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Vasquez-Trespalacios EM, Rivera Rivera JN, McIntyre M, Santiago-Datil W, Wenham RM, Vadaparampil ST, Buras AL, Conley CC. High Financial Hardship among Patients with Advanced Ovarian Cancer. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:120-132. [PMID: 38635421 DOI: 10.1080/15524256.2024.2342285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Ovarian cancer is considered the most fatal and costly gynecologic cancer. Although personalized therapies have improved ovarian cancer prognosis, they have resulted in increased financial toxicity concerns among this population. This study evaluated financial toxicity in patients with advanced ovarian cancer. Using secondary data from a study of barriers to palliative care, financial toxicity (FT) was measured through the Comprehensive Score for Financial Toxicity scale. Univariate and bivariate analyses were used to assess the relationship between selected demographic (i.e., age, race, ethnicity, education, place of birth, insurance type, yearly household income, employment status) and treatment-specific variables (i.e., years since diagnosis, surgery, chemotherapy, radiation, hormonal and targeted therapy) with clinically relevant financial toxicity. Characteristics were compared using Fisher's exact or chi squared tests. A total of 38 participants with advanced ovarian cancer were included in this study; 24% (n = 9) reported clinically significant FT. Income (p = .001), place of birth (p = .048) and employment status (p = .001) were related to FT. Study findings highlight that advanced ovarian cancer patients experience high FT, particularly those with low income, who are not able to work and were born outside the US. Further research using larger datasets and more representative samples is needed to inform intervention development and implementation.
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Affiliation(s)
| | | | - McKenzie McIntyre
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Andrea L Buras
- Department of Gynecologic Oncology, Lacks Cancer Center, Grand Rapids, MI, USA
| | - Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, USA
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2
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Bertolaccini L, Mohamed S, Bardoni C, Lo Iacono G, Mazzella A, Guarize J, Spaggiari L. The Interdisciplinary Management of Lung Cancer in the European Community. J Clin Med 2022; 11:jcm11154326. [PMID: 35893419 PMCID: PMC9332145 DOI: 10.3390/jcm11154326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023] Open
Abstract
Lung cancer continues to be the largest cause of cancer-related mortality among men and women globally, accounting for around 27% of all cancer-related deaths. Recent advances in lung cancer medicines, particularly for non-small-cell lung cancer (NSCLC), have increased the need for multidisciplinary disease care, thereby enhancing patient outcomes and quality of life. Different studies in the European community have evaluated the impact of multidisciplinary care on outcomes for lung cancer patients, including its impact on survival, adherence to guideline treatment, utilization of all treatment modalities, timeliness of treatment, patient satisfaction, quality of life, and referral to palliative care. This publication will examine the roles and duties of all multidisciplinary members and the influence of multidisciplinary care on lung cancer outcomes in Europe. Multidisciplinary treatment is the foundation of lung cancer treatment. The optimal setting for interdisciplinary collaboration between specialists with complementary functions is multidisciplinary meetings. Multidisciplinary care in lung cancer facilitates the delivery of a high-quality service, which may improve lung cancer patients’ survival, utilization of all treatment modalities, adherence to guideline management, and quality of life, despite the fact that only limited observational data have demonstrated these results. To confirm the relationship between multidisciplinary treatment and improved lung cancer patient outcomes, however, further research is required.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
- Correspondence: ; Tel.: +39-02-57489665; Fax: +39-02-56562994
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Claudia Bardoni
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Juliana Guarize
- Unit of Interventional Pulmonology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
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3
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Heritage SR, Lynch-Kelly K, Kalvala J, Tulloch R, Devasar A, Harewood J, Khoury E, Abdelwahed A, Fung A, Bigogno CM, Gray R, Keshwara S, Joseph PJS, Selby P, Tharmalingam H. Medical Student Perspectives on Undergraduate Oncology Education in the UK. Clin Oncol (R Coll Radiol) 2022; 34:e355-e364. [PMID: 35595594 DOI: 10.1016/j.clon.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/31/2022] [Accepted: 04/27/2022] [Indexed: 11/03/2022]
Abstract
AIMS The British Oncology Network for Undergraduate Societies (BONUS) surveyed students who attended an oncology revision day to determine their views on the current quantity, quality and type of curriculum-based oncology teaching they have experienced. MATERIALS AND METHODS Students attending two BONUS revision days received a questionnaire assessing their experience of oncology teaching within the medical curriculum and interest in pursuing a future career in oncology using a 10-point Likert scale. Data were collected with informed consent to be anonymised and used for research. Student demographics and qualitative and quantitative data about experiences of oncology education were analysed. RESULTS In total, 451 students registered to attend the revision days. After removal of duplicates, non-responders and non-UK participants, responses from 153 students studying across years 1-6 at 22 UK medical schools were analysed. The mean quantity of oncology lectures students reported receiving was 8.9 hours and the mean quantity of clinic/ward-based oncology teaching was 7.5 hours. Ninety (62.1%) of the 145 students who responded to the relevant question reported that they had received dedicated teaching in oncology. Students who had received dedicated oncology teaching reported a statistically significantly higher mean quality 6.1 (95% confidence interval 5.6-6.5) versus 5.0 (95% confidence interval 4.3-5.5; P = 0.003) and quantity 5.2 (95% confidence interval 4.7-5.6) versus 4.3 (95% confidence interval 3.7-4.9; P = 0.03) of oncology teaching compared with those who had not received this. CONCLUSION Appropriate oncology education is essential for all medical students due to the high prevalence of cancer. All future doctors need the appropriate knowledge and communication skills to care for cancer patients. Our analysis provides quantitative evidence to support the value of specialist oncology teaching within the medical school curriculum in improving student-reported experience. National student-led revision days and events may widen interest in a future career in oncology and aid collaboration between oncology societies. It is important for the general undergraduate medical curriculum to integrate specialty content. An integrated curriculum should facilitate a holistic approach that spans prevention, screening, treatment and palliation rather than being split by subspeciality.
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Affiliation(s)
- S R Heritage
- School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - K Lynch-Kelly
- GKT School of Medical Education, King's College London, London, UK
| | - J Kalvala
- School of Medicine, University of Nottingham, Nottingham, UK
| | - R Tulloch
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - A Devasar
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - J Harewood
- School of Medical Education, Newcastle University, Newcastle, UK
| | - E Khoury
- School of Medicine, University of Liverpool, Liverpool, UK
| | - A Abdelwahed
- School of Medicine, Imperial College London, London, UK
| | - A Fung
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - C M Bigogno
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - R Gray
- School of Medicine, University of Dundee, Dundee, UK
| | - S Keshwara
- Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - P J S Joseph
- School of Medicine, University of Liverpool, Liverpool, UK
| | - P Selby
- University of Leeds, Leeds, UK; University of Lincoln, Lincoln, UK
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4
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Cufer T, Kosty M, Osterlund P, Jezdic S, Pyle D, Awada A, Close J, El-Saghir N, Lordick F, Rutkowski P, Tfayli A, Wildiers H. Current landscape of ESMO/ASCO Global Curriculum adoption and medical oncology recognition: a global survey. ESMO Open 2021; 6:100219. [PMID: 34924144 PMCID: PMC8710493 DOI: 10.1016/j.esmoop.2021.100219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background With the implementation of multidisciplinary treatment and development of multiple novel anticancer drugs in parallel with expanding knowledge of supportive and palliative care, a need for separate training and specialisation in medical oncology emerged. A Global Curriculum (GC) in medical oncology, developed and updated by a joint European Society for Medical Oncology/American Society of Clinical Oncology (ESMO/ASCO) GC Task Force/Working Group (GC WG), greatly contributed to the recognition of medical oncology worldwide. Material and methods ESMO/ASCO GC WG carried out a global survey on medical oncology recognition and GC adoption in 2019. Results Based on our survey, medical oncology is recognised as a separate specialty or sub-specialty in 47/62 (75%) countries participating in the survey; with a great majority of them (39/47, 83%) recognising medical oncology as a standalone specialty. Additionally, in 9 of 62 (15%) countries, medical oncology is trained together with haematology as a specialty in haemato-oncology or together with radiotherapy as a specialty in clinical oncology. As many as two-thirds of the responding countries reported that the ESMO/ASCO GC has been either fully or partially adopted or adapted in their curriculum. It has been adopted in a vast majority of countries with established training in medical oncology (28/41; 68%) and adapted in 12 countries with mixed training in haemato-oncology, clinical oncology or other specialty responsible for training on systemic anticancer treatment. Conclusions With 75% of participating countries reporting medical oncology as a separate specialty or sub-specialty and as high as 68% of them reporting on GC adoption, the results of our survey on global landscape are reassuring. Despite a lack of data for some regions, this survey represents the most comprehensive and up-to-date information about recognition of medical oncology and GC adoption worldwide and will allow both societies to further improve the dissemination of the GC and global recognition of medical oncology, thus contributing to better cancer care worldwide. ESMO/ASCO Global Curriculum (GC) supported medical oncology (MO) as a standalone specialty or sub-specialty worldwide. The ESMO/ASCO GC Working Group regularly updates the GC and conducted a worldwide survey on GC adoption and MO recognition. Based on the survey, MO is recognised as a specialty or sub-specialty in the majority (47/62; 75%) of participating countries. ESMO/ASCO GC has been adopted or adapted in 68% of participating countries without significant differences around the world. This most comprehensive information about MO recognition and GC adoption will support their further dissemination worldwide.
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Affiliation(s)
- T Cufer
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - M Kosty
- Division of Hematology/Oncology, Scripps Clinic, La Jolla, USA
| | - P Osterlund
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Oncology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - D Pyle
- International Affairs, American Society of Clinical Oncology (ASCO), Alexandria, USA
| | - A Awada
- Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - J Close
- University of Florida College of Medicine, Gainesville, USA
| | - N El-Saghir
- Department of Internal Medicine, NK Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - F Lordick
- Department of Oncology, University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A Tfayli
- Department of Internal Medicine, NK Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - H Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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5
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Abrams HR, Durbin S, Huang CX, Johnson SF, Nayak RK, Zahner GJ, Peppercorn J. Financial toxicity in cancer care: origins, impact, and solutions. Transl Behav Med 2021; 11:2043-2054. [PMID: 34850932 DOI: 10.1093/tbm/ibab091] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Financial toxicity describes the financial burden and distress that can arise for patients, and their family members, as a result of cancer treatment. It includes direct out-of-pocket costs for treatment and indirect costs such as travel, time, and changes to employment that can increase the burden of cancer. While high costs of cancer care have threatened the sustainability of access to care for decades, it is only in the past 10 years that the term "financial toxicity" has been popularized to recognize that the financial burdens of care can be just as important as the physical toxicities traditionally associated with cancer therapy. The past decade has seen a rapid growth in research identifying the prevalence and impact of financial toxicity. Research is now beginning to focus on innovations in screening and care delivery that can mitigate this risk. There is a need to determine the optimal strategy for clinicians and cancer centers to address costs of care in order to minimize financial toxicity, promote access to high value care, and reduce health disparities. We review the evolution of concerns over costs of cancer care, the impact of financial burdens on patients, methods to screen for financial toxicity, proposed solutions, and priorities for future research to identify and address costs that threaten the health and quality of life for many patients with cancer.
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Affiliation(s)
- Hannah R Abrams
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sienna Durbin
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cher X Huang
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Rahul K Nayak
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Greg J Zahner
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeffrey Peppercorn
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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6
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Trapani D, Murthy SS, Boniol M, Booth C, Simensen VC, Kasumba MK, Giuliani R, Curigliano G, Ilbawi AM. Distribution of the workforce involved in cancer care: a systematic review of the literature. ESMO Open 2021; 6:100292. [PMID: 34763251 PMCID: PMC8591344 DOI: 10.1016/j.esmoop.2021.100292] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background A skilled health workforce is instrumental for the delivery of multidisciplinary cancer care and in turn a critical component of the health systems. There is, however, a paucity of data on the vast inequalities in cancer workforce distribution, globally. The aim of this study is to describe the global distribution and density of the health care workforce involved in multidisciplinary cancer management. Methods We carried out a systematic review of the literature to determine ratios of health workers in each occupation involved in cancer care per 100 000 population and per 100 cancer patients (PROSPERO: protocol CRD42018095414). Results We identified 33 eligible papers; a majority were cross-sectional surveys (n = 16). The analysis of the ratios of health providers per population and per patients revealed deep gaps across the income areas, with gradients of workforce density, highest in high-income countries versus low-income areas. Benchmark estimates of optimal workforce availability were provided in a secondary research analysis: mainly high-income countries reported workforce capacities closer to benchmark estimates. A paucity of literature was defined for critical health providers, including for pediatric oncology, surgical oncology, and cancer nurses. Conclusion The availability and distribution of the cancer workforce is heterogeneous, and wide gaps are described worldwide. This is the first systematic review on this topic. These results can inform policy formulation and modelling for capacity building and scaleup. Workforce is an essential component of the health systems. Stark inequalities are reported for the distribution of health workforce worldwide, but data are limited. We aimed at portraying the first global figure of the comprehensive cancer workforce for cancer management. Inequalities in density and distribution of the workforce regard all the key health personnel involved in cancer management. These data will inform the development of evidence-informed policies for the workforce in low- and middle-income countries.
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Affiliation(s)
- D Trapani
- European Institute of Oncology, IRCCS, Milan, Italy; European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - S S Murthy
- The John Goligher Colorectal Unit, St. James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Boniol
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - C Booth
- Queen's University Cancer Research Institute, Kingston, Canada
| | - V C Simensen
- Clinical Trials Unit, Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - M K Kasumba
- Malamulo Adventist Hospital, Makwasa, Malawi and The Pan-African Academy of Christian Surgeons (PAACS), Malawi
| | - R Giuliani
- European Society for Medical Oncology (ESMO), Lugano, Switzerland; The Clatterbridge Cancer Centre, Liverpool, UK
| | - G Curigliano
- European Institute of Oncology, IRCCS, Milan, Italy; European Society for Medical Oncology (ESMO), Lugano, Switzerland; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | - A M Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
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7
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Arai M, Ohno I, Takahashi K, Fan MM, Tawada A, Ishioka C, Takiguchi Y. Current status of medical oncology in Japan and changes over the most recent 7-year period: results of a questionnaire sent to designated cancer care hospitals. Jpn J Clin Oncol 2021; 51:1622-1627. [PMID: 34414432 PMCID: PMC8558914 DOI: 10.1093/jjco/hyab135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background According to a questionnaire sent to Designated Cancer Care Hospitals in Japan in 2013, only 39.4% of the institutes had medical oncology departments. Furthermore, most of these medical oncology departments were primarily responsible for the treatment of limited disease categories and the administration of newly developed therapeutic modalities, including molecular-targeted therapy. The aim of the present study was to update these previous findings and to clarify the changes over the intervening 7-year period. Methods The questionnaire was sent to all 393 Designated Cancer Care Hospitals on 13 March 2020. Similar to the previous questionnaires, questions were asked regarding the presence of a medical oncology department, the number of physicians in the department and the degrees of responsibility for drug therapies provided by medical oncologists to adult patients with solid cancers. Results In total, 270 institutions (68.7%) responded. Overall, 145 of these 270 institutions (53.7%) had medical oncology departments, representing a significant increase compared with the results of the previous study (P < 0.01). Among the institutions with a medical oncology department, these departments were responsible for the administration of over 30% of all cytotoxic and molecular-targeted drug therapies for extragonadal germ cell tumors, cancers of unknown primary site, soft tissues, head and neck, esophagus, stomach, colon and rectum, and pancreas as well as the administration of immune checkpoint inhibitors (ICI) for microsatellite instability-high tumors, cancers of the stomach, esophagus and head and neck, and melanoma. Conclusion The proportion of institutes with medical oncology departments in Japan has increased. In addition, the responsibility of medical oncology departments has expanded to include newly emerging drugs, such as ICIs.
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Affiliation(s)
- Makoto Arai
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Izumi Ohno
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koji Takahashi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Meng Meng Fan
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akinobu Tawada
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Chikashi Ishioka
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
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8
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Guirado M, Sanchez-Hernandez A, Pijuan L, Teixido C, Gómez-Caamaño A, Cilleruelo-Ramos Á. Quality indicators and excellence requirements for a multidisciplinary lung cancer tumor board by the Spanish Lung Cancer Group. Clin Transl Oncol 2021; 24:446-459. [PMID: 34665437 PMCID: PMC8525055 DOI: 10.1007/s12094-021-02712-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
Multidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.
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Affiliation(s)
- M Guirado
- Medical Oncology Department, Hospital General Universitario de Elche, 03203, Elche, Spain
| | - A Sanchez-Hernandez
- Medical Oncology Department, Consorcio Hospitalario Provincial de Castellón, 12002, Castellón de la Plana, Spain
| | - L Pijuan
- Pathology Department, Bellvitge University Hospital, 08907, L'Hospitalet de Llobregat, Spain
| | - C Teixido
- Thoracic Oncology Unit, Department of Pathology, IDIBAPS, Hospital Clinic of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - A Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Á Cilleruelo-Ramos
- Thoracic Surgery Department, Hospital Clínico Universitario Valladolid, 47005, Valladolid, Spain
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9
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Hitz F, Ribi K, Grote G, Kolbe M, Schmitz C, Lamb BW, Ruhstaller T, Berchtold P, Sevdalis N. Team functioning across different tumour types: Insights from a Swiss cancer center using qualitative and quantitative methods. Cancer Rep (Hoboken) 2021; 5:e1541. [PMID: 34582132 PMCID: PMC9351662 DOI: 10.1002/cnr2.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/18/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Multidisciplinary care is pivotal in cancer centres and the interaction of all cancer disease specialists in decision making processes is state‐of‐the‐art. Aim To describe differences of MDTMs by tumour type. Methods Twelve multidisciplinary team meetings (MDTMs) with participation of different cancer disease specialists at a tertiary hospital were assessed by an exploratory sequential mixed method approach with interviews, observations and a survey to address the following five topics: organisational structure and supporting technology; leadership; teamwork; decision‐making, perceived value and motivation. Thirteen persons with different tumour specialities and levels of seniority were interviewed. The 12 MDTMs were observed twice by uninvolved persons and evaluated by the participating physicians with a survey. Results There were no systematic differences between MDTMs for different tumour types with the exception of the non‐disease specific type MDTM, which was the only one for which the organisational structure was not driven by an electronic tool. However, several factors could be identified that generally influenced the functioning of the MDTMs. In particular, the quality of decision‐making was highly dependent on the availability of case‐based information and the presence of relevant cancer disease specialists. Leadership and teamwork were rated as important and were comparable across the MDTM. Team participants' motivation and perceived value of MDTMs was high across all meetings. Conclusion MDTM at a single institution did not demonstrate disease specific characteristics. An effective MDTM, irrespective of the tumour type, can be successfully structured by technical means and a chairperson coordinating the interaction of cancer disease specialists to improve the decision‐making process.
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Affiliation(s)
- Felicitas Hitz
- Oncology Haemtology, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Karin Ribi
- International Breast Cancer Study Group, Coordinating Center, Bern, Switzerland
| | - Gudela Grote
- Department of Management, Technology and Economics, ETH Zürich, Zürich, Switzerland
| | - Michaela Kolbe
- Department "Simulationszentrum", University Hospital Zürich, Zürich, Switzerland
| | | | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Thomas Ruhstaller
- Brustzentrum Ostschweiz and University of Basel, St.Gallen, Switzerland
| | | | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College, London, UK
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10
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Oncological Assistance in the Emergency Room Setting: The Role of a Dedicated Oncology Unit. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.110512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The appearance of symptoms that may be related to the worsening of the disease, as well as the toxicity of chemotherapy treatment or an acute complication, are the most frequent reasons for access to the emergency room (ER) for patients with cancer. To date, the Italian territorial health services, as well as local preventive medicine, are unable to provide adequate management of patients with cancer and, for this reason, diagnostic delays and inappropriate hospitalization in the oncology departments have occurred; moreover, it has been observed that many patients receive the first diagnosis of cancer directly in the ER, where the experience in the oncology field is often inadequate. Objectives: Cardarelli Hospital, in Naples, started twenty-two month Experimental Oncological Emergency Service, under the supervision of its own Oncology Department, with the double main objectives of encouraging de-hospitalization and improving diagnostic and therapeutic performance. Methods: We have developed a methodological protocol for patients’ admission to the ER, assuming that the host physician transfers patients with suspected cancer to a new hospital figure, the ER oncologist, who acts as supervisor and coordinator. The first consultation was carried out together with one or more specialists, identified by the supervisor. Based on their characteristics, the patients were divided into 4 categories: (1) Patients with a known diagnosis of cancer and already undergoing anticancer treatments; (2) patients who show complications due to ongoing cancer treatments; (3) patients who no longer respond to anticancer treatments due to the worsening of the disease; (4) patients who are first diagnosed with cancer in the ER. Each individual cohort of patients was directed towards what we have called diagnostic-therapeutic assistance paths (PDTA), specific protocols for each type of patient, which allowed us to reduce the time to diagnosis. Results: According to the data, the average hospitalization time for patients with lung cancer who followed the study was 10 days, compared to 16 days for patients who did not undergo cancer screening in the ER. Another relevant result demonstrated the improvement in the quality and efficiency of medical services by including first aid in the management of cancer patients regards de-hospitalization. In fact, thanks to the experimental protocol we applied, we were able to de-hospitalize 484 patients directly from the ER, which are over 34% of the total. Conclusions: Close integration between hospital medical fields and territorial medicine could improve the quality of cancer treatment and the efficiency of health services management. All of this without affecting the costs of public healthcare because of the considerable improvement in performance which allowed important savings.
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11
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Popescu RA, Roila F, Arends J, Metro G, Lustberg M. Supportive Care: Low Cost, High Value. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 33830830 DOI: 10.1200/edbk_320041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Supportive care aims to prevent and manage adverse effects of cancer and its treatment across the entire disease continuum. Research and clinical experience in dedicated centers have demonstrated that early appropriate supportive care interventions improve symptoms, quality of life, and overall survival in a cost-effective manner. The challenge is to assess symptoms and needs with validated tools regularly and, ideally, between clinic appointments; electronic patient-reported outcome measures and dedicated easily accessible supportive care units can help. As management of certain problems improves, others come to the fore. Cancer-related fatigue and malnutrition are very frequent and need regular screening, assessment of treatable causes, and early intervention to improve. Pharmacologic agents and phytopharmaceuticals are of little use, but other interventions are valuable: physical exercise, counseling on fatigue, and cognitive behavioral therapy/mind-body interventions (e.g., for fatigue). Nutrition should be oral, rich in proteins, and accompanied by muscle training adapted to the patient's condition. Psychological and societal counseling is often useful; nausea or other problems such as gastrointestinal dysmotility or metabolic derangements must be tackled. Chemotherapy-induced peripheral neuropathy frequently worsens quality of life and has no established prevention strategy (notwithstanding current interest in cryotherapy and compression therapy) and thus requires careful assessment of patient predisposition to develop it with the consideration of feasible dose and treatment alternatives. When painful, duloxetine helps. Nonpharmacologic strategies, including acupuncture, physical exercise, cryotherapy/compression, and scrambler therapy, are promising but require large phase III trials to become the accepted standard. Personalization of chemotherapy, dependent on realistic goals, is key.
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Affiliation(s)
| | - Fausto Roila
- Medical Oncology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Jann Arends
- Department of Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Giulio Metro
- Medical Oncology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Maryam Lustberg
- Division of Medical Oncology, The Ohio State University, Columbus, OH
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12
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Hardavella G, Frille A, Theochari C, Keramida E, Bellou E, Fotineas A, Bracka I, Pappa L, Zagana V, Palamiotou M, Demertzis P, Karampinis I. Multidisciplinary care models for patients with lung cancer. Breathe (Sheff) 2020; 16:200076. [PMID: 33664831 PMCID: PMC7910033 DOI: 10.1183/20734735.0076-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, even though there is a relative lack of consistent evidence that this care model improves outcomes. In this review, we present the available literature regarding how to set up and run an efficient multidisciplinary care model for lung cancer patients with emphasis on team members' roles and responsibilities. Moreover, we present some limited evidence about multidisciplinary care and its impact on lung cancer outcomes and survival. This review provides simple guidance on setting up and running a multidisciplinary service for lung cancer patients. It highlights the importance of defined roles and responsibilities for team members. It also presents concise information based on the literature regarding the impact of multidisciplinary care in lung cancer outcomes (e.g. survival of patients undergoing lung cancer surgery).
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Affiliation(s)
- Georgia Hardavella
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Armin Frille
- Dept of Respiratory Medicine, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany
| | - Christina Theochari
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Elli Keramida
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Elena Bellou
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Andreas Fotineas
- Radiation Oncology Dept, IASO Maternity Hospital, Athens, Greece
| | - Irma Bracka
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Loukia Pappa
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Vaia Zagana
- Dept of Nursing, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Maria Palamiotou
- Dept of Nursing, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Panagiotis Demertzis
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
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13
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Jalan D, Rubagumya F, Hopman WM, Vanderpuye V, Lopes G, Seruga B, Booth CM, Berry S, Hammad N. Training of oncologists: results of a global survey. Ecancermedicalscience 2020; 14:1074. [PMID: 32863868 PMCID: PMC7434506 DOI: 10.3332/ecancer.2020.1074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Indexed: 01/20/2023] Open
Abstract
While several studies have highlighted the global shortages of oncologists and their workload, few have studied the characteristics of current oncology training. In this study, an online survey was distributed through a snowball method for cancer care providing physicians in 57 countries. Countries were classified into low- or lower-middle-income countries (LMICs), upper-middle-income countries (UMICs) and high-income countries (HICs) based on World Bank criteria. A total of 273 physicians who were trained in 57 different countries responded to the survey: 33% (90/273), 32% (87/273) and 35% (96/273) in LMICs, UMICs and HICs, respectively. About 60% of respondents were practising physicians and 40% were in training. The proportion of responding trainees was higher in LMICs (51%; 45/89) and UMICs (42%; 37/84), than HICs (19%; 28/96; p = 0.013). A higher proportion of respondents from LMICs (37%; 27/73) self-fund their core oncology training compared to UMICs (13%; 10/77) and HICs (11%; 10/89; p < 0.001). Respondents from HICs were more likely to complete an accepted abstract, poster and publication from their research activities compared to respondents from UMICs and LMICs. Respondents identified several barriers to effective training, including skewed service to education ratio and burnout. With regard to preparedness for practice, mean scores on a 5-point Likert scale were low for professional tasks like supervision and mentoring of trainees, leadership and effective management of an oncology practice and understanding of healthcare systems irrespective of country grouping. In conclusion, the investment in training by the public sector is vital to decreasing the prevalence of self-funding in LMICs. Gaps in research training and enhancement of competencies in research dissemination in LMICs require attention. The instruction on cancer care systems and leadership needs to be incorporated in training curricula in all countries.
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Affiliation(s)
| | | | - Wilma M Hopman
- Kingston General Hospital Research Institute, Kingston, Ontario K7L 2V7, Canada
| | | | - Gilberto Lopes
- University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Bostjan Seruga
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia 1000
| | | | - Scott Berry
- Department of Oncology, University of Toronto, Toronto ON M4N 3M5, Canada
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston ON K7L 5P9, Canada
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14
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Rahman MA, Brekke J, Arnesen V, Hannisdal MH, Navarro AG, Waha A, Herfindal L, Rygh CB, Bratland E, Brandal P, Haasz J, Oltedal L, Miletic H, Lundervold A, Lie SA, Goplen D, Chekenya M. Sequential bortezomib and temozolomide treatment promotes immunological responses in glioblastoma patients with positive clinical outcomes: A phase 1B study. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:342-359. [PMID: 32578964 PMCID: PMC7416034 DOI: 10.1002/iid3.315] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Glioblastoma (GBM) is an aggressive malignant brain tumor where median survival is approximately 15 months after best available multimodal treatment. Recurrence is inevitable, largely due to O6 methylguanine DNA methyltransferase (MGMT) that renders the tumors resistant to temozolomide (TMZ). We hypothesized that pretreatment with bortezomib (BTZ) 48 hours prior to TMZ to deplete MGMT levels would be safe and tolerated by patients with recurrent GBM harboring unmethylated MGMT promoter. The secondary objective was to investigate whether 26S proteasome blockade may enhance differentiation of cytotoxic immune subsets to impact treatment responses measured by radiological criteria and clinical outcomes. METHODS Ten patients received intravenous BTZ 1.3 mg/m2 on days 1, 4, and 7 during each 4th weekly TMZ-chemotherapy starting on day 3 and escalated from 150 mg/m2 per oral 5 days/wk via 175 to 200 mg/m2 in cycles 1, 2, and 3, respectively. Adverse events and quality of life were evaluated by CTCAE and EQ-5D-5L questionnaire, and immunological biomarkers evaluated by flow cytometry and Luminex enzyme-linked immunosorbent assay. RESULTS Sequential BTZ + TMZ therapy was safe and well tolerated. Pain and performance of daily activities had greatest impact on patients' self-reported quality of life and were inversely correlated with Karnofsky performance status. Patients segregated a priori into three groups, where group 1 displayed stable clinical symptoms and/or slower magnetic resonance imaging radiological progression, expanded CD4+ effector T-cells that attenuated cytotoxic T-lymphocyte associated protein-4 and PD-1 expression and secreted interferon γ and tumor necrosis factor α in situ and ex vivo upon stimulation with PMA/ionomycin. In contrast, rapidly progressing group 2 patients exhibited tolerised T-cell phenotypes characterized by fourfold to sixfold higher interleukin 4 (IL-4) and IL-10 Th-2 cytokines after BTZ + TMZ treatment, where group 3 patients exhibited intermediate clinical/radiological responses. CONCLUSION Sequential BTZ + TMZ treatment is safe and promotes Th1-driven immunological responses in selected patients with improved clinical outcomes (Clinicaltrial.gov (NCT03643549)).
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Affiliation(s)
| | - Jorunn Brekke
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | | | | | | | - Andreas Waha
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Lars Herfindal
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Cecilie B Rygh
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
| | - Eirik Bratland
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Judit Haasz
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
| | - Hrvoje Miletic
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Arvid Lundervold
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
| | - Stein A Lie
- Department of Clinical Dentistry, University of Bergen, Norway
| | - Dorota Goplen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Martha Chekenya
- Department of Biomedicine, University of Bergen, Bergen, Norway
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15
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Seruga B, Sullivan R, Fundytus A, Hopman W, Ocana A, Joffe J, Bodoky G, Le Tourneau C, Vanderpuye V, Lopes G, Hammad N, Sengar M, Brundage M, Booth C. Medical Oncology Workload in Europe: One Continent, Several Worlds. Clin Oncol (R Coll Radiol) 2020; 32:e19-e26. [DOI: 10.1016/j.clon.2019.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/16/2019] [Accepted: 05/23/2019] [Indexed: 01/30/2023]
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16
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Kirby E, Broom A, Karikios D, Harrup R, Lwin Z. Exploring the impact and experience of fractional work in medicine: a qualitative study of medical oncologists in Australia. BMJ Open 2019; 9:e032585. [PMID: 31826894 PMCID: PMC6924865 DOI: 10.1136/bmjopen-2019-032585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Fractional (part-time) appointments are becoming more commonplace in many professions, including medicine. With respect to the contemporary oncological landscape, this highlights a critical moment in the optimisation of employment conditions to enable high-quality service provision given growing patient numbers and treatment volume intensification. Data are drawn from a broader study which aimed to better understand the workforce experiences of medical oncologists in Australia. This paper specifically aims to examine a group of clinicians' views on the consequences of fractional work in oncology. DESIGN Qualitative, one-on-one semistructured interviews. Interview transcripts were digitally audio recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory. SETTING New South Wales, Australia. PARTICIPANTS Medical oncologists (n=22), including 9 female and 13 male participants, at a range of career stages. RESULTS Four key themes were derived from the analysis: (1) increasing fractional employment relative to opportunities for full-time positions and uncertainty about future opportunities; (2) tightening in role diversity, including reducing time available for research, mentoring, professional development and administration; (3) emerging flexibility of medical oncology as a specialty and (4) impact of fractional-as-norm on workforce sustainability and quality of care. CONCLUSION Fractional appointments are viewed as increasing in oncology and the broader consequences of this major shift in medical labour remain unexamined. Such appointments offer potential for flexible work to better suit the needs of contemporary oncologists; however, fractional work also presents challenges for personal and professional identity and vocational engagement. Fractional appointments are viewed as having a range of consequences related to job satisfaction, burnout and service delivery. Further research is needed to provide a critical examination of the multiple impacts of workforce trends within and beyond oncology.
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Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, UNSW, Sydney, New South Wales, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Deme Karikios
- Medical Oncology, Nepean Cancer Care Centre, Nepean Hospital, Penrith, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rosemary Harrup
- Department of Medical Oncology/Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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17
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Treatment challenges in and outside a network setting: Head and neck cancers. Eur J Surg Oncol 2019; 45:40-45. [DOI: 10.1016/j.ejso.2018.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/11/2018] [Accepted: 02/06/2018] [Indexed: 11/17/2022] Open
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18
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Hui D, Cherny N, Latino N, Strasser F. The 'critical mass' survey of palliative care programme at ESMO designated centres of integrated oncology and palliative care. Ann Oncol 2018; 28:2057-2066. [PMID: 28911084 DOI: 10.1093/annonc/mdx280] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The ESMO Designated Centres (ESMO-DCs) of Integrated Oncology and Palliative Care (PC) Incentive Programme has grown steadily. We aimed to characterise the level of PC clinical services, education and research at ESMO-DCs. Methods We sent all 184 ESMO-DCs an electronic survey consisting of 78 questions examining the DC characteristics, palliative care clinical programme (structure, processes, and outcomes), primary PC delivery by oncologists, education, research and attitudes and beliefs towards the ESMO-DC programme. Results The response rate was 83% (152/184). 115 (76%) ESMO-DCs were from Europe, 87 (57%) were tertiary care centres. 136 (90%) had inpatient consultation teams, 135 (89%) had outpatient PC clinics, 107 (71%) had dedicated acute care beds, and 75 (50%) offered community-based PC. An estimated 70% (interquartile range [IQR] 28-80%) of patients with advanced cancer had a PC consultation before death, occurring 90 days before death (median, IQR 40-150 days) for outpatients and 21 days (IQR 14-45 days) for inpatients. 59 (39%) offered PC fellowship programme; 47 (32%) had mandatory PC rotations for oncology fellows. Ninety-nine (65%) had double-boarded palliative oncologists. 118 (78%) of the ESMO-DCs reported that routine symptom screening was offered in the oncology clinic and 30% of patients had documented end-of-life discussions by their oncologists. Most centres (>80%) perceived the ESMO-DC programme to increase their status. Conclusions The ESMO-DCs had a high level of PC infrastructure and provided access to a large proportion of patients with advanced cancer. The survey supports that the 13 criteria required for ESMO designation set a robust framework for integration, stimulated investment of resources into some palliative care programmes prior to accreditation, and raised the interest about palliative care among clinicians, trainees and patients.
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Affiliation(s)
- D Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - N Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - N Latino
- European Society for Medical Oncology Head Office, Viganello-Lugano
| | - F Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Cantonal Hospital, St. Gallen, Switzerland
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19
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Wong WKT, Kirby E, Broom A, Sibbritt D, Francis K, Karapetis CS, Karikios D, Harrup R, Lwin Z. A mixed methods analysis of experiences and expectations among early-career medical oncologists in Australia. Asia Pac J Clin Oncol 2018; 14:e521-e527. [PMID: 29377530 DOI: 10.1111/ajco.12844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
AIM A viable and sustainable medical oncology profession is integral for meeting the increasing demand for quality cancer care. The aim of this study was to explore the workforce-related experiences, perceptions and career expectations of early-career medical oncologists in Australia. METHODS A mixed-methods design, including a survey (n = 170) and nested qualitative semistructured interviews (n = 14) with early-career medical oncologists. Recruitment was through the Medical Oncology Group of Australia. Qualitative data were thematically analyzed and for the survey results, logistic regression modeling was conducted. RESULTS Early-career medical oncologists experienced uncertainty regarding their future employment opportunities. The competitive job market has made them cautious about securing a preferred job leading to a perceived need to improve their qualifications through higher degree training and research activities. The following themes and trends were identified from the qualitative and quantitative analyses: age, career stage and associated early-career uncertainty; locale, professional competition and training preferences; participation in research and evolving professional expectations; and workload and career development opportunities as linked to career uncertainty. CONCLUSION Perceived diminished employment opportunities in the medical oncology profession, and shifting expectations to be "more qualified," have increased uncertainty among junior medical oncologists in terms of their future career prospects. Structural factors relating to adequate funding of medical oncology positions may facilitate or inhibit progressive change in the workforce and its sustainability. Workforce planning and strategies informed by findings from this study will be necessary in ensuring that both the needs of cancer patients and of medical oncologists are met.
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Affiliation(s)
- W K Tim Wong
- School of Social Sciences, UNSW Sydney, New South Wales, Australia
| | - Emma Kirby
- School of Social Sciences, UNSW Sydney, New South Wales, Australia
| | - Alex Broom
- School of Social Sciences, UNSW Sydney, New South Wales, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Kay Francis
- Medical Oncology Group of Australia, New South Wales, Australia
| | | | - Deme Karikios
- Medical Oncology, Nepean Hospital, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Rosemary Harrup
- Haematology/Oncology Department, Royal Hobart Hospital, Tasmania, Australia
| | - Zarnie Lwin
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia
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20
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Hoesli RC, Shuman AG, Bradford CR. Decision Making for Diagnosis and Management. Otolaryngol Clin North Am 2017; 50:783-792. [DOI: 10.1016/j.otc.2017.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Engler J, Güthlin C, Dahlhaus A, Kojima E, Müller-Nordhorn J, Weißbach L, Holmberg C. Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28295783 DOI: 10.1111/ecc.12675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Abstract
The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany. We compared their perspectives on cooperation relationships in cancer care. Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone. Further research should focus on ways to foster GPs' integration in cancer care and evaluate if this can be reached by incorporating GPs in formal cooperation structures such as tumour boards.
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Affiliation(s)
- J Engler
- Institute of General Practice, University of Frankfurt/Main, Frankfurt am Main, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Güthlin
- Institute of General Practice, University of Frankfurt/Main, Frankfurt am Main, Germany
| | - A Dahlhaus
- Institute of General Practice, University of Frankfurt/Main, Frankfurt am Main, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - E Kojima
- Institute of General Practice, University of Frankfurt/Main, Frankfurt am Main, Germany
| | - J Müller-Nordhorn
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Weißbach
- Foundation of Men's Health, Berlin, Germany
| | - C Holmberg
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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22
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Dittrich C, Kosty MP, Jezdic S, Pyle D, Berardi R, Bergh J, El-Saghir NS, Lotz JP, Österlund P, Pavlidis N, Purkalne G. Global Curriculum Edition 2016: European Society for Medical Oncology/American Society of Clinical Oncology Recommendations for Training in Medical Oncology. J Clin Oncol 2017; 35:254-255. [DOI: 10.1200/jco.2016.70.2431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christian Dittrich
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Michael P. Kosty
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Svetlana Jezdic
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Doug Pyle
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Rossana Berardi
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Jonas Bergh
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Nagi S. El-Saghir
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Jean-Pierre Lotz
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Pia Österlund
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Nicholas Pavlidis
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
| | - Gunta Purkalne
- Christian Dittrich, Kaiser Franz Josef-Spital, and Applied Cancer Research–Institution for Translational Research, Vienna, Austria; Michael P. Kosty, Scripps Clinic, La Jolla, CA; Svetlana Jezdic, European Society for Medical Oncology, Lugano, Switzerland; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Rossana Berardi, Azienda Ospedaliero-Universitaria Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy; Jonas Bergh, Radiumhemmet, Karolinska Institutet and University
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Position paper of the Italian Association of Medical Oncology on early palliative care in oncology practice (Simultaneous Care). TUMORI JOURNAL 2016; 103:9-14. [PMID: 28009422 DOI: 10.5301/tj.5000593] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 11/20/2022]
Abstract
One of the priorities of personalized medicine regards the role of early integration of palliative care with cancer-directed treatments, called simultaneous care. This article, written by the Italian Association of Medical Oncology (AIOM) Simultaneous and Continuous Care Task Force, represents the position of Italian medical oncologists about simultaneous care, and is the result of a 2-step project: a Web-based survey among medical oncologists and a consensus conference. We present the opinion of more than 600 oncologists who helped formulate these recommendations. This document covers 4 main aspects of simultaneous care: 1) ethical, cultural, and relational aspects of cancer and implications for patient communication; 2) training of medical oncologists in palliative medicine; 3) research on the integration between cancer treatments and palliative care; and 4) organizational and management models for the realization of simultaneous care. The resulting recommendations highlight the role of skills and competence in palliative care along with implementation of adequate organizational models to accomplish simultaneous care, which is considered a high priority of AIOM in order to grant the best quality of life for cancer patients and their families.
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Morgan G, Lambertini M, Kourie HR, Amaral T, Argiles G, Banerjee S, Cardone C, Corral J, De Mattos-Arruda L, Öztürk A, Petrova M, Poulsen L, Strijbos M, Tyulyandina A, Vidra R, Califano R, de Azambuja E, Garrido Lopez P, Guarneri V, Reck M, Moiseyenko V, Martinelli E, Douillard JY, Stahel R, Voest E, Arnold D, Cardoso F, Casali P, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, McGregor K, Rauh S, Zielinski CC, Ciardiello F, Tabernero J, Preusser M. Career opportunities and benefits for young oncologists in the European Society for Medical Oncology (ESMO). ESMO Open 2016; 1:e000107. [PMID: 28255451 PMCID: PMC5174792 DOI: 10.1136/esmoopen-2016-000107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/01/2016] [Indexed: 11/03/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) is one of the leading societies of oncology professionals in the world. Approximately 30% of the 13 000 ESMO members are below the age of 40 and thus meet the society's definition of young oncologists (YOs). ESMO has identified the training and development of YOs as a priority and has therefore established a comprehensive career development programme. This includes a leadership development programme to help identify and develop the future leaders in oncology. Well-trained and highly motivated future generations of multidisciplinary oncologists are essential to ensure the optimal evolution of the field of oncology with the ultimate goal of providing the best possible care to patients with cancer. ESMO's career development portfolio is managed and continuously optimised by several dedicated committees composed of ESMO officers and is directly supervised by the ESMO Executive Board and the ESMO President. It offers unique resources for YOs at all stages of training and includes a broad variety of fellowship opportunities, educational courses, scientific meetings, publications and resources. In this article, we provide an overview of the activities and career development opportunities provided by ESMO to the next generation of oncologists.
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Affiliation(s)
- Gilberto Morgan
- Department of Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST,Genova, Italy
| | | | - Teresa Amaral
- Portuguese Air Force Health Direction, Lisbon, Portugal; Department of Dermatology, Center for Dermatooncology, Tübingen, Germany
| | - Guillem Argiles
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Susana Banerjee
- Department of Medical Oncology, The Royal Marsden Hospital, London, UK
| | - Claudia Cardone
- Department of Medical Oncology, Second University of Naples, Naples, Italy
| | - Jesus Corral
- Department of Oncology, Virgen del Rocio University Hospital,Sevilla, Spain
| | | | - Akif Öztürk
- Department of Medical Oncology, American Hospital,Istanbul, Turkey
| | - Mila Petrova
- Department of Medical Oncology, Nadezhda Hospital,Sofia, Bulgaria
| | - Laurids Poulsen
- Department of Oncology, Aalborg University Hospital,Aalborg, Denmark
| | | | | | - Radu Vidra
- Department of Oncology, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj Napoca, Romania
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust,Manchester, UK
| | | | | | - Valentina Guarneri
- Department of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, University of Padova, Padova, Italy
| | - Martin Reck
- Department of Thoracic Oncology, Lung Clinic Grosshansdorf, Grosshansdorf, Germany
| | - Vladimir Moiseyenko
- St. Petersburg Clinical and Scientific Oncological Center,St. Petersburg, Russian Federation
| | - Erika Martinelli
- U.O.C Oncologia Medica ed Ematologia Dipartimento Medico-Chrirurgico di Internistica Clinica e Sperimentale F. Magrassi e A. Lanzara, Naples, Italy
| | | | - Rolf Stahel
- University Hospital Zurich, Zurich, Switzerland
| | - Emile Voest
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dirk Arnold
- Department of Medical Oncology, Klinik für Tumorbiologie, Freiburg, Germany
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | | | - Andrés Cervantes
- Department of Hematology and Clinical Oncology, University of Valencia, Valencia, Spain
| | | | - Alexandru Eniu
- Department of Oncology, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj Napoca, Romania
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Centre Pluridisciplinaire d'Oncologie, Lausanne, Switzerland
| | | | - Stefan Rauh
- Department of Hematology and Oncology, Centre Hospitalier Emile Mayrisch, Differdange et Esch Grand Duchy of Luxembourg, Esch/Alzette, Luxembourg
| | - Christoph C Zielinski
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | | | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
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Broom A, Wong WKT, Kirby E, Sibbritt D, Karikios D, Harrup R, Lwin Z. A Qualitative Study of Medical Oncologists' Experiences of Their Profession and Workforce Sustainability. PLoS One 2016; 11:e0166302. [PMID: 27902706 PMCID: PMC5130192 DOI: 10.1371/journal.pone.0166302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/26/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medical oncology is a steadily evolving field of medical practice and professional pathway for doctors, offering value, opportunity and challenge to those who chose this medical specialty. This study examines the experiences of a group of Australian medical oncologists, with an emphasis on their professional practice, career experiences, and existing and emerging challenges across career stages. METHODS In-depth qualitative interviews were conducted with 22 medical oncologists, including advanced trainees, early-career consultants and senior consultants, focusing on: professional values and experiences; career prospects and pathways; and, the nexus of the characteristics of the profession and delivery of care. RESULTS The following themes were emergent from the interviews: the need for professional reinvention and the pressure to perform; the importance, and often absence, of mentoring and feedback loops; the emotional labour of oncology; and, the impact of cascading workload volume on practice sustainability. CONCLUSIONS Understanding professional experiences, career trajectories and challenges at the workforce level are crucial for understanding what drives the oncological care day-to-day. The results indicate that there are considerable potential tensions between the realities of professional, workforce demands and expectations for patient care. Such tensions have real and significant consequences on individual medical oncologists with respect to their futures, aspirations, satisfaction with work, caring practices, interactions with patients and potentially therapeutic outcomes.
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Affiliation(s)
- Alex Broom
- School of Social Sciences, UNSW Australia, Sydney, New South Wales, Australia
| | - W. K. Tim Wong
- School of Social Sciences, UNSW Australia, Sydney, New South Wales, Australia
| | - Emma Kirby
- School of Social Sciences, UNSW Australia, Sydney, New South Wales, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Deme Karikios
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Nepean Hospital, Sydney, New South Wales, Australia
| | | | - Zarnie Lwin
- Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
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Komiya T, Mackay CB, Chalise P. Status of oncologic specialties: global survey of physicians treating cancer. Int J Clin Oncol 2016; 22:237-243. [DOI: 10.1007/s10147-016-1055-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
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Kim DY, Lee YG, Kim BS. Survey of Medical Oncology Status in Korea (SOMOS-K): A National Survey of Medical Oncologists in the Korean Association for Clinical Oncology (KACO). Cancer Res Treat 2016; 49:588-594. [PMID: 27658389 PMCID: PMC5512367 DOI: 10.4143/crt.2016.313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/29/2016] [Indexed: 11/27/2022] Open
Abstract
Purpose This study was conducted to investigate the current role of medical oncologists in cancer care with a focus on increasing the recognition of medical oncology as an independent specialty. Materials and Methods Questionnaires modified from the Medical Oncology Status in Europe Survey dealing with oncology structure, resources, research, and patterns of care given by medical oncologists were selected. Several modifications were made to the questionnaire after feedback from the insurance and policy committee of the Korean Association for Clinical Oncology (KACO). The online survey was then sent to KACO members. Results A total of 214 medical oncologists (45.8% of the total inquiries), including 71 directors of medical oncology institutions, took the survey. Most institutions had various resources, including a medical oncology department (94.1%) and a department of radiation oncology (82.4%). There was an average of four medical oncologists at each institution. Medical oncologists were involved in various treatments from diagnosis to end-of-life care. They were also chemotherapy providers from a wide range of institutions that treated many types of solid cancers. In addition, 86.2% of the institutions conducted research. Conclusion This is the first national survey in Korea to show that medical oncologists are involved in a wide range of cancer treatments and care. This survey emphasizes the contributions and proper roles of medical oncologists in the evolving health care environment in Korea.
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Affiliation(s)
- Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yun Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Bong-Seog Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
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Dittrich C, Kosty M, Jezdic S, Pyle D, Berardi R, Bergh J, El Saghir N, Lotz JP, Österlund P, Pavlidis N, Purkalne G. ESMO/ASCO recommendations for a Global Curriculum (GC) in medical oncology-edition 2016. Ann Oncol 2016; 27:1378-81. [PMID: 27457308 PMCID: PMC4959930 DOI: 10.1093/annonc/mdw239] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Dittrich
- Centre for Oncology and Haematology, Kaiser Franz Josef-Spital, Vienna Applied Cancer Research-Institution for Translational Research, Vienna, Austria
| | - M Kosty
- Scripps Clinic, La Jolla, USA
| | - S Jezdic
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - D Pyle
- American Society of Clinical Oncology (ASCO), Alexandria, USA
| | - R Berardi
- Clinica di Oncologia Medica, A.O.U Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy
| | - J Bergh
- Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - N El Saghir
- Department of Internal Medicine, NK Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - J-P Lotz
- Department of Medical Oncology, APHP, Tenon Hospital, IUC-UPMC, Sorbonne University, Paris, France
| | - P Österlund
- Department of Oncology, HUCH Helsinki University Central Hospital, Helsinki, Finland
| | - N Pavlidis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - G Purkalne
- Clinic of Oncology, Pauls Stradins Clinical University Hospital, Riga, Latvia
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Moretti A, Ghidini M, De Angelis C, Lambertini M, Cremolini C, Imbimbo M, Berardi R, Di Maio M, Cascinu S, La Verde N. What Medical Oncologist Residents Think about the Italian Speciality Schools: A Survey of the Italian Association of Medical Oncology (AIOM) on Educational, Clinical and Research Activities. PLoS One 2016; 11:e0159146. [PMID: 27403529 PMCID: PMC4942109 DOI: 10.1371/journal.pone.0159146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/28/2016] [Indexed: 11/19/2022] Open
Abstract
Background and objectives Relevant heterogeneity exists among Postgraduate Schools in Medical Oncology, also within the same country. In order to provide a comprehensive overview of the landscape of Italian Postgraduate Schools in Medical Oncology, the Italian Association of Medical Oncology (AIOM) undertook an online survey, inviting all the residents to describe their daily activities and to express their overall satisfaction about their programs. Methods A team composed of five residents and three consultants in medical oncology prepared a 38 items questionnaire that was published online in a reserved section, accessible through a link sent by e-mail. Residents were invited to anonymously fill in the questionnaire that included the following sub-sections: quality of teaching, clinical and research activity, overall satisfaction. Results Three-hundred and eleven (57%) out of 547 invited residents filled in the questionnaire. Two-hundred and twenty-three (72%) participants declared that attending lessons was frequently difficult and 153 (49%) declared they did not gain substantial improvement in their knowledge from them. Fifty-five percent stated that they did not receive lessons on palliative care. Their overall judgment about didactic activity was low in 63% of the interviewed. The satisfaction for clinical activity was in 86% of cases good: 84% recognized that, during the training period, they acquired a progressive independence on patients' management. About research activity, the majority (79%) of participants in the survey was actively engaged in managing patients included in clinical trials but the satisfaction level for the involvement in research activities was quite low (54%). Overall, 246 residents (79%) gave a positive global judgment of their Medical Oncology Schools. Conclusions The landscape of Italian Postgraduate Schools in Medical Oncology is quite heterogeneous across the country. Some improvements in the organization of teaching and in the access to research opportunity are needed; the perception about clinical activity and the overall judgment of the programs are quite satisfactory.
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Affiliation(s)
- Anna Moretti
- Department of Medical Oncology, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Presidio Ospedaliero Fatebenefratelli, Milan, Italy
| | - Michele Ghidini
- Department of Medicine, Division of Oncology, Azienda Socio Sanitaria Territoriale Di Cremona, Presidio Ospedaliero di Cremona, Cremona, Italy
- * E-mail:
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples "Federico II", Naples, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Chiara Cremolini
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana University of Pisa, Pisa, Italy
| | - Martina Imbimbo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Rossana Berardi
- Medical Oncology, Università Politecnica delle Marche Ospedali Riuniti di Ancona, Ancona, Italy
| | - Massimo Di Maio
- Department of Medical Oncology, Università di Torino, SCDU Oncologia Medica, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, Università degli Studi di Modena, Modena, Italy
| | - Nicla La Verde
- Department of Medical Oncology, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Presidio Ospedaliero Fatebenefratelli, Milan, Italy
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Pavlidis N, Alba E, Berardi R, Bergh J, El Saghir N, Jassem J, Kosty M, Lopez R, Lotz JP, Österlund P, Purkalne G, Dittrich C. The ESMO/ASCO Global Curriculum and the evolution of medical oncology training in Europe. ESMO Open 2016; 1:e000004. [PMID: 27843580 PMCID: PMC5070208 DOI: 10.1136/esmoopen-2015-000004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Emilio Alba
- Seccion de Oncologia Medica, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Rossana Berardi
- Clinica di Oncologia Medica, AOU Ospedali Riuniti Ancona Università Politecnica delle Marche, Ancona, Italy
| | - Jonas Bergh
- Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Nagi El Saghir
- Department of Internal Medicine, American University of Beirut Medical Center, NK Basile Cancer Institute, Beirut, Lebanon
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdańsk, Poland
| | | | - RobertoIvan Lopez
- Department of Medical Oncology, Centro Oncologico Punta Pacifica, Panama, Panama
| | - Jean-Pierre Lotz
- Department of Medical Oncology, APHP, Tenon Hospital, IUC-UPMC, Sorbonne University, Paris, France
| | - Pia Österlund
- Department of Oncology, HUCH Helsinki University Central Hospital, Helsinki, Finland
| | - Gunta Purkalne
- Center of Radiation and Chemotherapy, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Christian Dittrich
- Ludwig Boltzmann Institute for Applied Cancer Research (LBI-ACR VIEnna) and Applied Cancer Research-Institution for Translational Research Vienna (ACR-ITR VIEnna) Centre for Oncology and Haematology Kaiser Franz Josef-Spital, Vienna, Austria
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Strasser F, Blum D, von Moos R, Cathomas R, Ribi K, Aebi S, Betticher D, Hayoz S, Klingbiel D, Brauchli P, Haefner M, Mauri S, Kaasa S, Koeberle D. The effect of real-time electronic monitoring of patient-reported symptoms and clinical syndromes in outpatient workflow of medical oncologists: E-MOSAIC, a multicenter cluster-randomized phase III study (SAKK 95/06). Ann Oncol 2015; 27:324-32. [PMID: 26646758 DOI: 10.1093/annonc/mdv576] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with advanced, incurable cancer receiving anticancer treatment often experience multidimensional symptoms. We hypothesize that real-time monitoring of both symptoms and clinical syndromes will improve symptom management by oncologists and patient outcomes. PATIENTS AND METHODS In this prospective multicenter cluster-randomized phase-III trial, patients with incurable, symptomatic, solid tumors, who received new outpatient chemotherapy with palliative intention, were eligible. Immediately before the weekly oncologists' visit, patients completed the palm-based E-MOSAIC assessment (Edmonton-Symptom-Assessment-Scale, ≤3 additional symptoms, estimated nutritional intake, body weight change, Karnofsky Performance Status, medications for pain, fatigue, nutrition). A cumulative, longitudinal monitoring sheet (LoMoS) was printed immediately. Eligible experienced oncologists were defined as one cluster each and randomized to receive the immediate print-out LoMoS (intervention) or not (control). Primary analysis limited to patients having uninterrupted (>4/6 visits with same oncologist) patient-oncologist sequences was a mixed model for the difference in patients global quality of life (G-QoL; items 29/30 of EORTC-QlQ-c30) between baseline (BL) and week 6. Intention-to-treat (ITT) analysis included all eligible patients. RESULTS In 8 centers, 82 oncologists treated 264 patients (median 66 years; overall survival intervention 6.3, control 5.4 months) with various tumors. The between-arm difference in G-QoL of 102 uninterrupted patients (intervention: 55; control: 47) was 6.8 (P = 0.11) in favor of the intervention; in a sensitivity analysis (oncologists treating ≥2 patients; 50, 39), it was 9.0 (P = 0.07). ITT analysis revealed improvement in symptoms (difference last study visit-BL: intervention -5.4 versus control 2.1, P = 0.003) and favored the intervention for communication and coping. More patients with high symptom load received immediate symptom management (chart review, nurse-patient interview) by oncologists getting the LoMoS. CONCLUSION Monitoring of patient symptoms, clinical syndromes and their management clearly reduced patients' symptoms, but not QoL. Our results encourage the implementation of real-time monitoring in the routine workflow of oncologist with a computer solution.
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Affiliation(s)
- F Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - D Blum
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - R von Moos
- Department of Oncology, Cantonal Hospital Chur, Chur
| | - R Cathomas
- Department of Oncology, Cantonal Hospital Chur, Chur
| | | | - S Aebi
- Department of Oncology, University Hospital Bern, Bern
| | - D Betticher
- Department of Oncology, Cantonal Hospital Fribourg, Fribourg
| | - S Hayoz
- SAKK Coordinating Center, Bern
| | | | | | | | - S Mauri
- Department of Oncology, Cantonal Hospital Lugano, Lugano
| | - S Kaasa
- European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - D Koeberle
- Clinic Oncology/Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Giuliani J, Bonetti A. The Multidisciplinary Management of Cancer in Daily Clinical Practice: Towards a Community Hospital Comprehensive Cancer Center. J Gastrointest Cancer 2015; 47:123-4. [PMID: 26611572 DOI: 10.1007/s12029-015-9785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jacopo Giuliani
- Department of Oncology, Mater Salutis Hospital, ASL 21 della Regione Veneto, Via Gianella 1-37045, Legnago, VR, Italy.
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, ASL 21 della Regione Veneto, Via Gianella 1-37045, Legnago, VR, Italy
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Bos ACRK, van Erning FN, van Gestel YRBM, Creemers GJM, Punt CJA, van Oijen MGH, Lemmens VEPP. Timing of adjuvant chemotherapy and its relation to survival among patients with stage III colon cancer. Eur J Cancer 2015; 51:2553-61. [PMID: 26360411 DOI: 10.1016/j.ejca.2015.08.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/28/2015] [Accepted: 08/15/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Currently available data suggest that delaying the start of adjuvant chemotherapy in colon cancer patients has a detrimental effect on survival. We analysed which factors impact on the timing of adjuvant chemotherapy and evaluated the influence on overall survival (OS). PATIENTS AND METHODS Stage III colon cancer patients who underwent resection and received adjuvant chemotherapy between 2008 and 2013 were selected from the Netherlands Cancer Registry. Timing of adjuvant chemotherapy was subdivided into: ⩽ 4, 5-6, 7-8, 9-10, 11-12 and 13-16 weeks post-surgery. Multivariable regressions were performed to assess the influence of several factors on the probability of starting treatment within 8 weeks post-surgery and to evaluate the association of timing of adjuvant chemotherapy with 5-year OS. RESULTS 6620 patients received adjuvant chemotherapy, 14% commenced after 8 weeks. Factors associated with starting treatment after 8 weeks were older age (Odds ratio (OR) 65-74 versus < 65 years 1.3 (95% confidence interval (CI): 1.14-1.58); OR ⩾ 75 versus < 65 years 1.6 (1.25-1.94)), emergency resection (OR 1.8 (1.41-2.32)), anastomotic leakage (OR 8.1 (6.14-10.62)), referral to another hospital for adjuvant chemotherapy (OR 1.9 (1.36-2.57)) and prolonged postoperative hospital admission (OR 4.7 (3.30-6.68)). Starting 5-8 weeks post-surgery showed no decrease in OS compared to initiation within 4 weeks (Hazard ratio (HR) 5-6 weeks 0.9 (0.79-1.11); HR 7-8 weeks 1.1 (0.91-1.30)). However, commencing beyond 8 weeks was associated with decreased OS compared to initiation within 8 weeks (HR 9-10 weeks 1.4 (1.21-1.68); HR 11-12 weeks 1.3 (1.06-1.59); HR 13-16 weeks 1.7 (1.23-2.23)). CONCLUSION Our data support initiating adjuvant chemotherapy in stage III colon cancer patients within 8 weeks post-surgery.
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Affiliation(s)
- A C R K Bos
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - F N van Erning
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Y R B M van Gestel
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - G J M Creemers
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M G H van Oijen
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - V E P P Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Samalavicius NE, Mineikyte R, Janulionis E, Liutkeviciute-Navickiene J, Atkocius V. Postgraduate Cancer Education and Training in Lithuania: Harmonization According to the EU Rules. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:360-6. [PMID: 25263627 DOI: 10.1007/s13187-014-0737-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The purpose of this article is to discuss Lithuanian postgraduate cancer education according to the data of 2013. In Lithuania, a specialization in an area called clinical oncology is absent; as independent specialities in oncology, there are both medical oncologists and radiation oncologists. These types of oncologists complete rigorous residency training in the clinics. Separate courses are provided in different residency programmes. Currently, there are two medical oncology and radiation oncology programmes for 3rd-, 4th- and 5th-year residents, one at the National Cancer Institute and another at the Lithuanian University of Health Sciences and Kaunas Clinics. Today, there are only 45 radiation oncologists and 56 medical oncologists licensed in Lithuania. This means that each radiation oncologist and medical oncologist is providing for 397 and 319 new cancer cases per year, respectively, or there are 0.3 practising in the major specialties of oncology per 10,000 population. Most other medical residency programmes expose their trainees to oncology for only 1 month either in the 1st or the 2nd year of residency. Due to the growing number of new cancer cases worldwide, these programmes have to be extended, especially for family and internal medicine residents. Lithuanian postgraduate cancer education and training is in the process of harmonization according to the EU rules. All the Lithuanian residency programmes are certificated by an independent public agency and are recognized by a number of countries, including all the countries of the EU.
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Numico G, Cristofano A, Mozzicafreddo A, Cursio OE, Franco P, Courthod G, Trogu A, Malossi A, Cucchi M, Sirotovà Z, Alvaro MR, Stella A, Grasso F, Spinazzé S, Silvestris N. Hospital admission of cancer patients: avoidable practice or necessary care? PLoS One 2015; 10:e0120827. [PMID: 25812117 PMCID: PMC4374858 DOI: 10.1371/journal.pone.0120827] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/27/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cancer patients are frequently admitted to hospital due to acute conditions or refractory symptoms. This occurs through the emergency departments and requires medical oncologists to take an active role. The use of acute-care hospital increases in the last months of life. PATIENTS AND METHODS We aimed to describe the admissions to a medical oncology inpatient service within a 16-month period with respect to patients and tumor characteristics, and the outcome of the hospital stay. RESULTS 672 admissions of 454 patients were analysed. The majority of admissions were urgent (74.1%), and were due to uncontrolled symptoms (79.6%). Among the chief complaints, dyspnoea occurred in 15.7%, pain in 15.2%, and neurological symptoms in 14.5%. The majority of the hospitalizations resulted in discharge to home (60.6%); in 26.5% the patient died and in 11.0% was transferred to a hospice. Admissions due to symptoms correlated with a longer hospital stay and a higher incidence of in-hospital death. CONCLUSION We suggest that hospital use is not necessarily a sign of inappropriately aggressive care: inpatient care is probably an unavoidable step in the cancer trajectory. Optimization of inpatient supportive procedures should be a specific task of modern medical oncology.
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Affiliation(s)
- Gianmauro Numico
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
- * E-mail:
| | - Antonella Cristofano
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Alessandro Mozzicafreddo
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Olga Elisabetta Cursio
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Pierfrancesco Franco
- University of Torino, Department of Oncology, Radiation Oncology Unit, Corso Bramante 88, 10126 Torino, Italy
| | - Giulia Courthod
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Antonio Trogu
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Alessandra Malossi
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Mariella Cucchi
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Zuzana Sirotovà
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Maria Rosa Alvaro
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Anna Stella
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Fulvia Grasso
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Silvia Spinazzé
- Medical Oncology and Hematology, Azienda USL della Valle d’Aosta, Viale Ginevra 3, 11100 Aosta, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Research Center, Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124 Bari, Italy
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Malietzis G, Mughal A, Currie AC, Anyamene N, Kennedy RH, Athanasiou T, Jenkins JT. Factors Implicated for Delay of Adjuvant Chemotherapy in Colorectal Cancer: A Meta-analysis of Observational Studies. Ann Surg Oncol 2015; 22:3793-802. [PMID: 25777086 DOI: 10.1245/s10434-015-4479-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND The survival benefit of administering adjuvant chemotherapy (AC) in colorectal cancer is well established, as is the impact of its timing. Although various factors have been associated with treatment delay, their implications remain controversial. We determined clinicopathological factors associated with delay in transition to AC via systematic review and meta-analysis. METHODS Studies assessing factors for delay in initiating AC were identified from MEDLINE, EMBASE, and Cochrane Databases. Studies were included only if relevant clinicopathological factors were adequately described and appropriate comparative groups were balanced. For each study, the odds ratio (OR) and 95 % confidence interval (CI) were estimated, regarding response to early versus delayed AC initiation. RESULTS We identified 15 eligible studies involving 67,537 patients. Twelve studies were multicentre studies and three were single-center cohort studies. Meta-analysis demonstrated age >75 years [4 studies, OR = 1.44 (95 % CI 1.32-1.58)], marital status-single [3 studies, OR = 1.32 (95 % CI 1.20-1.44)], low socioeconomic status (SES) [7 studies, OR = 1.67 (95 % CI 1.32-2.12)], worse comorbidity status [5 studies, OR = 1.47 (95 % CI 1.14-1.90)], low tumour grade [7 studies, OR = 1.06 (95 % CI 1.02-1.11)], prolonged length of stay [3 studies, OR 2.37 (95 % CI 2.10-2.68)], and readmission [3 studies, OR = 3.23 (95 % CI 1.66-6.26)] were significant predictors of delayed initiation of AC. Laparoscopy compared to an open surgical approach was a significant predictor of earlier AC initiation [5 studies, OR = 0.70 (95 % CI 0.51-0.97)]. CONCLUSIONS Laparoscopy is associated with earlier initiation of AC, encouraging its increased adoption. Social isolation and low SES merit consideration of approaches that counter the lack of social support and deprivation to improve cancer outcomes.
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Affiliation(s)
- George Malietzis
- Department of Surgery, St Marks Hospital, Harrow, Middlesex, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Aamer Mughal
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Andrew C Currie
- Department of Surgery, St Marks Hospital, Harrow, Middlesex, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Nicola Anyamene
- Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - Robin H Kennedy
- Department of Surgery, St Marks Hospital, Harrow, Middlesex, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | | | - John T Jenkins
- Department of Surgery, St Marks Hospital, Harrow, Middlesex, UK. .,Department of Surgery and Cancer, Imperial College, London, UK.
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De Bari B, Franco P, Niyazi M, Cornetto AP, Qvortrup C, Martin AN, Cacicedo J, Fernandez G, Louro LV, Lestrade L, Ciammella P, Greto D, Checkrine T, Youssef E, Filippi AR, Poulsen LØ, Alongi F. The Pocketable Electronic Devices in Radiation Oncology (PEDRO) Project: How the Use of Tools in Medical Decision Making is Changing? Technol Cancer Res Treat 2015; 15:365-76. [PMID: 25759425 DOI: 10.1177/1533034615572287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/15/2015] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To analyze the impact of mobile electronic devices (MEDs) and apps in the daily clinical activity of young radiation or clinical oncologists in 5 Western European countries (Italy, Germany, Spain, Portugal, and Denmark). METHODS A web-based questionnaire was sent to 462 young (≤40 years) members of the national radiation or clinical oncology associations of the countries involved in the study. The 15 items investigated diffusion of MEDs (smartphones and/or tablets), their impact on daily clinical activity, and the differences perceived by participants along time. RESULTS A total of 386 (83.5%) of the 462 correctly filled questionnaires were statistically evaluated. Up to 65% of respondents declared to use an electronic device during their clinical activity. Conversely, 72% considered low to moderate impact of smartphones/tables on their daily practice. The daily use significantly increased from 2009 to 2012: users reporting a use ≥6 times/d raised from 5% to 39.9%. Professional needs fulfillment was declared by less than 68% of respondents and compliance to apps indications by 66%. Significant differences were seen among the countries, in particular concerning the feeling of usefulness of MEDs in the daily clinical life. The perception of the need of a comprehensive Web site containing a variety of applications (apps) for clinical use significantly differed among countries in 2009, while it was comparable in 2012. CONCLUSIONS This survey showed a large diffusion of MEDs in young professionals working in radiation oncology. Looking at these data, it is important to verify the consistency of information found within apps, in order to avoid potential errors eventually detrimental for patients. "Quality assurance" criteria should be specifically developed for medical apps and a comprehensive Web site gathering all reliable applications and tools might be useful for daily clinical practice.
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Affiliation(s)
- Berardino De Bari
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Maximilian Niyazi
- Department of Radiation Oncology, University of Munich, Munich, Germany
| | - Andrea Peruzzo Cornetto
- Medical Physics Department, Ospedale Regionale `U. Parini', AUSL Valle d'Aosta, Aosta, Italy
| | - Camilla Qvortrup
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Arturo Navarro Martin
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Cacicedo
- Radiation Oncology Department, Cruces University Hospital, Barakaldo, Vizcaya, Spain
| | - Gonçalo Fernandez
- Radiotherapy Department, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - Luís Vasco Louro
- Radiotherapy Department, Champalimaud Centre for the Unknown (CCU), Lisbon, Portugal
| | - Laëtitia Lestrade
- Radiation Oncology Department, Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - Patrizia Ciammella
- Advanced Department, Radiotherapy Unit, Azienda Ospedaliera "Arcispedale Santa Maria Nuova", IRCCS, Reggio Emilia, Italy
| | - Daniela Greto
- Radiation Oncology Department, University of Florence, Florence, Italy
| | - Tarik Checkrine
- Radiation Oncology Department, Centre Hospitalier Ibn Rochd, Casablanca, Morocco
| | - Elkholti Youssef
- Centre Privé d'oncologie-radiothérapie Elkholti Guelliz, Marrakech, Morocco
| | | | | | - Filippo Alongi
- Radiation Oncology, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy
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Popescu R, Ciardiello F, Stahel R. Reply to the letter to the editor 'Still a long way to go to achieve multidisciplinarity for the benefit of patients: commentary on the ESMO position paper' by Valentini et al. Ann Oncol 2014; 25:1865. [PMID: 25028706 DOI: 10.1093/annonc/mdu246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- R Popescu
- Department of Medical Oncology, Hirslanden Clinic Aarau, Aarau, Switzerland.
| | - F Ciardiello
- Dipartimento di Medicina Sperimentale e Clinica "F. Magrassi", Seconda Università degli Studi di Napoli, Naples, Italy
| | - R Stahel
- Onkologie, Universitaetsspital Zuerich, Zürich, Switzerland
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Ciardiello F, Arnold D, Casali PG, Cervantes A, Douillard JY, Eggermont A, Eniu A, McGregor K, Peters S, Piccart M, Popescu R, Van Cutsem E, Zielinski C, Stahel R. Delivering precision medicine in oncology today and in future-the promise and challenges of personalised cancer medicine: a position paper by the European Society for Medical Oncology (ESMO). Ann Oncol 2014; 25:1673-1678. [PMID: 24950979 DOI: 10.1093/annonc/mdu217] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- F Ciardiello
- Department of Experimental and Clinical Medicine and Surgery 'F. Magrassi and A. Lanzara', Second University of Naples, Naples, Italy.
| | - D Arnold
- Klinik für Internistische Onkologie, Klinik für Tumorbiologie, Freiburg, Germany
| | - P G Casali
- Department of Cancer Medicine, Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy
| | - A Cervantes
- Department of Hematology and Medical Oncology, Institute of Heath Research INCLIVA, University Hospital of Valencia, Valencia, Spain
| | - J-Y Douillard
- Department of Medical Oncology, Centre René Gauducheau, Institut de Cancérologie de L'Ouest, St Herblain
| | - A Eggermont
- Institute Gustave Roussy, Villejuif/Paris-Sud, France
| | - A Eniu
- Cancer Institute Ion Chiricuta, Cluj-Napoca, Romania
| | - K McGregor
- European Society for Medical Oncology, Lugano
| | - S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - M Piccart
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - R Popescu
- Department of Medical Oncology, Hirslanden Medical Center, Aarau, Switzerland
| | - E Van Cutsem
- Department of Digestive Oncology, University Hospitals Leuven and KULeuven, Leuven, Belgium
| | - C Zielinski
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - R Stahel
- Clinic of Oncology, UniversitätsSpital Zürich, Zurich, Switzerland
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Takiguchi Y, Sekine I, Iwasawa S, Kurimoto R, Sakaida E, Tamura K. Current status of medical oncology in Japan--reality gleaned from a questionnaire sent to designated cancer care hospitals. Jpn J Clin Oncol 2014; 44:632-40. [PMID: 24821975 DOI: 10.1093/jjco/hyu059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Medical oncology in Japan has a relatively short history, with specialist certification starting in 2006, resulting in 867 certified medical oncologists as of 2014. Although the national government has appointed 397 Designated Cancer Care Hospitals, little is known about the actual situations of medical oncology services at these institutions. METHODS Questionnaires regarding the presence of a medical oncology department, the number of physicians in the department, the presence of certified medical oncologists and the degree of the medical oncologists' responsibilities for drug therapies in adults with solid cancers were sent to all 397 institutions between 21 January and 1 May 2013. RESULTS The response rate was 68.0%. Among the responses, 39.4% of the institutions had medical oncology departments with a median of three physicians. Most of the medical oncology departments were primarily responsible, as evaluated according to patient number, for the treatment of limited disease categories. The medical oncologists were significantly more responsible for molecular-targeted therapy than for chemotherapy in head and neck cancer or for cytokine therapy in renal cell carcinoma. The wide variety of adverse events associated with molecular-targeted therapy might have enhanced the roles of medical oncologists. As the proportion of hospitals with a medical oncology department increased according to the number of certified medical oncologists working at the institution, cultivating medical oncologists seems to be an urgent task for advancing medical oncology in Japan. CONCLUSIONS The present study provides fundamental data for the future development of medical oncology in Japan. The present study is to uncover the current situation of medical oncology in Japan.
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Affiliation(s)
- Yuichi Takiguchi
- Department of Medical Oncology, Graduated School of Medicine, Chiba University, Chiba
| | - Ikuo Sekine
- Department of Medical Oncology, Graduated School of Medicine, Chiba University, Chiba
| | - Shunichiro Iwasawa
- Department of Medical Oncology, Graduated School of Medicine, Chiba University, Chiba
| | - Ryota Kurimoto
- Department of Medical Oncology, Graduated School of Medicine, Chiba University, Chiba
| | - Emiko Sakaida
- Department of Hematology, Graduated School of Medicine, Chiba University, Chiba
| | - Kenji Tamura
- Department of Medical Oncology, Chuo Hospital, National Cancer Center, Tokyo, Japan
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Abstract
In medical oncology, how can we be sure that the right drug is being administered to the right patient at the right time? The implementation of quality assurance criteria is important in medical oncology, in order to ensure that the patient receives the best treatment safely. There is very little literature about quality assurance in medical oncology, as opposed to radiotherapy or cancer surgery. Quality assurance must cover the entire patient care process, from the diagnosis, to the therapeutic decision and drug distribution, including its selection, its preparation and its delivery to the patient (administration and dosage), and finally the potential side effects and their management. The dose-intensity respect is crucial, and its reduction can negatively affect overall survival rates, as shown in breast and testis cancers for example. In head and neck medical oncology, it is essential to respect the few well-standardized recommendations and the dose-intensity, in a population with numerous comorbidities. We will first review quality assurance criteria for the general medical oncology organization and then focus on head and neck medical oncology. We will then describe administration specificities of head and neck treatments (chemoradiation, radiation plus cetuximab, postoperative chemoradiation, induction and palliative chemotherapy) as well as their follow-up. Lastly, we will offer some recommendations to improve quality assurance in head and neck medical oncology.
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Affiliation(s)
- G Numico
- Department of Medical Oncology, Azienda USL Della Valle D'Aosta, Aosta
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