persistent symptoms, concerns, and self-management strategies among cancer survivors. This corpus, along with the baseline natural language processing models developed for named entity recognition and text classification, lays the groundwork for future methodological advancements in cancer survivorship research. Importantly, insights from this study could be evaluated against established clinical guidelines for symptom management in cancer survivorship care. By revealing the feasibility of using consumer-generated data for mining survivorship-related experiences, this study offers a promising foundation for future research and argumentation analysis aimed at improving long-term outcomes and support for cancer survivors.

Prognostic Value of Measurable Residual Disease after Venetoclax and Decitabine in Acute Myeloid Leukemia

Young adult (YA) cancer survivors have been historically under-represented in cancer survivorship research, which has contributed to more disparate health outcomes compared with young and older cancer survivors. Using qualitative methods, this study explored YAs' perceptions of cancer survivorship and identified YA-specific barriers and preferences for participation in cancer survivorship research. Individual interviews and focus groups were conducted with YA cancer survivors (N = 19) attending a patient-focused oncology conference. Grounded theory methodology guided analyses by using an inductive data-driven approach to thematic content analysis. Participants averaged 33 years old (standard deviation [SD] = 5.5), were 10 years postdiagnosis (SD = 2.3), and were primarily female (79%). Key cancer survivorship topics included adjusting to a "new normal," staying connected with cancer peers, and dealing with post-treatment medical care. Perceptions of YA survivorship research were mixed. YAs appreciated and were optimistic about the potential for benefit from research. Specific barriers for participation included perceptions of research being inaccessible, overwhelming, and frustrating; participation as inconvenient and burdensome; and researchers being viewed with skepticism and mistrust. They recommended: (1) making age-appropriate, patient-focused changes (e.g., language and design of study materials); (2) increasing participants' control, flexibility, and convenience of procedures; and (3) creating a back-and-forth dialogue between YAs and researchers. We assessed YA survivors' perceptions of YA cancer survivorship and research. Communication strategies are needed to address negative perceptions and perceived barriers to research participation. This includes tailoring of dissemination efforts and developmentally targeted implementation of YA priorities into the research process. Age-specific, patient-focused research practices may foster trust within the YA cancer survivor community and improve research participation.

Expectant Management of Extranodal Marginal Zone Lymphoma of Bronchial-Associated Lymphoid Tissue (BALT)

Brentuximab Vedotin with Chemotherapy for Stage 3/4 Classical Hodgkin Lymphoma (cHL): 4-Year Update of the Echelon-1 Study

Expression of Major Histocompatibility Complex (MHC) Class II, but Not MHC Class I, Predicts Outcome in Patients with Classical Hodgkin Lymphoma (cHL) Treated with Nivolumab (Programmed Death-1 [PD-1] Blockade)

PURPOSE Research impact assessments (RIAs) are exercises conducted to measure research outputs, outcomes, and impacts of research projects and programs. While use among funders has been growing, RIA adoption has been fragmented, and a global, multi-funder RIA on cancer survivorship research has not been conducted. The field is an ideal case-study for RIA because the number of cancer survivors worldwide is currently over 30 million and projected to increase, and has comparatively less investment than research on other CSO categories. We aim to examine the global evidence base produced by cancer survivorship projects funded by International Cancer Research Partnership (ICRP) partners to determine their broader research, economic, and social impacts. METHODS Our evaluation will measure the impacts of projects from ICRP funders for 2006-2018 coded to CSO codes 6.1 Patient Care of Survivorship Issues or 6.6 End-of-life Care, using the Canadian Academy of Health Sciences Framework. To ensure high methodological quality, we have utilized seven key steps for RIA implementation developed from our previous work, including setting the stage for analysis (considering context, goals, and stakeholders); framework selection; metrics/indicator selection; primary data collection; data synthesis; communicating results; and reflecting on best practices. Impact data will be sourced from Dimensions. Ai and Overton; two leading databases capturing global research and policy impacts. RESULTS Among 146 cancer research funders participating in the ICRP during 2006-2018, 103 funded a total of 5,814 projects coded to CSO codes 6.1 and 6.6. Anticipated results include the numbers of matching projects identified within Dimensions. Ai with linked publications, altmetrics, clinical trials, and datasets, and linked policy citations identified through Overton as well as an overview of the types and ranges of impacts found. Preliminary results show high coverage of ICRP projects within the Dimensions. Ai database, and the ability to identify impacts increasingly likely among public funders. CONCLUSION Understanding downstream impacts of funded research is critical to ensuring that public and charitable funds are making a tangible impact towards improving survivorship and end-of-life care for persons living with and beyond cancer. We hope our analysis is the first of several that may begin to link research impacts with future opportunities to improve patient-oriented care and research.

Response to the substantial and long-term impacts that a cancer diagnosis and treatment has on the growing population of cancer survivors, requires priority-driven, impactful research. This study aimed to map Australian cancer survivorship research activities to identify gaps and opportunities for improvement and compare activities against identified survivorship research priorities. An online survey was completed by Australian researchers regarding their cancer survivorship research, and the barriers they identified to conducting such research. Current research activity was compared to recently established Australian survivorship research priorities. Overall, 178 participants completed the online survey. The majority of the research undertaken utilized survey or qualitative designs and focused on breast cancer, adult populations, and those in early survivorship (<5 years post-treatment). Barriers to conducting survivorship research included funding, collaboration and networking, mentoring, and time constraints. There was moderate alignment with existing research priorities. Investigating models of care and health service delivery were the most frequently researched priorities. Research priorities that were less commonly investigated included patient navigation, patient-reported outcomes, multimorbidity, fear of cancer recurrence, and economic issues. This study provides the first snapshot of Australian survivorship research activity. Comparison to established priorities demonstrates health services research is receiving attention and highlights areas for potential pursuits, such as rare cancers or multimorbidity. Findings indicate the need for improved funding and infrastructure to support researchers in advancing the survivorship research agenda.

394 Background: Prostate cancer (PCa) is the most prevalent malignancy in Canadian men; in 2023, an estimated 24,700 men will be diagnosed while ~4,700 will die of their disease. Lifetime risk of developing PCa is approximately 1-in-8 and approximately 3% of all deaths of Canadian men are caused by the disease. While Canada has a robust, modern health research landscape, with major academic centres located in all provinces and territories, the investment in academic PCa research – and the impact of that investment – has not been systematically quantified. An improved understanding of this landscape is necessary to ensure research funding remains efficient, impactful, and equitable. As such, we evaluated the size, scope, and impact of the investment in academic PCa research in Canada. Methods: We extracted funding records from the Canadian Research Information System (CRIS), the United States Congressionally Directed Medical Research Program database and the United States National Institutes of Health RePORT database for the National Cancer Institute, using keywords ‘prostate’ OR ‘prostatic’ AND ‘cancer’ OR ‘carcinoma’ for 1999-2021. US-sourced records were included when the principal investigator (PI) was based at a Canadian institution at the time the award was granted. Records were validated using data from the Canadian Cancer Research Alliance (CCRA). Intramural and industry-derived funding was unavailable and thus excluded from the analysis. Results: We identified 1,748 unique funding events (FEs) from 33 sources. These FEs involved 1,561 investigators and had an inflation-adjusted value of $682,113,116. The top three funders of PCa research were the Canadian Institutes of Health Research, Movember Canada, and the Canadian Cancer Society. Basic and translational research received ~83% of all funding while psychosocial, health economics, and epidemiology research received only ~7.2%. Strikingly, we found that 30.5% of all funding was held by 1% of investigators. We identified 6,671 dyads ( ie. pairs of collaborating investigators); 85% collaborated only once, while 15% collaborated at least twice (range: 2-19). Female investigators participated in significantly fewer collaborations than males (P: 3.28 x 10-3) and were less likely than expected to serve as PI (P: 8.87 x 10-8). FEs with ≥ one female PI had a significantly lower value than those with only male PIs (P: 1.34 x 10-6) and FEs with only female PIs had a significantly value than those with only male PIs (P: 7.32 x 10-4). Conclusions: While Canadian PCa research has been highly funded over the past 25 years, there remain substantial funding disparities across scientific disciplines, geographic regions, and, in particular, gender. There is also substantial ‘wealth inequality’; a small minority of investigators receive most of the funding. We are currently assessing stakeholder attitudes toward these disparities, to help inform the next phase of PCa research funding in Canada.

Trends and advances in cancer survivorship research: challenge and opportunity

Ibrutinib Induces Durable Remissions in Treatment-Naïve CLL Patients with 17p Deletion/TP53 Mutations: Five Year Follow-up from a Phase 2 Study

The International Cancer Research Partnership (ICRP) is an alliance of governmental and charitable organizations from the USA, Canada, Europe, Australia and Japan, funding regional, national and international cancer research grants and awards. One key activity of the partnership is the ICRP database of information about member’s funded grant projects (N&amp;gt;60,000 grants, from 80 members, totaling $13.6 billion USD). Each project is coded to a Common Scientific Outline (CSO) classification, a classification system of broad areas of cancer research. Obesity has been associated with an increased risk of developing several cancer types, including breast cancer. Worldwide, obesity rates have nearly doubled since 1980 (WHO), and there is significant concern that rising rates of obesity will result in additional obesity-related cancer incidence. Breast cancer is the most common cancer in women worldwide and its incidence has risen in most countries in the last 30 years.1 In addition, there is convincing research evidence that body fatness is linked to breast cancer incidence (postmenopause).2 With this in mind, the ICRP has analyzed obesity-related breast cancer research in its portfolio over three time periods: 2006, 2008 and 2010. Methods: Using a combination of keyword searches and manual review, a total of over 1040 awards over the period 2006-2010 were found in the ICRP portfolio that were related to obesity and cancer. Of these, 353 awards were considered to be relevant to breast cancer (relevance ≥25%). These were assessed by Common Scientific Outline (CSO) areas.3 Results: The numbers of obesity-relevant awards and research investment were higher for breast cancer than for any other cancer type in the ICRP portfolio from 2006 to 2010. Research was being conducted across all CSO areas, from basic biology, etiology, prevention, early diagnosis/prognosis to treatment and cancer survivorship. Between 2006 and 2010, there was a slight decrease in etiology research (CSO2), and an increase in research into cancer survivorship (CSO6). It is notable that training awards are increasing, indicating that the research organizations contributing data to this analysis consider workforce training to be a priority area. Conclusion: We were able to use the ICRP database to identify trends in funded grant projects related to obesity research and breast cancer. Despite increased numbers of awards, the overall stasis in research funding over this period, and the decline in investment in etiology is concerning. As breast cancer incidence continues to increase, research efforts to understand the causes of increased incidence are essential. Further research investment in these areas may be required. 1 http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx (accessed 7th January 2014) 2 World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Report. Food, Nutrition, Physical Activity and the Prevention of Breast Cancer, 2010 3 https://www.icrpartnership.org/CSO.cfm Citation Format: Kari Wojtanik, Rhonda Aizenberg, Susan Higginbotham, Lynne Davies. ICRP analysis: Obesity research in breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-09-05.

Ibrutinib + Obinutuzumab Versus Chlorambucil + Obinutuzumab As First-Line Treatment in Patients with Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma (CLL/SLL): Results from Phase 3 iLLUMINATE

Previous research in childhood cancer and hematopoietic cell transplant (HCT) survivorship has relied on the use of standardized questionnaires that assess symptoms of psychological functioning but do not sufficiently capture the cancer survivorship experience. Study aims are to quantitatively and qualitatively assess the psychosocial functioning of pediatric cancer and HCT survivors seen in a multidisciplinary survivorship clinic, determine survivorship concerns, and assess potential demographic and medical correlates of psychosocial outcomes. Data were collected using a retrospective chart review of a parent-report questionnaire of the child's psychological functioning, responses to a semistructured interview that qualitatively assessed adjustment to life after treatment, and documented medical late effects. Results indicated the majority of survivors had healthy psychological adjustment based upon a parent-report questionnaire. However, nearly 72% of survivors reported 1 or more survivorship concerns during the interview, with the primary concerns being current and future health or physical functioning, including the possibility of cancer recurrence. A content analysis of the interview responses indicated HCT survivors had more school or cognitive functioning concerns compared with survivors who did not have an HCT. Further research should use survivorship-specific measures to better identify survivors at risk and determine the impact of late effects on their quality of life.

To describe the experiences of cancer survivors and caregivers with healthcare providers in the context of the Internet as a source of health information. Qualitative description. Online cancer communities hosted by the Association of Cancer Online Resources. Purposive sample of 488 cancer survivors, with varying cancer types and survivorship stages, and caregivers. Secondary data analysis using Krippendorff's thematic clustering technique of qualitative content analysis. Survivorship, healthcare relationships, and the Internet. Disenchantment with healthcare relationships was associated with failed expectations related to evidence-based practice, clinical expertise, informational support, and therapeutic interpersonal communication. Survivors and caregivers exercised power in healthcare relationships through collaboration, direct confrontation, becoming expert, and endorsement to influence and control care decisions. Disenchantment propelled cancer survivors and caregivers to search the Internet for health information and resources. Conversely, Internet information-seeking precipitated the experience of disenchantment. Through online health information and resources, concealed failures in healthcare relationships were revealed and cancer survivors and caregivers were empowered to influence and control care decisions. The findings highlight failures in cancer survivorship care and underscore the importance of novel interdisciplinary programs and models of care that support evidence-informed decision making, self-management, and improved quality of life. Healthcare professionals need to receive education on survivors' use of the Internet as a source of health information and its impact on healthcare relationships. Future research should include studies examining the relationship between disenchantment and survivorship outcomes.