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Journal of Oncology Practice logoLink to Journal of Oncology Practice
. 2015 Mar 10;11(3):e336–e350. doi: 10.1200/JOP.2014.001511

HemOnc.org: A Collaborative Online Knowledge Platform for Oncology Professionals

Jeremy L Warner 1,, Andrew J Cowan 1, Aric C Hall 1, Peter C Yang 1
PMCID: PMC5706141  PMID: 25736385

Future enhancements, including more metadata about drugs and increasingly detailed efficacy and toxicity information, will continue to improve the value of this free source of chemotherapy drug and regimen information.

Abstract

Purpose:

Cancer care involves extensive knowledge about numerous chemotherapy drugs and chemotherapy regimens. This information is constantly evolving, and there has been no freely available, comprehensive, centralized repository of chemotherapy information to date.

Methods:

We created an online, freely accessible, ad-free, collaborative wiki of chemotherapy information entitled HemOnc.org to address the unmet need for a central repository of this information. This Web site was developed with wiki development software and is hosted on a cloud platform. Chemotherapy drug and regimen information (including regimen variants), as well as other information of interest to hematology/oncology professionals, is housed on the site in a fully referenced and standardized format. Accredited users are allowed to freely contribute information to the site.

Results:

From its inception in November 2011, HemOnc.org has grown rapidly and most recently has detailed information on 383 drugs and 1,298 distinct chemotherapy regimens (not counting variants) in 92 disease subtypes. There are regularly more than 2,000 visitors per week from the United States and international locations. A user evaluation demonstrated that users find the site useful, usable, and recommendable.

Conclusion:

HemOnc.org is now the largest free source of chemotherapy drug and regimen information and is widely used. Future enhancements, including more metadata about drugs and increasingly detailed efficacy and toxicity information, will continue to improve the value of the resource.

Introduction

Cancer medicine is a large and complex arena, with 120+ disease subtypes that are often treated in radically different ways.1 The body of knowledge surrounding the treatment of cancer has grown rapidly as conventional chemotherapeutics have been augmented and sometimes supplanted by novel therapies, such as immunotherapy and targeted agents. Because of this complexity, the field has become fractured, with clinical trials and resultant treatment paradigms becoming increasingly narrow in scope. This has resulted in narrow approvals by the US Food and Drug Administration, widespread off-label use,2 and a dauntingly large knowledge space. Chemotherapy treatments are complex, costly, and potentially highly toxic; thus, there are multiple stakeholders with an interest in accurate and timely information about dosages, sequencing of therapies, supportive medications, and durations of treatment. These include, but are not limited to, physicians and physician extenders, nurses, pharmacists, cost and resource decision makers, payers, vendors of computerized provider order entry software, and patients.

In November 2011, we began an experiment that was based on the fundamental question: How can we improve the sharing and access of information in cancer medicine? This question was inspired in part by the Web site Chemoregimen.com,3 which was a commonly used free source of chemotherapy regimen information and primary references. By 2011, it was evident that this Web site was no longer being updated, and it had become a partner with a commercial entity, the Monthly Prescribing Reference. Additionally, there were no means to correct or augment the information content of the Chemoregimen site. To our knowledge, there were no other noncommercial electronic media that offered a comparable information source for chemotherapy regimens and chemotherapeutics. Thus, we created HemOnc.org to provide an online, collaborative, wiki-based knowledge base for chemotherapy regimens, chemotherapeutics, and other related information of interest to hematology/oncology professionals.

Wikis are Web sites that allow people to collaborate on the Internet to create documents and knowledge bases.4 In traditional publishing, articles are written by a limited number of authors/editors, and once published, the content is fixed, except for infrequent erratum and retractions. Information flows in one direction, from the content creators to the content consumers. Conversely, wikis crowdsource information from a potentially much larger pool of contributors, who may add or edit information in an article in real-time to incrementally improve articles through continuous revision. This facilitates a more rapid and comprehensive means of knowledge dissemination. Information flows back and forth between the original content creators and content consumers.

Wikis retain past versions of pages, which allows for straightforward auditing, reversal of errors, and attribution of contributions. Wikis are accessible from any Internet-connected device, searchable, and have internally cross-linked information to connect pages to one another, which facilitates ease of information discovery for users. However, depending on the qualifications and expertise of contributors, wikis have been criticized for being vulnerable to the addition of inaccurate or poorly edited information. Furthermore, depending on how openly granted editing rights are, wikis can be prone to vandalism. Despite these potential disadvantages, this model has proven to be quite successful; the free online encyclopedia Wikipedia5 is perhaps the most well-known example of a wiki. The legitimacy of this approach has recently been bolstered by the finding that pharmacology information on Wikipedia is 99.7% accurate compared with textbooks of pharmacology.6

We were specifically interested in whether an open, collaborative, chemotherapy regimen knowledge base that would be more comprehensive and accurate than existing resources could be created using a wiki platform. This article reports on the progress to date and the initial successes and challenges, and includes the results of a user evaluation.

Methods

Needs Analysis

Before creation of the site, we informally polled oncology trainees and attending physicians to ascertain focus areas for development. One of the most frequently cited frustrations was the lack of a comprehensive, up-to-date chemotherapy regimen reference. Commonly used references were often years old and contained a limited set of references that sometimes did not match the listed regimen. One group's chemotherapy ordering system did not consistently list references for the regimens being ordered. As a result, trainees in particular believed that they were spending too much time trying to find rather than reading the primary literature. Clinicians who were questioned wanted to have a reference that could be used from anywhere and a way to easily record useful information or Web sites to be accessed at a later time. They expressed frustration about the limits of information sharing via only direct communication and conferences and wished to have a means to share information with a broader audience outside of their institution and invite collaboration. Approximately 18 months after the Web site's creation, we conducted a formal survey of its users through the Web site to elicit usability feedback and to learn about users' experiences with errors and inconsistencies found in other resources.

Knowledge base generation.

To appropriately frame the scope of HemOnc.org, we created an organizational matrix based on Zack's knowledge strategy.7,8 This strategy describes knowledge as a function of two axes: Levels and Categories. Categories include: declarative knowledge (termed know-what knowledge), procedural knowledge (know-how), and analytic knowledge (know-why). Levels include core knowledge, advanced knowledge, and innovative knowledge. The initial focus of development was to flesh out the core knowledge components as much as possible. To inform these elements, a wide range of source materials was used to identify data for inclusion in the site. A list of commonly used sources is available (http://hemonc.org/wiki/Sources). Content was manually created by clinicians with access rights to the site.

Drug and chemotherapy regimen information.

For chemotherapeutics and supportive medications included on the wiki, a page was created for each individual drug with general information about mechanism of action and specific information about safety, FDA approval history, common usage, and synonyms. Appendix Table A1 (online only) lists the current categories being applied to individual drugs. Information on antiemetic potential, which is a key concern for many chemotherapeutics, is accessible on the left sidebar of every page (http://hemonc.org/wiki/Antiemesis). For chemotherapy regimens included on the site, regimens are provided on a disease subtype–specific page and further classified by the context in which they were evaluated (eg, first-line metastatic, relapsed/refractory, adjuvant, and so on). An example is shown in Figure 1. Additional details about the information included on drug and chemotherapy regimen pages are available in the Appendix (online only).

Figure 1.

Figure 1.

A portion of the rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen description for untreated follicular lymphoma. There are currently seven variants of this regimen for this context on HemOnc.org. Study design, efficacy, and toxicity information are shown directly above the regimen. All drug names are active links to the respective drug pages. The original reference is listed at the end of the regimen (references are listed in chronologic order), with links to the original article as well as the PubMed abstract page.

Other information.

In addition to a primary focus on chemotherapy drugs and regimens, HemOnc.org has several other content areas. These include sample order sets, lists of diagnosis and billing codes that are commonly used in hematology/oncology practice, reference tables for vesicant and irritant chemotherapeutics, performance status, corticosteroid conversions, and a large number of external links. There is also an extensive style guide (http://hemonc.org/wiki/Style_guide) to guide content contributors.

Platform and security.

HemOnc.org is hosted on a server within a data center run by Linode (Galloway, NJ), a computer hosting provider. The server runs on the Ubuntu Linux operating system (Canonical, London, United Kingdom) with Apache (Apache Software Foundation, Forest Hill, MD) as the Web server and MySQL (Oracle, Redwood City, CA) as the database. The Web site is powered by MediaWiki software (Wikimedia Foundation, San Francisco, CA). There are multiple security measures taken to ensure the integrity and performance of the system. The server is regularly patched with security updates to limit susceptibility to unauthorized access (hacking), and multiple offsite backups are regularly created to protect against data loss. Traffic for the site is routed through the CloudFlare content delivery network (CloudFlare, San Francisco, CA), which helps to improve speed and block traffic from spammers and bots (which include malicious software and/or humans that harvest user data to post or e-mail unsolicited, commercial, and/or malicious content). Asirra9 (Animal Species Image Recognition for Restricting Access; Microsoft, Redmond, WA) is used during the account creation process to ensure that creators are human rather than automated computer programs that are attempting to create spam accounts. Most importantly, the administrators verify the credentials of all users who wish to obtain access rights to add or modify content, and every account is manually approved.

Contributorship.

The Web site does not require visitors to login or have an account to use the site, but people who sign up for a free account have additional benefits, such as custom views. After creating an account, individuals must manually contact the administrators if they wish to have editing privileges. Editing privileges are generally restricted to hematology/oncology professionals (eg, physicians, nurse practitioners, physician assistants, and pharmacists). Thus far, 23 users have been granted editing privileges on the site. Of those 23 users, 10 have contributed content to HemOnc.org.

Results

Content Growth

The first version of the HemOnc.org Web site went live in November 2011. By December 2011, there was content on 66 distinct chemotherapy regimens in eight disease subtypes, and 132 drugs (all FDA approved). By June 2014, there were 1,298 distinct chemotherapy regimens in 58 disease subtypes that are further divided into 92 distinct entities (Appendix Table A2, online only), and 383 drugs (100 of which are in clinical trials). Figure 2 shows the growth of chemotherapy regimen and drug content over time. Annotation of chemotherapy regimens has also increased over time. In June 2013, less than 5% of regimens had information about study design; by February 2014, more than 99% of regimens had such information. The content of drug pages has also expanded over time, with information about FDA approval dates and indications, as well as synonyms, including RxNorm concept unique identifiers, for some drugs. For example, dexamethasone has three RxNorm concept unique identifiers (dexamethasone acetate [22690]; dexamethasone phosphate [235486]; dexamethasone sodium phosphate [48933]) and 529 synonyms. The latest enhancement to the site, which is still underway, is the addition of categorization metatags to drugs (Appendix Table A1).

Figure 2.

Figure 2.

(A) The number of chemotherapy regimens for which information is available on HemOnc.org (count does not include variants of the same regimen). Counts were sampled at 3-month intervals. (B) The number of drugs (antineoplastic and supportive) for which information is available on HemOnc.org. Counts were sampled at 3-month intervals.

Visitors.

Figure 3 illustrates how the user traffic to HemOnc.org has changed during its existence. The site had 34,327 visits in 2012, and traffic increased by 159% in 2013, when there were 88,974 visits. From January 2014 through July 2014, there were 63,252 visits. Overall, 69.5% of users entered the site from search engines; 23.7% of users directly entered the address in their Web browsers or had it bookmarked; and 6.8% of users arrived via referral links from other sites. Over time, presumably as people became more familiar with the site, a greater percentage of them accessed it directly. For example, in July 2014, 32.5% of users directly accessed the site, 61.1% used a search engine, and 6.3% entered via a referral link.

Figure 3.

Figure 3.

The number of visitors per month to HemOnc.org. The blue line represents the total number of visitors. The yellow, green, and brown lines represent the number of visitors per month who entered the site via search engines, directly entering the address in web browsers, and referral links from other sites, respectively.

User evaluation.

We conducted a survey to evaluate the usability of the site. The survey was open from May 1 through May 31, 2013. Survey data were collected and managed using REDCap (Research Electronic Data Capture) software hosted at Vanderbilt University.10 REDCap is a secure, Web-based application that is designed to support data capture for research studies, providing an intuitive interface for validated data entry, audit trails for tracking data manipulation and export procedures, automated export procedures for seamless data downloads to common statistical packages, and procedures for importing data from external sources. Because this survey was anonymous and HemOnc.org does not fall under the auspices of an institutional review board, institutional review board approval was not obtained. Participants were invited by site announcements, social media, and e-mails to hematology/oncology fellowship programs. Usability was assessed by 100-point Likert scales (0 being worst and 100 being best). Other data, including information about which other resources the respondents often used, were collected via multiple choice questions with optional free text entry.

There were 139 respondents, the majority of which were physicians (61%; 26% were nurses, 10% were pharmacists, and 3% were other). The respondents expressed that the site was useful (median score, 90; interquartile range [IQR], 76-99.5), usable (median score, 85; IQR, 69-98), and recommendable to colleagues (median score, 87; IQR, 72-99). All respondents (100%) reported using other references (eg, textbooks), but 70.5% reported accuracy issues with these references. The issues most commonly reported by respondents were: lack of precision needed to properly give the regimen (55%); schedule of administration incorrect (25%); dosage, including body-surface area–based dosing, missing or incorrect (23%); spelling/typographic errors (9%); and route of administration incorrect (5%). Interestingly, only 38 respondents (27%) reported using information provided through their electronic medical record (EMR).

Many respondents indicated a willingness to contribute to the site, including through indirect means such as e-mailing editors with corrections—although only four of 139 (3%) reported being active contributors. For those unwilling to contribute (23 respondents; 17%), the leading reason was a lack of time (15 of 23, 65%). Additional details are available in Appendix Table A3 (online only).

Discussion

HemOnc.org has been a success, as measured by the increase in content, number of visitors, and generally positive user satisfaction. Because of its wiki platform, new content can be added and adapted in real-time to provide whatever information is most interesting to its users. In addition to providing content to a wide variety of stakeholders who are participating in the care of patients with cancer, the site has enabled secondary investigations into the manner in which evidence for cancer treatment evolves over time. For example, we have used HemOnc.org as a content source to inform a treatment regimen network analysis of first-line treatments of chronic myelogenous leukemia,11,12 and have also conducted preliminary investigations into the reclassification of the cancer ontology as a function of treatment.13 Future work will expand on these preliminary studies; one goal is the automated synthesis of treatment guidelines.14 This is especially relevant for disease contexts for which there are large numbers of published regimens, such as the first-line treatment of chronic lymphocytic leukemia (30 regimens on HemOnc.org, 19 of which have been evaluated in randomized controlled trials) or the treatment of metastatic erb-b2 receptor tyrosine kinase 2 (ERBB2/HER2) –negative breast cancer (40 regimens on HemOnc.org, 29 of which have been evaluated in randomized controlled trials).

Several challenges have emerged with this process, most notably, the lack of broad user participation with regard to updating content, and the challenges of dissemination. With respect to the former, it has been well documented that content generation and editing is nonuniform in social media, with a small number of users contributing disproportionately to projects such as Wikipedia.15,16 Medical professionals are typically well compensated for their time and have many conflicting priorities vying for their time, such as patient care, academic pursuits, and teaching. It may be appealing to some individuals to be able to instantly share information that is attributed to them on a well-trafficked, specialized site that their peers visit, but because there is no monetary reward for contributions and limited prestige is associated with an emerging Web site, user participation may remain a challenge. People who requested editing privileges and who did not subsequently contribute or stopped contributing often cited lack of time as a main factor.

Dissemination presents another set of challenges, primarily related to the fact that HemOnc.org is noncommercial and does not have a traditional marketing budget. Thus, awareness of the site is spread by traditional word-of-mouth, media exposure,17 reciprocal exposure on sites such as MyCancerGenome.org,18 and social media outlets such as Facebook and Twitter. It is notable that a majority of traffic arrives through search engines. The importance of search engine optimization cannot be overemphasized, and we have found some success here. For example, a search for the phrase vesicant chemotherapy on Google or Bing will return HemOnc.org as the first result (as of the writing of this article).

A future wish list for enhanced functionality includes improving usability on mobile platforms; enabling HL7 Infobutton technology19 so that drug and regimen information can be obtained by external EMRs; completion of efficacy and toxicity data for all regimens; verification of all unverified regimens; inclusion of more gray literature and abstract sources; determination of so-called outdated status for older regimens that are no longer commonly used; and increased outreach and engagement of patients. Additional information could be added on topics including the cost of treatments, drug shortages, and adverse events.

Many oncology practices use proprietary EMRs and oncology suites with built-in chemotherapy order sets, but they are limited by the release cycles of their vendors or expediency of their in-house order set writers. In a landscape in which the work of discovering new information is often internally duplicated many times over because of lack of information sharing across institutions, we believe that a free, public resource such as HemOnc.org can complement existing tools and be a valuable supplement for our field so that information can be rapidly disseminated and accessed.

In conclusion, HemOnc.org has become, over the course of approximately 3 years, the largest, freely available chemotherapy drug and regimen resource. We anticipate continued growth in content and invite all readers of this article to consider participation in this collaborative project.

Acknowledgment

We thank the contributors of HemOnc.org.

A preliminary version of the survey results was presented in poster format at the American Society of Clinical Oncology Quality Care Symposium, San Diego, CA, November 1 and 2, 2013.

Appendix

Drug information.

For chemotherapeutics and supportive medications included on the wiki, a page was created for each individual drug with, ideally, the following information: (1) general information, including a description of the mechanism of action, route of administration, extravasation information (when available for intravenous medications), and links to package inserts and Risk Evaluation and Mitigation Strategy information (when present); (2) patient drug information, including links to widely used patient drug information Web sites (Chemocare.com and UpToDate); (3) diseases for which the drug is commonly used; (4) date(s) of US Food and Drug Administration (FDA) approval, including the specific indication and any changes in indication; (5) synonyms, including brand name(s) and precise names in the RxNorm terminology (a systematic nomenclature for drugs developed by the National Library of Medicine; Nelson SJ, et al: J Am Med Inform Assoc 18:441-448, 2011); (6) structured categories based on mechanism of action, indication, and so on. For example, the drug carfilzomib [http://hemonc.org/wiki/Carfilzomib_(Kyprolis)] is categorized as a proteasome inhibitor, a multiple myeloma medication (on the basis of FDA indication; Herndon TM, et al: Clin Cancer Res 19:4559-4563, 2013), a Waldenström macroglobulinemia medication (on the basis of positive phase II trial results; Treon SP, et al: Blood 124:503-510, 2014), and a drug FDA approved in 2012. For drugs to be listed on the wiki, they should have FDA or European Medicines Agency approval or have promising published results (generally defined as phase II results that are sufficiently positive to warrant a phase III trial). Investigational drugs are denoted as such and additionally categorized into an investigational agents category. Discontinued drugs (eg, gemtuzumab ozogamicin) are categorized as such; clinical trial drugs failing in the evaluation stage are removed from the wiki when the failure is clearly disclosed by the manufacturer.

Regimen information.

For chemotherapy regimens included on the site, regimens are listed on a disease subtype–specific page and further classified by the context in which they were evaluated, for example, first-line metastatic, relapsed/refractory, adjuvant, and so on. Under each major contextual subheading, regimens are listed in alphabetical order by their commonly known abbreviation (eg, R-CHOP [rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone]) or by individual drug names in the absence of a commonly known abbreviation. Synonyms are listed as well as the Unified Medical Language System structured concept (Bodenreider O: Nucleic Acids Res 32:D267-D270, 2004) when available (eg, Unified Medical Language System concept unique identifier C0393023 represents R-CHOP). Each variant of a regimen is listed separately, with the primary author and study consortium name, if there is one, listed (eg, there are seven variants of R-CHOP listed for untreated diffuse large B-cell lymphoma; the first variant listed was used by the LNH-98.5 [Coiffier B, et al: N Engl J Med 346:235-242, 2002] and LNH03-6B [Delarue R, et al: Lancet Oncol 14:525-533, 2013] study consortiums). Directly under each individual variant, a colored box containing information about the level of evidence for the regimen is displayed, using a green-yellow-red traffic light metaphor. Generally, green represents regimens that have been evaluated in a randomized fashion (eg, phase III studies), yellow represents regimens that have been evaluated in at least 20 patients in a nonrandomized fashion (eg, phase II studies, large pilots), and red represents regimens that have been evaluated in fewer than 20 patients or have been evaluated retrospectively. The chemotherapy regimen is then listed by individual drug (with a link to the individual drug page) with dosage, route, infusion time, and day(s) of administration listed. Missing or ambiguous information in the primary article is denoted, except for infusion time, which is usually missing and therefore simply omitted when not available. Supportive medications reported in the article are also listed (these are often omitted or ambiguous). Finally, the length of cycles and the total number of cycles are listed. Primary references are then listed accompanying each regimen, with the following special tags as needed: Abstract (no manuscript has yet been published to our knowledge); Update (an update to a previously published regimen); Retrospective; Meta-Analysis. Once a regimen has been published in a peer-reviewed publication, abstracts are hidden from view. Links to original articles as well as the PubMed citation are provided for every reference, and references for a full publication, rather than an abstract or other early publication, that was reviewed and confirmed as accurate by an authorized contributor are denoted as “contains verified protocol.” References that contain regimen information that could not be thoroughly reviewed —such as publications to which the contributors did not have subscription access—are denoted as “contains protocol.”

Table A1.

The Main Drug Categories and Subcategories in HemOnc.org

Categories
Cytotoxic chemotherapy
    Alkylating agents
    Anthracyclines
    DNA synthesis inhibitors
    Nitrogen mustards
    Nitrosureas
    Nucleic acid analogs
    Platinum agents
    Proteasome inhibitors
    Taxanes
    Microtubule inhibitors
    Topoisomerase inhibitors
    Vinca alkaloids
    Antimetabolites
    Antifolates
    Purine analogues
    Pyrimidine analogues
Kinase inhibitors
    AAK inhibitors
    ALK inhibitors
    Bcr-Abl inhibitors
    BRAF inhibitors
    BTK inhibitors
    CDK inhibitors
    EGFR inhibitors
    FGFR inhibitors
    FLT3 inhibitors
    HDAC inhibitors
    JAK inhibitors
    KIT inhibitors
    LYN inhibitors
    MEK inhibitors
    MET inhibitors
    mTOR inhibitors
    PDGFR inhibitors
    PLK1 inhibitors
    RET inhibitors
    ROS1 inhibitors
    SRC inhibitors
    SYK inhibitors
    TEK inhibitors
    VEGF inhibitors
Corticosteroids and corticosteroid mimetics
    Antiandrogens
    Corticosteroid synthesis inhibitors
    Androgen receptor inhibitors
    5 alpha-reductase inhibitors
    GnRH agonists
    GnRH antagonists
    Aromatase inhibitors
    Selective estrogen receptor modulators
    Corticosteroids
    Somatostatin analogs
Biologics
    Antibody medications
    Antibody-drug conjugates
    Anti-HER2 medications
    IL-6 inhibitors
    Enzymes
    Immunotherapy
    Immunomodulatory drugs
Investigational and discontinued
    Investigational
    Discontinued
Supportive medications
    Corticosteroids
    Bisphosphonates
    RANK ligand inhibitors
    Antimicrobial
    Antivirals
    PCP prophylaxis
    Chemotherapy protective agents
Radioactive agents
    Alpha emitters
    Radioimmunotherapy
Benign hematology medications
    Hemostasis medications
    Coagulation factors
    Fibrinolysis inhibitors
    Direct thrombin inhibitors
    Factor Xa inhibitors
    Heparins
    Low-molecular-weight heparins
    Phosphodiesterase inhibitors
    Cyclooxygenase inhibitors
    P2Y12 ADP inhibitors
    Chelators
Hematopoietic growth factors
    Erythrocyte growth factors
    Granulocyte growth factors
    Megakaryocyte growth factors
Miscellaneous
    Retinoids
    Vitamins
    Immunosuppresants
    Vasopressin analogs
Medications by cancer subtype
    Acute lymphocytic leukemia medications
    Acute myeloid leukemia medications
    Acute promyelocytic leukemia medications
    Aggressive non-Hodgkin lymphoma medications
    Anal cancer medications
    Basal cell and squamous cell skin cancer medications
    Bladder cancer medications
    Bone cancer medications
    Breast cancer medications
    Cancer of unknown primary medications
    Castleman's disease medications
    CNS cancer medications
    CNS lymphoma medications
    Cervical cancer medications
    Chronic lymphocytic leukemia and small lymphocytic lymphoma medications
    Chronic myelogenous leukemia medications
    Chronic myelomonocytic leukemia medications
    Colon cancer medications
    Esophageal cancer medications
    Essential thrombocythemia medications
    Follicular lymphoma medications
    Gastric cancer medications
    Hairy cell leukemia medications
    Head and neck cancer medications
    Hepatobiliary cancer medications
    HIV-associated lymphoma medications
    Hodgkin lymphoma medications
    Hodgkin lymphoma, nodular lymphocyte–predominant medications
    Immune thrombocytopenic purpura medications
    Light-chain amyloidosis medications
    Mantle cell lymphoma medications
    Marginal zone lymphoma medications
    Melanoma medications
    Mesothelioma medications
    Multiple myeloma medications
    Myelodysplastic syndrome medications
    Myelofibrosis medications
    Non-Hodgkin lymphoma medications
    Non–small-cell lung cancer medications
    Neuroendocrine tumor medications
    Ovarian cancer medications
    Pancreatic cancer medications
    Paroxysmal nocturnal hemoglobinuria medications
    Penile cancer medications
    Polycythemia vera medications
    Prostate cancer medications
    Rectal cancer medications
    Renal cancer medications
    Sarcoma medications
    Small-cell lung cancer medications
    T-cell lymphoma medications
    Testicular cancer medications
    Thymoma medications
    Thyroid cancer medications
    Transplantation medications
    Uterine cancer medications
    Waldenström macroglobulinemia medications
Medications by year of approval
    Specific year of initial approval (eg, 2010)

NOTE. There are 12 main drug categories. One medication can belong to as many subcategories as are relevant.

Abbreviations: AAK, Aurora A kinase; ADP, adenosine diphosphate; ALK, anaplastic lymphoma kinase; BRAF, serine/threonine-protein kinase B-Raf; BTK, Bruton's tyrosine kinase; CDK, cyclin-dependent kinase; EGFR, epidermal growth factor receptor; FGFR, fibroblast growth factor receptor; FLT3, fms-related tyrosine kinase 3; GnRH, gonadotropin releasing hormone; HDAC, histone deacetylase; HER2, human epidermal growth factor receptor 2; IL-6, interleukin 6; JAK, Janus kinase; KIT, tyrosine-protein kinase c-Kit; LYN, tyrosine-protein kinase Lyn; MEK, mitogen-activated protein kinase kinase; MET, hepatocyte growth factor receptor; mTOR, mammalian target of rapamycin; PCP, pneumocystis pneumonia; PDGFR, platelet-derived growth factor receptor; PLK1, polo-like kinase 1; RET, tyrosine-protein kinase ret; ROS1, proto-oncogene tyrosine-protein kinase ROS; SRC, proto-oncogene tyrosine-protein kinase Src; SYK, spleen tyrosine kinase; TEK, angiopoietin-1 receptor; VEGF, vascular endothelial growth factor.

Table A2.

Disease Subtypes Currently Represented on HemOnc.org, With No. of Regimens for Each Subtype (excludes regimen variants)

Subtype No. of Regimens
Benign hematology
    Aplastic anemia 1
    Autoimmune thrombocytopenic purpura 6
    Castleman's disease 1
    Paroxysmal nocturnal hemoglobinuria 2
Malignant hematology
    Acute lymphocytic leukemia 23
         Ph positive
         Ph negative
    Acute myeloid leukemia 41
    Acute promyelocytic leukemia 22
    Aggressive non-Hodgkin lymphoma 68
        DLBCL
        Burkitt's lymphoma
        Primary mediastinal B-cell lymphoma
        Gastric DLBCL
    Chronic lymphocytic leukemia and small lymphocytic lymphoma 55
    Chronic myelogenous leukemia 25
        Chronic phase
        Accelerated phase
        Blast crisis
    Chronic myelomonocytic leukemia 1
    CNS lymphoma 7
    Essential thrombocythemia 2
    Follicular lymphoma 51
    Hairy cell leukemia 5
    HIV-associated lymphoma 9
    Hodgkin lymphoma 26
    Hodgkin lymphoma, nodular lymphocyte-predominant 8
    Large granular lymphocytic leukemia 2
    Light-chain amyloidosis 14
    Mantle cell lymphoma 29
    Marginal zone lymphoma 20
    Multiple myeloma 52
    Myelodysplastic syndrome 10
    Myelofibrosis 6
    Polycythemia vera 1
    T-cell lymphoma 28
        Anaplastic large-cell lymphoma
        Cutaneous T-cell lymphoma
        Extranodal NK/T-cell lymphoma, nasal type
        NK/T-cell lymphoma
        Peripheral T-cell lymphoma NOS
    Waldenström macroglobulinemia 11
Other
    Transplantation conditioning regimens 18
    Autologous stem-cell transplantation
    Allogeneic stem-cell transplantation
Solid oncology
    Anal cancer 4
    Basal cell and squamous cell skin cancer 8
        Basal cell carcinoma
        Squamous cell carcinoma
    Bladder cancer 27
    Bone cancer 28
        Chondrosarcoma
        Ewing's sarcoma
        Osteosarcoma
        Malignant fibrous histiocytoma of bone 94
    Breast cancer
        HER2 negative
        HER2 positive
    CNS cancer 35
        Anaplastic glioma
        Glioblastoma multiforme
        Oligodendroglioma
        Supratentorial astrocytoma
    Cervical cancer 27
    Colon cancer 34
    Esophageal cancer 79
    Gastric cancer 6
    Head and neck cancer 31
    Hepatobiliary cancer 24
        Hepatocellular carcinoma
        Biliary tract cancer
    Melanoma 27
    Mesothelioma 11
    Neuroendocrine tumors 29
        Adrenal gland tumors
        Carcinoid tumors
        Pancreatic neuroendocrine islet cell tumors
        Pheochromocytoma
    Non–small-cell lung cancer 39
    Ovarian cancer 31
    Pancreatic cancer 21
    Penile cancer 11
    Prostate cancer 36
    Rectal cancer 9
    Renal cancer 18
    Sarcoma 27
        Angiosarcoma
        GI stromal tumor
        Giant-cell tumor of bone
        Kaposi sarcoma
        Various other histologies
    Small-cell lung cancer 27
    Testicular cancer 17
        Pure seminoma
        Nonseminoma
    Thymoma 9
    Thyroid cancer 8
        Medullary
        Various other histologies
    Unknown primary 14
        Adenocarcinoma or carcinoma NOS
        Squamous cell carcinoma
        Neuroendocrine
    Uterine cancer 23
        Endometrioid
        Various other histologies
Total 1,298

Abbreviations: DLBCL, diffuse large B-cell lymphoma; HER2, human epidermal growth factor receptor 2; NK, natural killer; NOS, not otherwise specified.

Table A3.

Results of Questions From Usability Survey

Questions and Answers Respondents
No. %
Q1: Have you contributed to HemOnc.org?
    A1: Yes 4 3
    A2: No 135 97
Q2 (Multiple choices are allowed): HemOnc.org is a collaborative wiki. This type of site allows all of its users to work together and edit the pages you see. In what ways would you consider contributing to this site?
    A1: Add example order sets 18 13
    A2: Add new regimens 23 17
    A3: Add new references 31 22
    A4: Correct mistakes 33 24
    A5: Create new pages that will be helpful to me in clinical practice, such as checklists for certain diseases 27 19
    A6: Would not create an account and personally modify any information, but would e-mail an editor about errors, references/papers to be added, or other information to be included 44 32
    A7: Would not be interested in contributing at all 23 17
Q3 (Only visible if A7 is checked for Q2, above; multiple choices are allowed): Which of the following best describes the reason for your unwillingness to contribute?
    A1: Fear of introducing errors 6 26
    A2: HemOnc.org not likely to be around for long 1 4
    A3: I'm not tech-savvy enough 6 26
    A4: Information is complete already 1 4
    A5: Lack of knowledge (real or perceived) 3 13
    A6: Not enough time 15 65
    A7: Not worth my time 2 9
    A8: Too steep of a learning curve 0 0
Q4 (Multiple choices are allowed): Please choose which of the below, if any, would help you start contributing (or contribute more, if you're already contributing)
    A1: Continuing medical education (CME) or similar professional development recognition 38 27
    A2: A different user interface 9 6
    A3: Inclusion in future publications based on number of contributions 15 11
    A4: Recognition as a content expert (eg, section editor) 21 15
    A5: Reminder emails 22 16
    A6: A small monetary compensation for each contribution 21 15
    A7: None of the above 47 34
    A8: Other 5 4

NOTE. These questions specifically focused on the degree to which users have contributed, reasons for noncontribution, and barriers to contribution. Except for Q1, answers may not sum up to 100% because the questions were multiple choice, and leaving a question unanswered was permitted.

Abbreviations: A, answer; Q, question.

Authors' Disclosures of Potential Conflicts of Interest

Disclosures provided by the authors are available with this article at jop.ascopubs.org.

Author Contributions

Conception and design: Jeremy L. Warner, Peter C. Yang

Financial support: Jeremy L. Warner

Administrative support: Jeremy L. Warner

Collection and assembly of data: All authors

Data analysis and interpretation: Jeremy L. Warner, Peter C. Yang

Manuscript writing: All authors

Final approval of manuscript: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

HemOnc.org: A Collaborative Online Knowledge Platform for Oncology Professionals

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or jop.ascopubs.org/site/misc/ifc.xhtml.

Jeremy L. Warner

No relationship to disclose

Andrew J. Cowan

Stock or Other Ownership: Doximity

Consulting or Advisory Role: Doximity

Aric C. Hall

No relationship to disclose

Peter C. Yang

Stock or Other Ownership: Merck, Pfizer, Cyclacel

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