Hannah R. Abrams

Perhaps It Was Too Good to Be True: Oncologists Struggle to Report G2211 | JCO Oncology Practice

New article in @jco-asco.bsky.social gets into the details, but why do you think people are not yet using it?

ascopubs.org/doi/10.1200/...

Fig 2. Medicare projected versus actual utilization of G2211. All physicians were anticipated to report 83.7 million uses of the code but only reported 24.7. Hematology/oncology physicians expected to report 3.2 million but only reported 1.6 million.

Why aren't docs using code G2211?

G2211 is a new billing code for longitudinal care of complex conditions, but overall MDs are using it ~25% the rate anticipated. Other pay was adjusted to make room, so this is in net a loss to MDs providing continuity of care - the thing we want.

Trump Required Hospitals To Post Their Prices for Patients. Mostly It’s the Industry Using the Data. - KFF Health News Politicians have pushed for price transparency in health care. But instead of patients shopping for services, it’s mostly health systems and insurers that are using the information, as fodder for nego...

Regardless of the partisan affiliation of the sitting president, "price transparency" was always going to be most useful for firms with actual market power versus patient-consumers #InformationAssymetry

Adding to my HPM 756 slides. The point about homicide is especially salient.

Fig 1. Reference characteristics to the article by Ross et al by year of publication. Stacked area chart depicting the distribution of citation characteristics referencing the article by Ross et al, categorized by publication year (2010-2025). Each color represents a distinct citation characteristic: Affirmative, contrastive, assumptive, conceptual, methodologic, perfunctory, and negative. Vertical dashed lines mark two key regulatory events: the 2011 cisplatin label update and the 2015 label revision.

It's taken over 10 years for an erroneous reference to (almost) make it out of the citation chain.

Less about the reference itself (incorrect claim re: cisplatin ototoxicity) and more about our science.

Case report here @jco-asco.bsky.social:
ascopubs.org/doi/10.1200/...

Increasing options for chemotherapy-induced peripheral neuropathy: in a 38-patient RCT, low intensity vibration was safe, well adhered-to, and improved neuropathy + function:

ascopubs.org/doi/10.1200/... #oncsky @jco-asco.bsky.social @ohsuknight.bsky.social

A multi panel comic depicting a survivorship journey over years including some scares of recurrence but many joyful interactions and nature trips

A multi panel comic depicting a survivorship journey over years including some scares of recurrence but many joyful interactions and nature trips

A multi panel comic depicting a survivorship journey over years including some scares of recurrence but many joyful interactions and nature trips

A multi panel comic depicting a survivorship journey over years including some scares of recurrence but many joyful interactions and nature trips. Growing old with you is all I ever wanted.

Every now and again I catch up with xkcd and... well... I didn't expect to be crying in my office this morning.

Two years
Seven years
Ten years
Fifteen years

This is what we dream about when we talk of #survivorship #survonc 🖤

Screenshot of a Powerpoint slide entitled "what is health equity research?". It features three blocks of text linked by three arrows. The first text block is entitled "Theoretically-grounded" - grounded in social and political theories that explain the allocation of resources and hazards that underlie all health disparities along the axes of "social difference." The next is entitled "Methodologically sound," and reads "Methodological rigor is not a substitute for theory, but emphasis on matching research questions, data, and methods is key." The third is entitled, "Grounded in Public Health Practice" and reads "Does this address a need for PH policy design or practice?

In my teaching (which jointly emphasizes methodological rigor and conceptual clarity), I use this slide:

"Curative hope" in oligometastatic breast cancer: ~50% of surveyed US medical oncologists recommend consolidative tx to all cancer sites.

It's a brave new world, and a setting where patients often deserve to get second/multiple opinions! @jco-asco.bsky.social #OncSky

ascopubs.org/doi/10.1200/...

Time from cancer diagnosis → treatment is rising: 21 days in 2004 to 28 days in 2015.

Much of this is because of ⬆️ in stage 1 & there may be some good reasons - eg careful shared-decision making & planning. But how do we support people during the (often) anxious wait?

ascopubs.org/doi/full/10....

If you're interested in learning more about how we might reduce overuse/waste, we wrote this review in @jco-asco.bsky.social JCO OP including some of the earlier low-dose nivo data, and I also highly recommend oncdoc.org for oral oncology drugs.

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2. Xeloda (capecitabine) was approved in 1998, & in 2025 FDA has added a black box warning to test for DPYD variants. As we catch up to a pharmacogenomic era, Mark Ratain & Peter O'Donnell summarize the dire need for data: when you find a variant, what dose to Rx?

Helpfully, they provide some recs:

Extended duration of treatment using reduced-frequency dosing of anti-PD-1 therapy in patients with advanced melanoma and Merkel cell carcinoma - PubMed ICI administration at RFD can allow extension of treatment duration, while preserving efficacy and reducing logistical and financial burden. RFD approach deserves further exploration in prospective…

This adds to prior work in this area, including studies of every 3 MONTH dosing for merkel cell carcinoma & 20mg dose in HNSCC.

pubmed.ncbi.nlm.nih.gov/37733060/
pubmed.ncbi.nlm.nih.gov/36265101/
@bhatia-s-md.bsky.social

"What dose?" is the name of the game this week @jco-asco.bsky.social as ghosts of 2000s haunt modern oncology.

1. We've known since 2010 nivo is active at low doses/long intervals. This week Vanita Noronha & team show just 20mg (vs 240mg) is active in 5 ca types.
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#Telehealth has been a huge boon to oncology: save pts time, see people who might not be able to travel.

Q in new study @jco-asco.bsky.social: is "webside manner" affecting quality? Are we just adding extra appts?

A: Largely, no! Similar communication, slight ⬆️ appts.

ascopubs.org/doi/full/10....

Pilot Randomized Trial of Medical Cannabis to Reduce Symptom Burden in Patients With Newly Diagnosed Advanced Pancreatic Cancer (CanPan) | JCO Oncology Practice PURPOSEPatients with pancreatic adenocarcinoma frequently experience severe symptoms. Medical cannabis has shown promise for symptom management, yet high-quality data are lacking because of…

Too small a study (32 pts) to change practice currently; however, in states where patients are already using or asking about use, something helpful this study does is publish their protocol. This may be a useful starting place for oncologists looking for guidance.

ascopubs.org/doi/10.1200/...

In this small pilot study, #PanCan pancreatic cancer patients randomized to receive medical cannabis while starting chemotherapy had improvement in pain (44% vs 20%), appetite (56% vs 30%), and insomnia (67% vs 30%).

The State of Rural Primary Care in the United States Rural Americans face significant barriers to accessing adequate primary care; tailored federal and state programs can help address some of these challenges.

"Nearly half of rural residents are uninsured or insured by public payers. This limited payer mix, coupled with relatively low reimbursement rates and high provision of uncompensated care compared to nonrural areas, poses challenges to the financial stability of rural primary care."

Starting in 1 hour! Tune in to our webinar on radiation therapy in liposarcoma. Join us soon and learn how radiation plays a key role in care.
bit.ly/Radiation-We... #LipoEducation #RadiationTreatment #liposarcoma

Where are US patients with cancer traveling for care?

Medicare claims analyzed in JCO CCI: unsurprisingly, community-based networks carry a large load. Notably, confined to 12h drive & unclear how satellite sites included, but a close look at the map may surprise you:

ascopubs.org/doi/10.1200/...

What, it isn't straightforward?

From theory to practice: in #JCOOP, a conceptual model to describe how practices cope with losing a rural oncologist - and a new podcast interview with @fumikochino.bsky.social to really dive into a real-world example. #HealthPolicy

Still TBD: how many of these were true cancer diagnoses, and what's the right sensitivity/specificity to shoot for with a program like this? How will referring behavior change once this program is more entrenched - will it become like "STAT" imaging, where over-use can reduce efficiency gains?

Fig A3. Improvements in efficiency of care by age.

Just adding a "🚩 suspected cancer" flag reduced the time from referral to appointment by over 50%(and dropped the time from referral -> diagnosis of cancer by 63 days)
@nychealthsystem.bsky.social @jco-asco.bsky.social

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Fig 1. Association of donor age with OS. (A) The plot shows the unadjusted HR for death according to donor age. A linear model (red line) is compared with a more flexible spline model (blue line), which allows for a non-linear relationship. Shaded ribbons represent 95% CIs. The similarity between the two models and the fact that their CIs consistently overlap an HR of 1.0 indicates that there is no significant linear or nonlinear association between donor age and survival in this cohort. (B) Kaplan-Meier analysis of OS stratified by dichotomized donor age: donors younger than 32 years (red) versus those 32 years and older (blue). There was no statistically significant difference in survival between the two groups (log-rank P = .51). HR, hazard ratio; OS, overall survival.

How important is #HCT donor age in the #PTCy era? Large single-center study in JCO OP raises the question of how strongly age should be prioritized:

ascopubs.org/doi/10.1200/... @EJShpallMD

Scoop: The leaked protocol of the CDC-funded Hepatitis B vaccine trial in Guinea-Bissau. “This is another Tuskegee.” The protocol reveals that the trial will withhold the Hepatitis B birth dose from thousands—without placebos, without universal maternal screening, and with endpoints critics call indefensible.

We have the CDC-funded Hepatitis Vaccine trial in Guinea-Bissau protocol.

It’s worse than you thought.

Check it out, first in Inside Medicine…

with @pauloffit.bsky.social David Boulware and others.

insidemedicine.substack.com/p/scoop-the-...

SNF capacity is the bottleneck that keeps people waiting in ER hallways and make-shift hospital rooms. SNF beds are crucial to our health system. Since 2020, capacity is down 5%, with less slack, due to staffing shortages.

@jamainternalmed.com @mlbarnett.bsky.social: jamanetwork.com/journals/jam...

Link to paper:

ascopubs.org/doi/10.1200/...

Fig 2. Constraints related to the patient, the pharmacy, and the outpatient infusion centers to be taken into account when concentrating outpatient ICI administrations in a stipulated time window in the morning. ICI, immune checkpoint inhibitor. Pharmacy constraints: physiochemical stability, risk of waste. Patient: distance home-hospital, diurnal preference. Day unit: priority rankings, long multi drug regimens.

Proposed Action We propose the following approaches to make early ToDA of ICI feasible in daily routine practice: • ASSESS: establish a nurse-led telephone assessment on the eve of ICI administration with full blood work-up available to confirm clinical and biologic permissiveness to ICI treatment; • AVOID (as far as possible and according to the habits of each center): do not schedule medical consultation and ICI treatment on the same day to reduce risks of delays in treatment administration (prefer teleconsultations the day before treatment for patients living far from the center); • ALWAYS administer ICI first when in combination with IV chemotherapy or other agents, unless reverse sequencing is recommended; • ALLOCATE: prioritize two or three ICI mornings per week and save the remaining two or three mornings for long-term combination treatments not including ICIs; • ANTICIPATE: whenever possible, cytotoxic reconstruction units could prepare ICIs in the evening of the eve so that they are ready to be administered early on the following morning.

🌅 Several studies have suggested checkpoint inhibitors dosed AM may be assoc w/ improved outcomes- but strong risk of confounding.

Out now in #JCOOP: review of literature & discussion of how practices could actually implement this. Suspect will be very dependent on local AM traffic!

Potential for cure in metastatic gastric cancer with actionable biomarkers?

- 51 pts/1710 treated over 9 years in Japan
- "Potential cure" = PFS >3 years, NED, >1 year since last tx w/o progression (consolidative surgery allowed)
- dMMR 23%, CPS ≥10 30%, HER2+ 24%

ascopubs.org/doi/10.1200/...