Hannah R. Abrams

@hannahrabrams

Sarcoma doctor at Fred Hutch, hoping to make rare cancer research easier & more efficient for patients/caregivers. Social Media Editor @ JCO OP. Views are my own. #MedSky

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Hannah R. Abrams@hannahrabrams· 28d

To a non-expert, this seems to be a neat new tool: Google can now create and export isochrones (maps of the space within a given travel time from a point) from a given point. Here's the space within 30 minutes of Seattle's trauma hospital (Harborview), for ex. developers.google.com/maps/documen...

Information page for Isochrones API.The Isochrones API calculates the area that a person can reach from a specific origin point within a set amount of time. Unlike a radius, which measures a straight-line distance, an isochrone accounts for actual road network travel times to create a polygon that represents true reachability.

Common use cases include:

Delivery logistics: Determine which customers are servable within 30 minutes of a warehouse.
Real estate: Find properties within a 45-minute commute of a workplace.
Urban planning: Analyze the accessibility of essential services like hospitals or grocery stores.
To get started, see Set up the Isochrones API.

30 minute isochrone for Harborview Medical Center

Hannah R. Abrams@hannahrabrams· Jun 25

Managing bone health in breast cancer survivors on aromatase inhibitors: comprehensive review out now in JCO OP! @jessicaallenmd.bsky.social ascopubs.org/doi/full/10....

Hannah R. Abrams@hannahrabrams· Jun 22

...And in a world of near universal prior auth for cancer drugs regardless (@michaelannica.bsky.social @fumikochino.bsky.social), unclear that MA vs traditional sees a big difference there.

Hannah R. Abrams@hannahrabrams· Jun 22

Nice editorial @thewonkologist.bsky.social & Dr. Nancy Keating about revisiting our priors re: Medicare Advantage for cancer care. While there is reason to be cautious and investigate, current data on MA vs traditional medicare in cancer is far from conclusive. ascopubs.org/doi/10.1200/...

Hannah R. Abrams@hannahrabrams· Jun 21

Did not know cancer centers can technically now bill for patient navigation. I agree with the patients interviewed here: navigation is extremely high-value, and also I do not think it should be behind a paywall. ascopubs.org/doi/10.1200/...

Hannah R. Abrams@hannahrabrams· Jun 20

Waiting for clinical teams to order NGS slows down turnaround time by 2 weeks on average. It's time for insurance companies & cancer centers to work together & set up automatic pipelines in these situations, so patients don't have a long anxious wait to start treatment. ascopubs.org/doi/10.1200/...

Fig 2. (A) TAT intervals and definitions. (B) and (E) Yearly NSCLC CGP TAT and trend analysis (2018-2024). Boxes indicate median TAT, and whiskers indicate IQR. Dotted lines are linear trendlines: (B) overall TAT [Y = –1.154 × X + 2,361.0], (C) ordering TAT [Y = 0.2143 × X – 419.5], (D) specimen TAT [Y = –0.1357 × X + 279.0], and (E) molecular TAT [Y = –1.079 × X + 2,190.0]. P values reflect linear regression analysis (*P < .05, **P < .01, ***P < .001). CGP, comprehensive genomic profiling; NSCLC, non–small cell lung cancer; TAT, turnaround time.

Hannah R. Abrams@hannahrabrams· Jun 18

Midjourney has announced they're developing a full-body 60 second "ultrasonic CT". I want better & cheaper imaging. But the idea that: 50K scanners x 720 min x 30d = 1 billion scans/mo Seems totally unaware of supply/demand, logistical constraints of getting people in/out, & privacy concerns

Hannah R. Abrams@hannahrabrams· Jun 3

On the #ASCO26 hot topics of KRAS and toxicity: systematic review & meta-analysis in JCO OP of sotorasib dosing shows trend to improved PFS with LOWER dosing. Less toxicity -> longer time on-treatment? @jco-asco.bsky.social ascopubs.org/doi/10.1200/...

Hannah R. Abrams@hannahrabrams· May 30

Key #desmoid tumor takeaways from RINGSIDE presentation (varegacestat) #ASCO26 #sarcoma today: - ORR 55.7%, remainder largely shrunk but under 30% - Quick time to pain improvement - only 4 weeks in many - 80% need for dose reduction primarily d/t diarrhea

Hannah R. Abrams@hannahrabrams· May 30

JCO OP at #ASCO26: Follow up yesterday's session, "Cancer Care in Times of Crisis and in Immigrant and Displaced Populations." Full case discussion out now @jco-asco.bsky.social: ascopubs.org/doi/10.1200/...

Hannah R. Abrams@hannahrabrams· May 30

#ASCO26 Abstract 12160: impressive effort to review charts of n = 848 patients for whether corticosteroids for irAE → worse cancer outcomes. Adds to/confirms existing literature in this area suggesting the concern is really with high doses.

Impact of corticosteroid exposure on long-term immune checkpoint in- hibitor responses in solid tumors. First Author: Theresa Medina, University of Colorado, Aurora, CO. Text beyond allowed length; summary: The steroid exposure was defined as very high if prednisone (or equivalent) ≥ 20mg/day and length of exposure was ≥ 42 days. 64.8% of patients experienced an irAE and 44.7% of patients developed G3-4 irAE requiring corticosteroids +/- steroid sparing agent. The low impact corticosteroid exposure did not affect PFS, OS or tumor specific survival. The very high impact CS exposure was associated with decrease in PFS (p = 0.02) but not with OS or TSS (p = 0.3). The high impact steroid sparing agent was associated with decrease in PFS (not significant) but the very high impact steroid sparing agent was associated with decrease in PFS. The chronic irAE was associated with slight improvement in PFS (not significant).

Hannah R. Abrams@hannahrabrams· May 29

3. BCG + CIT: Knew from the abstract: pCR 68%, 42% had any BCG tox, 9% G3. Paper adds: while largely comprehensive, notably 20% of ITT didn’t get all doses of rBCG Would love to hear from bladder experts what your thoughts were now that the full paper is out! #ASCO26 ascopubs.org/doi/pdf/10.1...

Hannah R. Abrams@hannahrabrams· May 29

Paper adds: Forest plot w/o other clear predictors of response. Re: huge difference between κ and ƛ AL, anselamimab was generated w/ kappa isotype immunogen. KMs for overall vs κ-only & ƛ-only pop below! #ASCO26 ascopubs.org/doi/10.1200/...

Fig 2. Kaplan-Meier analysis of time to ACM in the (A) overall population, (B) patients with the kappa isotype, and (C) patients with the lambda isotype. Censor events are shown by vertical tick marks. ACM, all-cause mortality; PCD, plasma cell dyscrasia.

Hannah R. Abrams@hannahrabrams· May 29

What can we tell folks w/ taxane-induced peripheral neuropathy after early-stage cancer re: whether it will recover? @SWOG.org 1714, #ASCO26 abs 12117: - Of 1321 pts, 553 had TIPN at end of tx. - 48.5%, it improved - 33.8% didn't change - 17.7% worsened @drdawnhershman.bsky.social #survivorship

Hannah R. Abrams@hannahrabrams· May 27

Tips for fellows going to their first #ASCO26 (as I prepare to go to my whole of... second): Google "mccormick place floor plan" and pick your favorite version of the map to save to your phone. I'm sure the blue 3D one works for some people, but it does not for me! 😂

Hannah R. Abrams@hannahrabrams· May 23

It's not in your head: prior auth has increased over the past 10 years in oncology. (Though not as much as other specialties.) @jco-asco.bsky.social ascopubs.org/doi/10.1200/...

Hannah R. Abrams@hannahrabrams· May 21

We have a lot of mechanisms to prevent OVER dosing of chemotherapy. This week in #JCOOP, Dr. Ruth Choa & colleagues outline a case in which an EMR error led a patient to receive an UNDER dose -only 50%- for 4/8 cycles of curative-intent treatment. @jco-asco.bsky.social ascopubs.org/doi/10.1200/...

Inadvertent Dose Reduction of Chemotherapy in a Patient Receiving Multiagent Neoadjuvant Chemotherapy
Authors: Ruth E. Choa, MD, PhD https://orcid.org/0000-0002-4798-7565 ruth_choa@dfci.harvard.edu, Kevin H. Lin, MD, PhD, Matthew L. Meizlish, MD, PhD https://orcid.org/0000-0002-4306-5061, Christof C. Smith, MD, PhD https://orcid.org/0000-0001-6517-0439, Katherine J. Feder, MD, MS, and Joseph O. Jacobson, MD, MSc

...AL elected to proceed with chemotherapy but was concerned about the acute toxicity of one of the agents. To accommodate these concerns, he and his oncologist decided on a modified regimen in which the agent is administered in divided doses, with half doses administered on days 1 and 2 rather than the full dose on Day 1. The intention was to use this split-dosing strategy for the first cycle, then resume standard chemotherapy for cycle 2 if the treatment was tolerated. However, day 2 of the order was accidentally deleted from the chemotherapy plan, and AL inadvertently received only half of the intended dose of the agent. Patient, provider, and pharmacy team all missed catching this error in the first cycle. Using the short-cut copy-forward function of the computerized prescriber order entry system (CPOE) of a proprietary electronic health record (EHR), the error was propagated forward for an additional 2 cycles until cycle 4 of the 8 planned cycles.

Hannah R. Abrams@hannahrabrams· May 18

340B as it exists now is crucial to oncology care. In JCO OP this month, @ascocancer.bsky.social releases updated policy recommendations for reform of the program: ascopubs.org/doi/10.1200/... @jco-asco.bsky.social

Title of article: 340B Drug Pricing Program: An Updated ASCO
Policy Statement

Authors:
Blase Polite, MD, MPP, FASCO 1 ; Niharika Dixit, MD 2 ; John Hennessy, BCPA 3 ; Marissa Rivera, MBA 4 ; Ashley Sumrall, MD, FACP, FASCO 5 ;
Wade Swenson, MD, MPH, MBA, FACP 6 ; Kashyap Patel, MD 7 ; Natalie Dickson, MD, MMHC, FACP 8 ; Jonathan Phillips, MPH 9 ;
Azam Masood, MPH 9 ; and Allyn Moushey, MSW 9

TABLE 2. ASCO Policy Recommendations for Reforming the 340B Drug Pricing Program
Changes to program eligibility
A new formula to determine 340B eligibility for non–hospital-af liated providers should be established. We suggest dividing the number of Medicaid,
uninsured, and dual-eligible patients by total patient visits (under a single TIN) to create a new measure known as the indigent care ratio
Independent oncology practices with multiple locations should be able to register a child site for the 340B Program as long as they bill under the same Tax ID
(TIN) as the eligible parent practice
ASCO supports reforms to ensure a covered entity’s right to engage multiple contract pharmacies. We recommend capping fees paid to contract
pharmacies and TPAs and establishing a civil monetary penalty for excessive fees
Transparency and accountability
Increase reporting and auditing requirements for 340B entities
Any institution accessing 340B discounts should be required to demonstrate they substantially meet the nancial assistance policy criteria outlined in IRS
501(r)
New civil monetary penalties (CMPs) should be broadened to include entities that fail to demonstrate transparency and adherence to requirements for
limiting patient nancial liability and directing savings back into direct patient care. Existing CMPs for manufacturers should remain in place and be
strengthened
End the exclusion of orphan drugs from 340B pricing for certain entities such as CAHs
Avoid narrowing the patient de nition to exclude insured patients and instead develop a de nition that would require the covered entity to have an ongoing
clinical relationship with the patient
Other nancial reforms
The HHS secretary or federal policymakers should either appropriate funds or implement other funding mechanisms to support reformed program oversight
and operations
Abbreviations: CAH, critical access hospitals; TPA, third-party administrator.

Hannah R. Abrams@hannahrabrams· Mar 24

Should we be reserving stem cells for every patient with #myeloma treated with BCMA CAR T? Reduces severe infections by over half, but >4x cost. Need risk-stratification (or IVIG) to make sustainable. Cost effectiveness modeling in #JCOCCI : ascopubs.org/doi/10.1200/... @ziadbakouny.bsky.social

Title page and abstract:
Cost-Effectiveness of Maintaining Higher Stem-Cell Collection Thresholds in the Chimeric Antigen Receptor T-Cell Era for Multiple Myeloma
Ehsan Malek, MD 1 ; Brian Betts, MD 1 ; Megan Herr, PhD 1 ; Marco Davila, MD 1 ; Shernan Holtan, MD 1 ; James J. Driscoll, MD, PhD 2,3 ; and Han Yu, PhD 1

FIG 3. Cost breakdown by strategy. Stacked bar chart of per-patient costs for the no-boost and boost
strategies. In the no-boost arm, all costs are attributable to hospitalization for infection. In the boost
arm, upfront reserve collection accounts for the majority of costs, while infection-related costs are
markedly lower. Total costs for each strategy represent the sum of upfront collection/storage fees
and longitudinal infection-related hospitalization costs. USD, US dollars.

Figure demonstrates cost per patient >$20,000 in boost group, under $5000 in no boost group. Majority of costs attributable to cost of stem cell collection up-front.

Hannah R. Abrams@hannahrabrams· Mar 22

This is cool: fullerenes, these neat carbon structures discovered in 1985 @ Rice University, significantly reduced incidence of radiation dermatitis in people with head & neck cancer getting radiation. Tx groups not perfectly matched, but encouraging study. ascopubs.org/doi/10.1200/...

Hannah R. Abrams@hannahrabrams· Mar 21

2. How do people living in low broadband access areas feel about Telehealth visits? Surprisingly open - and asking for more proactive outreach. ascopubs.org/doi/10.1200/...

Table 3. Practice Implications for Oncology Providers in Low-Broadband Settings
Practice Domain Key Implication
Proactive Offering Proactively offer VTVs even in low-broadband regions; patients may adopt VTV when given the option
Modality Matching Reserve in-person care for essential physical examinations, labs, transfusions, or imaging, while offering VTV for follow-ups, counseling, and routine check-ins
Situational Flexibility Frame VTV as a safe and practical alternative, especially, during adverse weather, long travel distances, or out-of-state circumstances
Digital Readiness Build digital comfort through low-stakes trial runs, patient portal tutorials, or staff-led technology coaching to reduce first-visit barriers
Relational Care Validate patients' preference for face-to-face care while emphasizing strategies to maintain connection, attention, and trust during VTV
Future Planning Normalize VTV as a scalable option that patients may increasingly rely on with aging, mobility limitations, or worsening weather conditions

Hannah R. Abrams@hannahrabrams· Mar 21

Two important patient-perspective studies JCO OP @jco-asco.bsky.social this week: 1. What do people w/ advanced cancer participating in early-phase clinical trials (ie, Phase 1) understand about their prognosis? 27% believe cancer is curable 38% report never discussing prognosis w/ oncologist.

TABLE 2. Participant-Reported Measures: Prognostic Perceptions and
Hope at the Time of Phase I Clinical Trial Enrollment
27.4% report goal of cancer treatment is to cure cancer, 40% describe themselves as not terminally ill, and 37.8% report never or rarely discussing prognosis with oncologist.

Hannah R. Abrams@hannahrabrams· Mar 16

Broken incentives: when a $3K/year cancer treatment may cost patients more than a $200K/year one. 💸 Why isn't structured exercise getting the uptake it should? Follow up in @jco-asco.bsky.social on economics of #ChallengeTrial @csoncol.bsky.social ascopubs.org/doi/pdf/10.1...

Title: Economics of Translating Research Into Practice: The Case of
Exercise to Prevent Cancer Recurrence
Allan S. Detsky, MD, PhD 1,2,3 ; Kerry S. Courneya, PhD 4 ; Christopher M. Booth, MD 5 ; and Shivan J. Mehta, MD, MBA, MSHP 6,7

Finally, there is a distinct appeal of an exercise program for
patients and family members because of its effectiveness,
low toxicity, and broad accessibility. However, this appeal
depends on how it is paid for and framed. If they are faced
with direct costs because of the lack of insurance coverage,
they may never adopt it because people are price sensitive in
their health care purchase decisions. There is also the be-
havioral bias that patients and clinicians have toward drugs.
Through the availability heuristic, they may only see medical
therapies as helping in their ability to ght cancer. Thus,
they may not fully engage in exercise or be willing to pay
much out of pocket.
The results of the CHALLENGE trial have issued a challenge to
parties that fund and insure health care costs. Are they willing
to fund interventions beyond drugs, devices, and traditional
medical procedures that show comparable effectiveness and
are likely more economically attractive? The economic issues
related to this discovery raises a paradox: It may in fact be
easier to implement a new anticancer medicine with serious
side effects that costs $200,000 USD/year (where the pro t
motive, pathways to implementation and relationships be-
tween the interested parties are well known and previously
traveled) than a much more economically attractive program
of structured exercise proven to be effective in a rigorously
conducted large randomized trial that breaks new ground (ie,
shows an overall survival bene t). That is, it is easier to be
practice-changing than paradigm-changing.

Hannah R. Abrams@hannahrabrams· Feb 26

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.

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.

Hannah R. Abrams@hannahrabrams· Feb 5

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/...

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.

Hannah R. Abrams@hannahrabrams· Feb 1

"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/...

Hannah R. Abrams@hannahrabrams· Jan 31

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....

Hannah R. Abrams@hannahrabrams· Jan 31

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. ascopubs.org/doi/10.1200/...

Hannah R. Abrams@hannahrabrams· Jan 31

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:

Hannah R. Abrams@hannahrabrams· Jan 31

"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. ascopubs.org/doi/10.1200/...