News in brief: Gender inequity for blood cancer trial investigators; High-risk CLL may have a long indolent preclinical phase; Discharge summary abbreviations cause confusion

Women under-represented in blood cancer trials

Gender inequity persists in the running of Australian oncology research with female representation as lead investigators as low as 4% in some academic cancer trials, a study shows.

A review of principal investigators for 321 Australian oncology group trials found that 37% overall were women.

The lowest representation of female principal investigators was 4.2% for the Australia and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), followed by 11.3% for the Australasian Gastrointestinal Trials Group (AGITG), 33.3% for the TransTasman Radiation-Oncology Group (TROG) and Australasian Leukaemia and Lymphoma Group (ALLG).

Female representation was  41.7% for the Cooperative Trials Group for Neuro-Oncology (COGNO), 43.7% for the Breast Cancer Trials (BCT) group, 44% for the Cancer Research in Primary Care (PC4) group, 46.9% for Melanoma And Skin Cancer Trials (MASC), 54.8% for the Palliative Care Clinical Studies Collaborative (PaCCSC), 55.2 % for the Australia and New Zealand Sarcoma Association (ANZSA) and 80% for the Australia and New Zealand Gynaecological Oncology Group (ANZGOG).

The number of female principal investigators by craft groups were 66/158 for medical oncology, 29/86 for radiation oncology and 5/59 for surgical oncology.

“Proactive strategies to address the imbalance should be adopted,” said study author Dr Vi Luong of Monash Health, Melbourne, who presented the results at the recent COSA 2021 meeting.

High-risk CLL may have a long indolent preclinical phase

The indolent preclinical phase of chronic lymphocytic leukaemia (CLL) may be longer than previously thought, with some high-risk subtypes of CLL occurring as many as 16 years prior to diagnosis, according to Dutch researchers

A team at Utrecht University examined the composition of the B-cell receptor immunoglobulin (BcR IG) repertoire during early stages of CLL in samples obtained up to 22 years prior to diagnosis. According to the investigators, the stereotypy of the BcR IG is a prognostically relevant immunogenetic feature in CLL.

They compared 124 healthy individuals who subsequently received a diagnosis of CLL or small lymphocytic leukemia with 188 matched controls and found the median frequency of the dominant clonotype was significantly higher in the patients with CLL versus controls (54.9% vs. 0.38%, respectively; p<0.0001). Those with a shorter time to diagnosis had a significantly higher dominant clonotype frequency (p<0.0001). Additionally, individuals who had a dominant clonotype frequency greater than 2% of the total repertoire had a shorter duration from blood sampling to CLL diagnosis.

Results from next-generation sequencing demonstrated detectable skewing of the IGH gene repertoire in 21 out of 28 patients with CLL at up to 15 years prior to diagnosis. Additionally, some patients with CLL who had clinical transformation to aggressive B-cell lymphoma had noticeable skewing in the IGH gene repertoire up to 16 years prior to CLL diagnosis. A total of 25 patients carried stereotyped BcR IG at up to 17 years before receiving a CLL diagnosis. In addition, high-risk stereotyped clonotypes observed as early as 16 years prior to diagnosis often exhibited a lower dominant clonotype frequency, or less than 20% of IGH gene repertoire.

“We speculate that somatic genetic aberrations, (auto)stimulation, epigenetic and/or microenvironmental influences are required for the transformation into overt CLL,” the researchers wrote in the journal Blood.

“As the observed skewing in the IGH gene repertoire often occurs prior to B-cell lymphocytosis, we consider our findings as a novel extension to the characterization of monoclonal B-cell lymphocytosis (MBL).”

Discharge summary abbreviations cause confusion;

Medical abbreviations used by specialists in hospital discharge summaries are often confusing to the GPs who receive them and also ambiguous for hospital colleagues and junior doctors, an Australian study has found.

A retrospective audit of 802 discharge summaries at a Queensland regional health service found that they contained an average of 17 abbreviations, and almost one in five GPs were unable to interpret at least one of them.

Almost all (94%) of GPs said that ambiguous abbreviations had a negative impact on patient care and 60% said they spent too much time of clarifying them. Abbreviations could also have multiple possible meanings in different contexts and led to confusion for 15% of junior doctors working in other departments of the same hospital, the study found.

While most had no problems with abbreviations such as Hb and IHD, the abbreviations that had widest range of misinterpretations or ‘don’t know’ responses included NAD, DEM, PE, LC, TGA, TCH and BAE.

The study authors said hospitals should adopt a standardised list of acceptable abbreviations for medical documentation, which is made available to both hospital medical staff and GPs.

They also noted that abbreviations were very location specific, with marked differences between those used by Melbourne and Sydney hospitals.

The findings are published in the Internal Medicine Journal.

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