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The September issue of ONCOLOGY features a rare case study on glioblastoma, discussions on end-of-life care, and insights into the field of pediatric oncology. 

September ONCOLOGY Publication

What to Consider After Diagnosing a Patient with Ductal Carcinoma in Situ?

While ductal carcinoma in situ (DCIS) is a pre-cancerous diagnosis, it remains a hot topic of discussion among radiation oncologists. At the 

2026 American College of Radiation Oncologists (ACRO) Summit

, Jean L. Wright, MD, FASTRO, delivered a presentation titled “Updates and Best Practices for DCIS”, which highlighted new research in DCIS. Wright, the chair of the radiation oncology department, as well as a professor, at the University of North Carolina School of Medicine, spoke with CancerNetwork® in the wake of her presentation.

The discussion began with Wright putting the diagnosis into context. DCIS is a non-obligate precursor to invasive disease; it does not guarantee that all patients who are diagnosed with DCIS will develop invasive disease. As there are a multitude of treatment options available in DCIS, which Wright stated in an earlier portion of the interview, much of the treatment decision made stems from what the patient wishes to accomplish and how they tolerate risk. This risk refers to both recurrences as well as toxicity. Despite these risks, the range of treatment options means that there will be a reasonable option available to the patient.

Wright reiterated the importance of the patient’s perspective. As a result of this and the various treatment options, there is no perfect treatment that works for all patients; however, when choosing the right one, a physician can treat to a patient’s desires and goals.

What were the key takeaways from your presentation?

Well, I would say, whenever I talk about DCIS, the main thing that I always like to emphasize, and I started off at the beginning of the talk, just putting the diagnosis itself in context. This is a pre-cancerous diagnosis, or we think of it as a non-obligate precursor to invasive disease, meaning that not everybody who has a diagnosis of DCIS is ultimately going to develop invasive disease, although many will, and that it's really invasive disease that has the potential to impact survival and cause problems down the line. The first and foremost thing is just that I always reassure my patients and think about that we have a lot of options. A lot of what we decide to do depends on the patient's willingness to tolerate risk, both with respect to recurrences but also the risk of toxicities. So just having that holistic view of what the diagnosis is, and that there's going to be a range of reasonable choices, and that the patient's perspective is very, very important. For that reason, it's not like there are some cases where you're just like, “This is what we have to do.” We know that to have a good outcome, we have to do this with DCIS. There’s a lot we can consider.

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Because there are so many options available for treating DCIS, the chosen method is often based upon the patients’ preferences, said Jean L. Wright, MD, FASTRO.

Building Trust and Removing Barriers in Clinical Trial Diversity

Despite clinical trials being the engine of oncologic progress, representation remains a significant hurdle in achieving equitable outcomes. For Kathie-Ann Joseph, MD, MPH, FACS, bridging this gap requires more than just opening new study sites; it demands a fundamental shift in how the oncology community approaches patient trust and trial logistics.

Joseph spoke with CancerNetwork® about the imperative of "cultural concordance" in the clinical workforce and the need to reframe trials as a pillar of standard care rather than an experimental burden. She also challenged trial designers to mitigate the geographic and socioeconomic barriers that frequently lead to patient attrition among underrepresented groups.

Jospeh is chief of Breast Surgery and co-director of the Breast Oncology Program, Rutgers Cancer Institute and Jack & Sheryl Morris Cancer Center; associate chief surgical officer for System Integration and Quality, RWJBarnabas Health; director of Breast Surgical Services, RWJBarnabas Health Southern Region; and professor of surgery, Rutgers Robert Wood Johnson Medical School.

We have clinical trial enrollment in general. I would love to see it improve overall. Nationwide, we need to see if every patient with breast cancer, if applicable, should be enrolled in a clinical trial. First, you need to develop trust with your patients. The trials should be available so that it’s not too much of a burden on the patient. [Patients] need to see people like me, doctors that look like me, and more staff that looks like them, that they can trust. For any doctor, any oncologist, it’s about building that trust so they understand that clinical trials should be part of the standard care. It’s not something that is an experiment, but it’s something that we’re doing to advance the treatment of cancer care, and if that can be explained in a way that the patients understand, but we need to address the barriers that patients experience when they enroll in a trial. If it involves a lot of testing, blood draws and so forth, and patients live far away, we have to start to think about ways that we can address it, so these trials don’t become a burden to the patient. If that means if patients can do things locally in their community, so if they live far away, we need to think about that too, so that patients don’t drop out of trials and so forth. We just have to be thoughtful about the way that we design trials and make it easier for them to not just sign up for a trial and want to sign up for a trial, but also to continue and complete a trial.

Certain strategies are needed to improve clinical trial diversity, focusing on building patient trust, increasing workforce representation, and reducing logistical burdens.

Parul Barry, MD, discusses advances like ultra-hypofractionated radiation and the growing role of AI in streamlining workflows for breast cancer care.

2026 American College of Radiation Oncology (ACRO) Summit

, Parul Barry, MD, a radiation oncologist at University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center and Magee-Womens Hospital, highlighted the evolving landscape of breast cancer treatment. Barry discussed the transition to shorter radiation schedules, the potential for combining systemic therapies with radiation, and the emerging role of theranostics and artificial intelligence in enhancing clinical workflows and patient outcomes.

CancerNetwork®: Are there any presentations that have stood out to you so far regarding breast radiation oncology?

 Several presentations have explored shorter radiation schedules to make treatment more accessible, as well as optimizing regional nodal irradiation for patients with node-positive or high-risk breast cancer.

How has ultra-hypofractionated breast radiation changed clinical workflows and the patient experience?

The change has been dramatic, especially since the start of the COVID-19 pandemic, as we moved toward using 5-fraction schedules more frequently. We found that patient compliance and the ability to complete treatments within the scheduled time have increased, along with patient satisfaction. Completing treatment in 5 short sessions is a palatable way for patients to achieve a durable cure compared with traditional 5-to-7-week schedules.

As antibody-drug conjugates (ADCs) and targeted therapies move earlier into breast cancer care, how can radiation teams adapt sequencing and toxicity management strategies?

These therapies, such as HER2-directed ADCs or sacituzumab govitecan-hziy [Trodelvy], are critical for managing cancer. Integrating them with radiation for patients at high risk for relapse requires excellent communication between radiation oncologists, medical oncologists, and surgeons to ensure seamless transitions between treatments. Currently, we avoid concurrent use of radiation and ADCs due to toxicity concerns. However, there is significant interest in using them together in the future to potentiate effects in resistant, high-risk cancers.

Are there specific trials or trends in the breast cancer space that you are following closely?

I am interested in trials combining chemotherapy and radiation, such as studies for inflammatory breast cancer. There was also an ETCTN trial (NCT04052555) investigating berzosertib with radiation, and the combination of immunotherapy and radiation is very interesting for the high-risk population. I am focused on combining systemic therapy and radiation for the curative management of advanced and high-risk breast cancers.

Are you currently involved in any research that you would like to discuss?

At UPMC, we are conducting advanced research in the preoperative space by delivering radiation before surgery to assess cancer response. If we can eliminate the cancer with high-dose radiation before surgery, we can evaluate whether patients can de-escalate or skip systemic therapy, endocrine therapy, or even surgery. This involves a collaborative team focusing on precision radiation, medical, and surgical oncology. We also utilize translational researchers for rapid processing of ctDNA or immune function samples. Additionally, we are investigating theranostics and radiopharmaceutical therapy for all subtypes of metastatic breast cancer through multiple clinical trials.

What potential does theranostics have to propel the treatment of breast cancer?

For patients living with metastatic breast cancer as a chronic disease, the cancer can become resistant to systemic therapies over time. Radiopharmaceutical therapy offers a different mechanism that stimulates the immune system and treats the cancer differently. It can target specific proteins, such as fibroblast activation protein (FAP), and may sensitize metastatic cancers to future systemic therapies.

What topics would you like to see gain more attention within the radiation oncology community?

Compliance with endocrine therapy is approximately 50% in real-world data because patients often stop due to [adverse] effects like joint pain. Low-dose radiotherapy to the joints can reduce pain and improve mobility, allowing patients to continue their endocrine therapy. This is a way to treat benign disease to improve cancer cure rates. I also want to see more focus on using theranostics to radiosensitize patients who have been heavily pre-treated with systemic therapy.

Looking 3 to 5 years into the future, what developments are you anticipating?

I expect growth in surface guidance and more conformal boluses for post-mastectomy radiation, particularly for inflammatory breast cancer. Artificial intelligence will be extremely helpful for contouring and developing targets, which improves access and allows for timely treatment as we move toward 5-fraction regimens. We may also see the use of definitive primary radiation for early-stage breast cancer, like how it is used in lung cancer.

Is there anything else you would like to add about the state of breast radiation oncology?

This is an exciting time to be a breast radiation oncologist. We have many new developments on the horizon and can offer diverse options for patients through collaborative work with surgeons, medical oncologists, and survivorship teams.

Testing the addition of an anti-cancer drug, berzosertib, to the usual treatment (radiation therapy) for chemotherapy-resistant triple-negative and estrogen and/​or progesterone receptor positive, HER2 negative breast cancer. ClinicalTrials.gov. Updated February 2, 2026. Accessed February 6, 2026. https://tinyurl.com/2huubwt8

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Advancing Precision and Access in Breast Radiation Oncology

Deb Schrag, MD, MPH, discusses her journey into GI oncology, the development of patient-reported outcome systems, and her vision for the upcoming ASCO presidency.

Oncology has transitioned from a generalist field to one of immense sub-specialization, expanding to nearly 1000 different therapeutic options. For Deb Schrag, MD, MPH, the incoming president of the American Society of Clinical Oncology (ASCO) for the 2027-2028 term, this evolution highlights a shift from simply memorizing data to mastering the application and communication of accessible knowledge.

A gastrointestinal (GI) oncologist and population scientist, Schrag’s career has been defined by a commitment to the “science of care delivery”. Her early medical training in New York City during the height of the human immunodeficiency virus (HIV) and multidrug-resistant tuberculosis epidemics provided a front row seat to how social determinants of health dictate patient outcomes. This experience launched a career-long dedication to public health and multidisciplinary collaboration—a "team sport" approach she likens more to soccer than tennis.

In an interview with CancerNetwork®, Schrag reflects on the following:

 Her work developing an open-source, global system to capture toxicity and adverse effects directly from the patient perspective, ensuring clinicians understand how patients feel between office visits.

 Addressing clinician burnout through the integration of AI to reduce administrative "drudgery" and the cultivation of high-functioning teams able to nurture resilience .

 Her vision for advancing ASCO’s mission by accelerating the translation of discovery into scalable, real-world care and ensuring that the discovery engine and research mission is preserved.

Through it all, Schrag remains guided by a simple yet profound piece of advice: "Stay curious". By maintaining sharp observational skills and directing attention toward meaningful insights, she believes the oncology community can move beyond helping patients survive to helping them truly thrive.

CancerNetwork: Are you able to discuss your undergraduate days and what drew you to the field of Gi oncology?

Schrag: I’m from New York City, went to Boston for college, and came home for medical school. I did my undergraduate medical training at Columbia Presbyterian at the height of the HIV epidemic. It was a triple epidemic of HIV, multidrug-resistant tuberculosis, and cocaine. I had a front row seat to how social determinants of health influenced patient outcomes. I had an opportunity to see all the multiple dimensions and components of the complexity of patients’ lives and how that influenced the health care that they were able to access and receive, and how that determined outcomes. It launched my interest in public health and population science.

My interest in GI oncology emerged later…. Like so many people, I was influenced by some terrific mentors. What I liked about GI oncology was the variety of diseases some caused by genetic risk, others by lifestyle, behavioral factors and others by environmental exposure. Right now we are struggling to understand the epidemic of early onset cancers, particularly colorectal cancer.GI oncology is a team sport, and I found collaborating and working with surgeons, radiation oncologists, radiologists and pathologists to achieve the best possible outcomes for patients immensely rewarding. The joy of working as part of a multidisciplinary team and seeing team care enables us to push boundaries and achieve amazing things for our patients.

What are some of the most significant shifts you've witnessed in oncology?

Oncology started out as a generalist field, and it’s become more sub-specialized. When I started training in the 1990s, there were fewer than 50 drugs.. Now there are nearly 1000, so it is no longer possible for a human being to retain all that knowledge. It used to be that we memorized all the drugs and their [adverse] effects. Now knowledge is at our fingertips available in an instant on our phones, but the skill we need is the application of that knowledge and the ability to navigate complexity. How we access information and knowledge has changed, and how we do our work has changed.. It’s not so much knowing facts and information as knowing how to retrieve information, how to select the best information, and how to communicate that information in an impactful way that matters now. Information is also democratized because our patients and their families also have access to information. For example, we have to communicate with our patients and help them understand why trials are important and why a trial is right, or why a particular treatment is right, even if it has some challenging [adverse] effects. Early on, oncology was about what you knew. . Now what matters is how you apply the existing body of knowledge and how you convey and communicate it to achieve maximum impact. As we enter the era of machine learning and AI, how we obtain, discover and apply knowledge is undergoing further change—and for cancer care professionals the stakes are high.

Looking back at your career, is there a trial or study that you’ve worked on that you’re most proud of or that you consider your biggest achievement?

I worked with a close colleague, and a team to develop a system to capture toxicity and the[adverse] effects of cancer treatment from the patient perspective. Many oncologists know about the CTCAE system that oncologists use to grade how severe [adverse] effects like nausea are.

We developed a system to elicit from patients, the severity of [adverse] effects, the frequency of [adverse] effects, and how much they’re interfering with patients’ daily lives. When we developed that system, we figured out how to ask patients the right questions. The patient reported outcomes version of the CTCAE or PRO-CTCAE is now out in the public domain and available in over 30 different languages. It’s maintained by the National Cancer Institute, and it’s been integrated into no longer hundreds, but 1000s of clinical trials for patients around the world. It’s completely free, open, and available. It of empowers patient engagement and generates outcome data that’ don’t just reflect how long survival is but how people feel on treatment. When new drugs are approved by the FDA having these outcomes ensure that we understand the effects of new agents on survival as well as how people function and feel--- from both patient and clinician perspective. I believe that is a significant step forwards in how we make therapeutic advances in cancer medicine. 

I’m proud of that work all accomplished as part of incredible teams, and I do think that, as we have more and more cancer treatments and patients are living longer and longer, we can pivot some of our attention to not just helping people survive, but helping them survive well. More than survive, we want people to thrive. After cancer treatment, we want to ask our patients, are you back on track, to whatever your previous track and life trajectory was? It is going to be different for a college student with Hodgkin’s disease vs an 80-year-old who may have bladder cancer. They have very different life trajectories. Whatever your thriving is, did we get you back there with our treatments? Did we manage to get you to where you were before the cancer diagnosis veered you off course for a bit? We have ways to measure that now that can help the next patient make a better decision. That work, to me, is fundamental, and I’m proud of it.

Regarding your ASCO presidency, what is something that you're most looking forward to accomplishing during your tenure?

I’m looking forward to advancing ASCO's mission. The global cancer community is powerful, particularly when we join forces and are aligned for what I would call the best values that transcend political, geographic, and economic boundaries. That’s the big picture answer. Specifically, I’m excited about advancing the discovery and translation agenda, and in particular, figuring out how we take all this amazing discovery and integrate it more quickly into care and scale it so that it reaches more people more quickly. What you might call the “science of care delivery”.

ASCO has reported on a workforce shortage, with many clinicians retiring or being burnt out. How will you attempt to combat this while helping mid-level clinicians nurture their careers?

I wish there were an easy answer or one word. [If there were], the one word would probably be AI, but that’s not so simple. AI is a piece of it. We can use AI to eliminate some of the drudgery or tasks related to approvals and various layers of administrative work that have just become a part of modern medicine, but we have to hold the line and minimize that, and work on leveraging these powerful new tools to help automate or reduce the burden of some of the work that may be necessary. But that doesn’t bring joy. What brings joy to most physicians are the interpersonal connections, the judgment, the insight, and the relationships and critically, the opportunity to make new discoveries that change lives. Filling out forms and documentation doesn’t add a lot of joy. We have to figure out how AI can help us eliminate some of the tedious drudgery so we can focus on the humanistic and creative aspects of our roles which are meaningful

Harnessing the power of AI and teaching the global workforce how to use AI [is imperative]. The oncology workforce skews senior, but the senior members of the workforce need to be trained, and the next generation is going to kick it up a notch and take it to the next level. We have to engage the next generation and help them understanding how rewarding careers in oncology are despite the challenges. In the future, new professionals will partner with us and play a greater role in helping us make impactful discoveries. For example, we’re going to have more engineers partnering with us. We’ve had nurse practitioners for a couple of decades now. We’ll see that continue to grow, but we have to engage them and integrate them into our practice and ensure that we partner together effectively. We also need to understand the science of teamwork and how we work together. High-functioning teams are probably one of the best antidotes to burnout. When people feel like they’re part of a high-functioning team and they feel known and understood and that their roles matter, they feel more joy in their work, and they’re less prone to burnout. Burnout can be associated with loneliness and isolation, and loneliness and isolation are not good for anyone. They are especially devastating for people in helping professions like medicine. Nurturing the joy in medicine and tapping into what motivated people to enter the profession in the first place are critical tasks.

What is one piece of advice that you still carry to this day?

It’s so simple, but don’t forget to read. Keep reading. Which is a simple way of saying, stay curious. Stay engaged. Keep paying attention. These days it may be listening to a podcast or audiobook, but that is just another form of reading. What it means, is try to learn something new. Read something not just in your comfort zone. For me, that may be reading a study in the field of infectious disease or in the field of informatics, or something that’s not directly in my field, maybe something from the cardiovascular field. And count something is a succinct way of saying, “Stay curious, Keep those observational skills open.” Observe. Pay attention. Your attention is a precious gift, and it is a powerful tool. What you’re paying attention to, what you’re counting, and what you’re noting do matter and will lead to insights and spark new ideas. These days, I do think we often talk about the data economy, but I also think we have an attention economy. There is so much information, so much knowledge, and so many opportunities that where we direct our attention is critically important.

Dr. Deb Schrag elected ASCO president for 2027-28 term. News release. ASCO. December 19, 2025. Accessed January 21, 2026. https://tinyurl.com/2vxpfh9b

Basch E, Iasonos A, McDonough T, et al. Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. 

. 2006;7(11):903-909. doi:10.1016/S1470-2045(06)70910-X

Kirkwood MK, Balogh EP, Accordino MK, et al. Where have we been and where are we going? The state of the hematology and medical oncologist workforce in America. 

. 2025;21(12):1775-1785. doi:10.1200/OP-25-00144

ASCO President Elect Talks Advancing Patient-Centered Care and Team-Based Innovation

Why Discuss Ductal Carcinoma In-Situ at a Major Oncology Conference?

Among the many hot topics discussed at the 

, radiation therapy for breast cancer was discussed frequently. Jean L. Wright, MD, FASTRO, delivered one such presentation on breast cancer titled “Updates and Best Practices for [ductal carcinoma in situ (DCIS)]”.

As evidenced by the name, she detailed the current updates and best practices for treating patients who are diagnosed with DCIS. Notably, while DCIS is not a high-risk diagnosis and is instead a low-risk diagnosis, there are a great deal of options available to patients, which can complicate the decision-making process. Currently, surgery does remain the standard-of-care; however, investigators still seek a non-surgical strategy to manage DCIS.

Wright, the chair of the radiation oncology department, as well as a professor at the University of North Carolina School of Medicine, spoke with CancerNetwork® during the Summit. Throughout the conversation, she also highlighted how, after a patient completes surgery, they are still able to decide between receiving endocrine therapy or radiation. Wright also reiterated the constant flow of new information and data on DCIS.

Why is it important to discuss DCIS care?

Well, it’s an important topic, because even though ductal carcinoma in situ is a low-risk diagnosis, as I emphasized in the presentation, the decision-making around how we’re going to treat patients with DCIS is amongst the most complex, just because of the very wide range of options that we have. As I shared in the talk, most patients present asymptomatically and have to first make a decision about undergoing surgery. Surgery is the standard treatment right now, but there is a lot of interest in exploring non-surgical management. There’s a lot of discussion that, particularly certain motivated patients, will bring that into the conversation, which you have to be facile with addressing. Then postoperatively, you have radiation, you have endocrine therapy, and then even within those categories, you have a wide range of options. There’s so much to consider. I’ll also say that just preparing for this talk, I looked back on what had been published even within the last year, and there's just constant new information that's coming out. There’s just a lot to think about.

According to Jean L. Wright, MD, FASTRO, the flow of new information and research pertaining to ductal carcinoma in situ is constant.

The implementation of AI into radiomics may help predict the likelihood of response to therapies among patients undergoing breast cancer treatment.

Outlining Advances in AI For Breast Cancer Screening/Radiomics

Clinical trials, including the phase 3 TAILORx trial (NCT00310180), have served as validation points for radiomic models, enabling clinicians to predict responses to endocrine therapy and other treatments with CT scans.

Arturo Loaiza-Bonilla, MD, MSEd, FACP, the systemwide chief of Hematology and Oncology at Saint Luke’s University, discussed key advances regarding the implementation of artificial intelligence (AI) in breast cancer screening and treatment. First, he highlighted a new step for breast cancer: validation of breast cancer screening at a population level.

Then, he explained that he is examining the use of AI in the early detection of cancer through mammograms, but that it has been applied to genomic testing and biomarker testing as well. Additionally, citing findings presented at the 

2025 San Antonio Breast Cancer Symposium,

 he stated that transformer-based architecture could predict recurrence in patients and identify certain patients who may require additional screening for germline alterations or risk factors.

Using radiomics as an example, he explained that a CT scan can be used to assess the probability of response with certain therapies. Citing studies such as the TAILORx trial, he concluded by suggesting that studies have validated many of these models for use in the clinic.

In breast cancer, the new steps are, first, validation at the population level. Each country and each region is doing its own clinical trials. I’m currently running for early detection with mammograms and others. We also have seen that the implementation of AI into the genomic testing, or the biomarker testing, on our patients is becoming relevant.

There were some updates from [the 2025 San Antonio Breast Cancer Symposium] showing how a potential transformer-based architecture can predict potential recurrence in patients. It can optimize those recurrent response scores that we are seeing from different vendors in a more meaningful way and find those niche patients that need either more screening or early detection of other things, such as germline alterations or risk factors, when we use any combination with other data sets.

In this case, for example, we can use radiomics. We know that with radiomics, we can, just by looking at a CT scan, understand if the patient is going to respond to, for example, endocrine therapy. That’s something that, for us, is mind blowing because we did not have that information before. Now, using the data sets for many clinical trials that have been done before––the [phase 3 TAILORx trial] and others––has been a major validation point for many of those models that are being deployed in the clinic, or at least in clinical practice for further validation.

Feng C, Muhammad H, Chavan SS, et al. Artificial intelligence predicts OncotypeDX recurrence scores directly from H&E-stained whole slide images of ER+/HER2- node-negative breast cancer surgical sections. Presented at: 2025 San Antonio Breast Cancer Symposium; December 9-12, 2025; San Antonio, TX. PS3-06-02