Oncology On The Go

In a conversation with CancerNetwork®, Kandace P. McGuire, MD, and Paschalia Mountziaris, MD, PhD, highlighted the use of L-Dex bioimpedance spectroscopy as a method for detecting lymphedema earlier in patients who undergo surgery for breast cancer. The experts discussed seamlessly integrating this novel modality into standard vitals workflows and detailed other considerations for improving long-term survivorship outcomes via proactive lymphatic care.
McGuire began by breaking down why detection of lymphedema typically occurs later after its development, describing how a sentinel lymph node biopsy and additive radiation can cause lymphatic damage and obstruction that correspond with symptoms months to years down the road. At her institution, bioimpedance spectroscopy, the use of a small electrical signal measuring “bioimpedance”, is employed at various points before and after breast cancer surgery to easily determine the likelihood of developing lymphedema through a nursing visit. According to Mountziaris, having a noninvasive method like this provides a “valuable tool” for informing patients of their risks of experiencing lymphedema.
The experts also discussed a need to develop a more nuanced method for detecting potential lymphedema among patients with a higher body mass index and spoke about fostering communication across the breast surgery oncology team, the plastic/reconstructive team, and physical rehabilitation specialists to monitor abnormal fluid changes in patients. Looking ahead, they emphasized making bioimpedance spectroscopy more accessible as a key goal in lymphedema care.
“We are privileged that McGuire and I have a great team and that I have the equipment that we’re able to provide these things for our patients. From my standpoint, some of these patients appear—to me, by measurements, and everything else—to have been cured of their lymphedema after these interventions,” Mountziaris stated. “Getting an L-Dex score on them is just another way to demonstrate that we did bring them to stage 0 or no lymphedema.”
McGuire is professor of surgery and chief of breast surgery at Virginia Commonwealth University (VCU) Massey Cancer Center. Mountziaris is assistant professor of surgery in the Division of Plastic and Reconstructive Surgery at VCU Massey Cancer Center.
Reference

VCU Massey now offers new technology for early detection of lymphedema. News release. December 8, 2025. Accessed January 14, 2026. https://tinyurl.com/2ktfzf5k

In a conversation with CancerNetwork®, Nathan Goodyear, MD, provided an overview of how to implement integrative modalities that may effectively supplement standard-of-care oncologic therapies. Beyond the use of intravenous vitamin C and other flagship strategies at his institution, Goodyear addressed potential misconceptions and biases surrounding integrative oncology and discussed how to re-engage patients back into evidence-based care.
Goodyear, an integrative oncologist at the Williams Cancer Institute, described how conventional modalities like surgery and radiotherapy may damage the immune system during cancer treatment, and how integrative strategies aim to re-engage and stimulate areas like the gut microbiome to safeguard patient quality of life. He touched upon how practices such as fecal transplantation, fasting, and intratumoral pulsed electric field (PEF) therapy can convert unresponsive diseases into “hot” tumors that immunologically react to treatment.
Looking across the medical field entirely, Goodyear described how certain “camps” may perceive integrative oncology as an “alternative” form of medicine. Citing an article published in JAMA Network Open showing how patient trust in US hospitals decreased from 71.5% in 2020 to 40.1% in 2024, Goodyear noted how such divisiveness among healthcare providers may have played a role in losing the support of patients.   
As part of mitigating the prejudicial, marginalizing attitudes towards integrative care as well as the infighting among physicians, Goodyear emphasized building bridges across holistic care, conventional oncology, and other fields to properly advance the treatment of patients. Having an open dialogue and debating the science behind new integrative modalities, he explained, will help in advocating for patients and establishing trust in their care teams.
“We must re-engage with [patients] through the science, through public debate and discourse with other doctors; that will re-engage the patient,” Goodyear stated. “More importantly, I think that will re-engage the patient’s trust in doctors. When we restore a doctor-patient relationship, medicine is going to get better, and patients are going to get better.”
Reference

Perlis RH, Ognyanova K, Uslu A, et al. Trust in physicians and hospitals during the COVID-19 pandemic in a 50-state survey of US adults. JAMA Netw Open. 2024;7(7):e2424984. doi:10.1001/jamanetworkopen.2024.24984

In a conversation with CancerNetwork®, Jose G. Trevino, II, MD, FACS, spoke about the current state of the pancreatic ductal adenocarcinoma (PDAC) paradigm as well as next steps for improving the prognosis of patients who present with this disease. Throughout the discussion, Trevino outlined the roles that surgical oncologists can play in disease management, the different demographic and socioeconomic drivers of disparate patient outcomes, and translational research focusing on factors like the tumor microenvironment.

Trevino stressed the idea of pancreatic cancer care as a “team science,” rejecting a “silo mentality” that involves handing off a patient from one department to the next. Because surgical approaches by themselves have remained “limited” in pancreatic cancer for the past 20 to 30 years, he emphasized continued collaboration with medical oncologists, radiation oncologists, and translational scientists to enhance patient quality of life. 

Regarding disparities, Trevino noted the importance of recognizing various barriers to treatment access among those in rural communities as well as unequal outcomes across different racial and ethnic groups of patients, including worse survival among Black populations. Additionally, in the face of continuously rising PDAC incidence, he stressed additional training across the board on how to detect the red flags associated with disease.

“…There has to be a ton of education for our patients and our physicians who see patients on a primary level to know what those red flags are when a patient comes to their clinic. Early detection of early lesions that could eventually turn into pancreatic adenocarcinoma is going to be the key to survival, ultimately. [If we] catch it before it becomes a cancer, we solve a huge problem,” Trevino stated. “Early detection of early lesions is key.”

Trevino is chair of the Division of Surgical Oncology and an associate professor in the Department of Surgery at VCU School of Medicine as well as surgeon-in-chief and Walter Lawrence, Jr., Distinguished Professor of Oncology at VCU Massey Cancer Center.

After the 2025 American Society of Hematology (ASH) Annual Meeting had passed, the  data were out, and the hematologist/oncologists of the world had time to digest the practice changes that awaited them upon their returns home. Rahul Banerjee, MD, FACP, and Brooke Adams, PharmD, BCOP, took part in an X Spaces discussion hosted by CancerNetwork® in collaboration with The American Society for Transplantation and Cellular Therapy (ASTCT) to highlight these potential changes.

Adams and Banerjee discussed abstracts from the meeting, including the phase 3 MajesTEC-3 trial (NCT05083169), which evaluated teclistamab-cqyv (Tecvayli) plus daratumumab (Darzalex) in patients with relapsed/refractory multiple myeloma who progressed on at least 1 prior line of therapy.1 A significant progression-free survival benefit was observed with the experimental combination compared with standard of care in this population.

They also discussed data from cohort A of the phase 2 IFM2021-01 trial (NCT05572229), which evaluated subcutaneous teclistamab in combination with subcutaneous daratumumab in patients with newly diagnosed multiple myeloma. Results demonstrated that the combination was effective and safe in the frontline treatment of patients who were ineligible for transplant.2

The discussion also covered the broader treatment landscape, as the experts compared the use of bispecific antibodies with BCMA-directed CAR T-cell therapies. Frontline bispecific strategies for transplant-ineligible populations were also topics of conversation, as well as post-transplant consolidation with bispecifics. Ultimately, they stated that multiple myeloma care is undergoing a paradigm shift toward deeper minimal residual disease negativity, possible treatment de‑escalation, and even serious use of the word “cure” for the disease.

Banerjee is an assistant professor in the Clinical Research Division at the Fred Hutchinson Cancer Center, and Adams is a clinical pharmacist in the Department of Stem Cell Transplant and Cellular Therapy and coordinator of the PGY-2 Oncology Residency at Orlando Health. Both are also members of the ASTCT content committee.

References

Mateos M-V, Bahlis N, Perrot A, et al. Phase 3 randomized study of teclistamab plus daratumumab versus investigator’s choice of daratumumab and dexamethasone with either pomalidomide or Bortezomib (DPd/DVd) in patients (Pts) with relapsed refractory multiple myeloma (RRMM): Results of majestec-3. Blood. 2025;146(suppl 2):LBA-6. doi:10.1182/blood-2025-LBA-6

Manier S, Lambert J, Marco M, et al. A phase 2 study of teclistamab in combination with daratumumab in elderly patients with newly diagnosed multiple myeloma: the IFM2021-01 teclille trial, cohort A. Blood. 2025;146(suppl 1):367. doi:10.1182/blood-2025-367

This episode of the collaborative podcast between Oncology on the Go and the American Psychosocial Oncology Society (APOS), hosted by Daniel C. McFarland, DO, features Michelle B. Riba, MD, and focuses on integrating psychosocial care into oncology for clinicians.

The discussion emphasizes that psychosocial issues profoundly impact both quality of life and cancer-related outcomes, making their assessment an integral part of care, not merely ancillary. The distress thermometer was developed by the NCCN in the late 1990s as a 0-to-10 scale, dubbed the "fifth vital sign". The term "distress" was chosen over psychiatric labels to capture the wide array of patient concerns, including pain, fatigue, sleep, spiritual, practical, and family issues.

Distress screening is now mandated at regular appointments in all cancer centers in the US. Clinicians are encouraged to screen for more specific issues like depression (linked to poor adherence and survival), anxiety (which can impede treatment adherence), and substance use. Oncologists are the doctors most able to consider a patient's totality of symptoms, and their role is integral to supporting psychosocial referrals.

To address the practical delivery of care, the collaborative care model is being advocated as a public health, population-based approach. Key components include:

Use of a standardized screening tool.

Management by a dedicated care manager.

Weekly consultation between the care manager and a consultant psychiatrist for triage and treatment advice.

The model allows oncologists to bill for care and learn more about these issues while ensuring patients receive evidence-based treatments. The clinicians concluded that fundamentally, mental health needs to be aligned alongside cancer care.

McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY. Riba is director of the PsychOncology Program, a clinical professor, and the associate chair for Integrated Medical and Psychiatric Services in the Department of Psychiatry at the University of Michigan Rogel Cancer Center, and psycho-oncology editorial advisory board member for the journal ONCOLOGY.