Background: The aim of this study is to evaluate the extent and associations with patient‐reported disruptions to cancer treatment and cancer‐related care during the COVID‐19 pandemic utilizing nationally representative data.Methods: This analysis uses data from the 2020 National Health Interview Survey (NHIS), an annual, cross‐sectional survey of US adults. Adults (age >18) who reported requiring current cancer treatment or other cancer‐related medical care in the second half of 2020 were included. Estimated proportions of patients with self‐reported changes, delays, or cancelations to cancer treatment or other cancer care due to the COVID‐19 pandemic were calculated using sampling weights and associations with sociodemographic and other health‐related variables were analyzed.Results: In total, 574 (sample‐weighted estimate of 2,867,326) adults reported requiring cancer treatment and/or other cancer care since the start of the COVID‐19 pandemic. An estimated 32.1% reported any change, delay, or cancelation. On sample‐weighted univariable analysis, patients who were younger, female, had one or fewer comorbidities, and uninsured were significantly more likely to report disruptions. On sample‐weighted, multivariable analysis, patients who were younger and female remained significant predictors. Nearly 90% of patients included in the study reported virtual appointment use. Patients reporting disruptions were also significantly more likely to report feelings of anxiety.Conclusions: An estimated 1/3 of patients experienced disruptions to cancer care due to the COVID‐19 pandemic. Patients experiencing disruptions in care were more likely to be female or younger which may reflect risk stratification strategies in the early stages of the pandemic, and also had higher rates of anxiety. The longitudinal impact of these disruptions on outcomes merits further study.

Active rejection (AR) remains a major risk factor for graft dysfunction and loss. Donor-derived cell-free DNA (dd-cfDNA) is a dynamic, noninvasive biomarker for AR. We hypothesized that dd-cfDNA monitoring post-rejection may enable physicians to stratify patients into those with more and less favorable prognoses. This prospective multi-center study of kidney transplant recipients (KTR) with biopsy proven AR (BPAR) monitored dd-cfDNA for eight weeks following diagnosis and recorded clinical outcomes at 12 months. Patients were classified using dd-cfDNA trends; trends were then associated with outcomes. Negative outcomes comprised: graft loss, subsequent BPAR, post-biopsy donor specific antibody, and/or lack of resolution of renal dysfunction. Of 488 KTR, 66 with BPAR were analyzed (TCMR: n=37; ABMR: n=24; Mixed: n=5). 76% experienced negative outcomes, 24% positive outcomes. Four distinct dd-cfDNA trends were identified: two with favorable prognosis (n=25), two with unfavorable prognosis (n=41). Among patients with favorable prognosis, the odds of experiencing positive outcomes were 60x higher (p=3.18x10-7), and of experiencing resolving kidney dysfunction at one year were 13x higher (p=2.15x10-5). Among KTR with BPAR, post-rejection dd-cfDNA trends were statistically associated with outcomes, suggesting dd-cfDNA may help physicians manage patients post-BPAR.

Since their conception with the smallpox vaccine, vaccines used worldwide have mitigated multiple pandemics, including the recent COVID-19 outbreak. Insightful studies have uncovered the complexities of different functional networks of CD4 T cells (T helper 1 (Th1); Th2, Th17) and CD8 T cells (T cytotoxic; Tc), as well as B cell (B^IgM, B^IgG, B^IgA and B^IgE) subsets, during the response to vaccination. Both T and B cell subsets form central, peripheral, and tissue-resident subsets during vaccination. It has also become apparent that each vaccination forms a network of T regulatory subsets, namely CD4+ CD25+ Foxp3⁺ T regulatory (Treg) cells and interleukin-10 (IL-10)-producing CD4+ Foxp3⁻ T regulatory 1 (Tr1), as well as many others, which shape the quality/quantity of vaccine-specific IgM, IgG, and IgA antibody production. These components are especially critical for immunocompromised patients, such as older individuals and allograft recipients, as their vaccination may be ineffective or less effective. This review focuses on considering how the pre- and post-vaccination Treg/Tr1 levels influence the vaccination efficacy. Experimental and clinical work has revealed that Treg/Tr1 involvement evokes different immune mechanisms in diminishing vaccine-induced cellular/humoral responses. Alternative steps may be considered to improve the vaccination response, such as increasing the dose, changing the delivery route, and/or repeated booster doses of vaccines. Vaccination may be combined with anti-CD25 (IL-2Rα chain) or anti-programmed cell death protein 1 (PD-1) monoclonal antibodies (mAb) to decrease the Tregs and boost the T/B cell immune response. All of these data and strategies for immunizations are presented and discussed, aiming to improve the efficacy of vaccination in humans and especially in immunocompromised and older individuals, as well as organ transplant patients.

The demographics of practicing physicians in the US have not represented the diverse populations they serve, and there is no exception in oncology care.^1,2 Recognizing the detrimental effects of these disparities on public health, oncology training programs have instilled benchmarks and initiatives to increase diversity among oncology physicians nationwide.³ However, data about representation in oncology specialties and the impact of these initiatives is lacking. This study aims to assess underrepresented minority (URM; ie, Black or African American individuals, Hispanic or Latino individuals, and Native American, American Indian, or Alaskan Native individuals) representation trends across training programs in oncology specialties from 2015 to 2020.

A Payer’s Perspective: A Comparison and Simulation of the Costs of Hemodialysis Versus Living Donor Kidney Transplant for Patients With End-Stage Renal Disease in Nigeria