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Teuwen LA, Young J, Alessy S, Özdemir BC, Martina D, Folorunso S, Bourlon MT, Prenen H, Segelov E. Intersectionality Between Country, Gender and Funding in Authorship for Phase III Trials Presented at the ASCO Annual Meeting 2022. JCO Glob Oncol 2024; 10:e2400238. [PMID: 39361907 DOI: 10.1200/go.24.00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/07/2024] [Accepted: 08/27/2024] [Indexed: 10/05/2024] Open
Abstract
PURPOSE Multiple disparities have been recognized in the area of location, gender, and funding for leadership in oncology clinical trials. Understanding their intersectionality is crucial to be able to formulate policies and actions, to ensure research is representative of the global oncology community. Here, data from phase III trials presented at the ASCO Annual Meeting of 2022 (ASCO22) were analyzed. METHODS The location of institution, gender of lead and senior authors, and funding source for solid tumor phase III trial abstracts presented at the ASCO22 were analyzed. World Bank analytical grouping version 2021-2022 was used to describe regions and countries as high (HIC), upper-middle (UMIC), lower-middle (LoMIC), and low-income (LIC). RESULTS Across 239 phase III abstracts, lead and senior authors respectively represented HIC institutions in 83% and 85%, UMIC in 13% and 12%, and LoMIC in 4% and 3%. No authors worked in LICs or sub-Saharan Africa. Women accounted for 29% of lead and 23% of senior authors. This distribution persisted across regions, with women as lead authors ranging from 19% (UMIC) to 31% (HIC), and as senior authors from 7% (UMIC) to 25% (HIC). Industry funded 62% of trials, academia 17%, and others 15%; 6% lacked funding. Industry funding was highest in HIC trials (66% for lead and senior authors), followed by UMICs (55% lead, 53% senior) and LoMICs (11% lead, 0% senior). Industry-sponsored trials were proportionally equally represented among female and male senior authors (63% each). CONCLUSION There is marked intersectionality in leadership of oncology clinical trials presented at the world's largest oncology conference.
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Affiliation(s)
- Laure-Anne Teuwen
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | | | - Saleh Alessy
- Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia
- Centre for Cancer, Society & Public Health, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Berna C Özdemir
- Department of Medical Oncology, Bern University Hospital, Bern, Switzerland
| | - Diah Martina
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Sharif Folorunso
- Clinical and Radiation Oncology, Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Maria T Bourlon
- Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Mexico
| | - Hans Prenen
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
| | - Eva Segelov
- Department of Clinical Research, Faculty of Medicine University of Bern and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Aziez S, Evin C, Azria D, Montpetit E, Gannam Y, El Houat Y, Ruffier A, Vendrely V, Laprie A, Huguet F. Impact of discrimination on training and career of radiation oncologists in France. Clin Transl Radiat Oncol 2024; 48:100840. [PMID: 39252882 PMCID: PMC11381992 DOI: 10.1016/j.ctro.2024.100840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 09/11/2024] Open
Abstract
Purpose In France, radiation oncologists are predominantly men with only 44 % of women. Many studies have highlighted gender disparities in medicine. The main objective of our study was to assess the impact of discriminations on radiation oncologists' career. Materials and methods An anonymous online questionnaire, adapted from the one used by the ESMO W4O group, was sent to all radiation oncologists in France between March and June 2022. It included questions related to professional experience, gender, socio-ethnicity, sexual orientation, and personal life. Results Among the 999 radiation oncologists and 168 residents in France, 225 questionnaires were collected (19.2 %). Among the respondents, 60 % were women and 25 % were residents. The mean age was 39.2 years (range: 25-78). The career satisfaction rate was 92 %, with no gender difference. Gender was considered to have a negative impact on the career development by 65 % of women. Social origin was an obstacle to career development for 37 % of all the respondents, and ethnic origin for 25 %. Sixty two percent of women reported having experienced inappropriate behavior or sexual harassment in their workplace, 38 % felt that having a child had "extremely" or "very" much impacted their career versus 8.5 % of men (p < 0.001). The most popular proposals for improvement were the creation of a network of women radiation oncologists with specific educational programs and the addition of quotas in institutions and key positions. Conclusions This study is the first one assessing the various type of discrimination experienced by radiation oncologists in France. We make a few proposals for improvement of training and working conditions, regardless of the origin and gender.
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Affiliation(s)
- Sabrina Aziez
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Cécile Evin
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - David Azria
- Department of Radiation Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Erik Montpetit
- Department of Radiation Oncology, Hôpital Privé Océane, Vannes, France
| | - Youssef Gannam
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Angers, France
| | - Yasmine El Houat
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse
| | - Amandine Ruffier
- Department of Radiation Oncology, Clinique Victor Hugo, Le Mans, France
| | - Véronique Vendrely
- Department of Radiation Oncology, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Anne Laprie
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
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Chen X, Shukla M, Saint Fleur-Lominy S. Disparity in hematological malignancies: From patients to health care professionals. Blood Rev 2024; 65:101169. [PMID: 38220565 DOI: 10.1016/j.blre.2024.101169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
In the recent few decades, outcomes in patients diagnosed with hematological malignancies have been steadily improving. However, the improved prognosis does not distribute equally among patients from different backgrounds. Besides cancer biology, demographic and geographic disparities have been found to impact overall survival significantly. Specifically, patients from underrepresented minorities including Black and Hispanics, and those with uninsured status, having low socioeconomic status, or from rural areas have had worse outcomes historically, which is uniformly true across all major subtypes of hematological malignancies. Similar discrepancy is also seen in the health care professional field, where a gender gap and a disproportionally low representation of health care providers from underrepresented minorities have been long existing. Thus, a comprehensive strategy to mitigate disparity in the health care system is needed to achieve equity in health care.
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Affiliation(s)
- Xiaoyi Chen
- Department of Medicine, Division of Hematology and Medical Oncology, New York University, Grossman School of Medicine, NY, New York, USA.
| | - Mihir Shukla
- Department of Medicine, Division of Hematology and Medical Oncology, New York University, Grossman School of Medicine, NY, New York, USA.
| | - Shella Saint Fleur-Lominy
- Department of Medicine, Division of Hematology and Medical Oncology, New York University, Grossman School of Medicine, NY, New York, USA; Perlmutter Cancer Center, NYU Langone Health, NY, New York, USA.
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Deville C, Charles-Obi K, Santos PMG, Mattes MD, Hussaini SMQ. Oncology Physician Workforce Diversity: Rationale, Trends, Barriers, and Solutions. Cancer J 2023; 29:301-309. [PMID: 37963363 DOI: 10.1097/ppo.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT This chapter will discuss (1) the rationale for physician workforce diversity and inclusion in oncology; (2) current and historical physician workforce demographic trends in oncology, including workforce data at various training and career levels, such as graduate medical education and as academic faculty or practicing physicians; (3) reported barriers and challenges to diversity and inclusion in oncology, such as exposure, access, preparation, mentorship, socioeconomic burdens, and interpersonal, structural, systemic bias; and (4) potential interventions and evidence-based solutions to increase diversity, equity, and inclusion and mitigate bias in the oncology physician workforce.
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Affiliation(s)
- Curtiland Deville
- From the Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Patricia Mae G Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Syed M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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Mattes MD, Thomas CR, Deville C. In Reply to Shueng et al. Int J Radiat Oncol Biol Phys 2023; 117:516-517. [PMID: 37652612 DOI: 10.1016/j.ijrobp.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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Kumar G, Kim J, Farazi PA, Wang H, Su D. Disparities in awareness of and willingness to participate in cancer clinical trials between African American and White cancer survivors. BMC Cancer 2022; 22:983. [PMID: 36109780 PMCID: PMC9479408 DOI: 10.1186/s12885-022-10082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer clinical trials (CCTs) are essential for cancer care, yet the evidence is scarce when it comes to racial disparities in CCT participation among cancer survivors in the Midwest. This study aimed to 1) assess disparities in the awareness of and willingness to participate in CCTs between African American and White cancer survivors; and 2) compare perceptions about CCTs between the two racial groups. METHODS The study was based on cross-sectional data from the survey "Minority Patient Participation in Cancer Clinical Trials" that collected information from 147 Black and White cancer survivors from Nebraska between 2015 and 2016. Chi-square tests and logistic regressions were used to assess differences between Black and White cancer survivors regarding their awareness, willingness, and perceptions associated with CCT participation. RESULTS After adjusting for the effects of socio-demographic, health status, and psychosocial variables, Black cancer survivors were much less likely than White cancer survivors to be aware of CCTs (AOR 0.26; CI 0.08-0.81), to express willingness to participate in CCTs (AOR 0.03; CI 0.01, 0.32) and to actually participate in CCTs (AOR 0.13; CI 0.04-0.38). Black cancer survivors reported a lower level of trust in physicians and were less likely than White cancer survivors to believe that CCTs make a significant contribution to science. CONCLUSIONS Relative to White cancer survivors, Black cancer survivors had much lower awareness of and willingness to participate in CCTs. Part of these differences might be related to the differential perception of CCTs, psychosocial factors, and trust in physicians between the two groups.
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Affiliation(s)
- Gaurav Kumar
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA
| | - Jungyoon Kim
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hongmei Wang
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dejun Su
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA.
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Chapman CH, Nomura K, Kothari A, Atluri' N, Saito AI. Workplace Gender Inequity Is Driven by Broader Societal Inequity: A Qualitative Study of Senior Japanese and American Radiation Oncologists. Adv Radiat Oncol 2022; 7:100879. [PMID: 35198834 PMCID: PMC8844661 DOI: 10.1016/j.adro.2021.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Gender inequity in medicine harms society, and often originates in the context of broader societal discrimination. This study explores the experiences of older women in the radiation oncology specialty in Japan and the United States, with an emphasis on understanding how broader gender inequity affects career trajectory. Radiation oncology is an ideal setting to investigate cross-cultural physician gender equity issues, because few women enter the field despite fewer barriers (eg, frequent emergencies, evening/weekend hours, long procedures) that are commonly cited by women as deterrents in specialty selection. Methods and Materials Between 2012 and 2016, the authors interviewed 14 older women in radiation oncology (department chairs or full professors), with 6 from Japan and 8 from the United States. Multiple analysts identified themes to explore the impact of societal gender inequity on female radiation oncologists’ careers. Results Five themes were identified: (1) childhood gender constructs affect career aspirations, (2) persistent sexism and gender-based workplace challenges affect women's careers, (3) gender inequity in the home affects women's careers, (4) non–gender-related factors intersect to affect women's career satisfaction, and (5) attaining gender equity appears to be even more challenging in Japan compared with the United States. Conclusions Female radiation oncologists in 2 of the most technologically advanced countries report that gender discrimination across their lifespans substantially affects career success. Because gender inequality reflects societal injustice and negatively affects scientific progress and patient outcomes, future research should focus on global approaches to address professional and domestic gender constructs that impede women's career progress.
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Affiliation(s)
- Christina Hunter Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan
| | - Kyoko Nomura
- Department of Public Health, AkitaUniversity Graduate School of Medicine, Akita City, Japan
| | | | | | - Anneyuko I. Saito
- Department of Radiation Oncology, Juntendo University, Faculty of Medicine, Bunkyo, Japan
- Corresponding author: Anneyuko I. Saito, MD, PhD
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Hornstein P, Tuyishime H, Mutebi M, Lasebikan N, Rubagumya F, Fadelu T. Authorship Equity and Gender Representation in Global Oncology Publications. JCO Glob Oncol 2022; 8:e2100369. [PMID: 35015565 PMCID: PMC8769149 DOI: 10.1200/go.21.00369] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Authorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution. @temidayo
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Affiliation(s)
- Paula Hornstein
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | | | - Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University, Nairobi, Kenya
| | - Nwamaka Lasebikan
- Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Temidayo Fadelu
- Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, MA
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Kamran SC, Niemierko A, Deville C, Vapiwala N. Diversity Trends by Sex and Underrepresented in Medicine Status Among US Radiation and Medical Oncology Faculty Over 5 Decades. JAMA Oncol 2021; 8:221-229. [PMID: 34882189 PMCID: PMC8662536 DOI: 10.1001/jamaoncol.2021.6011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance It remains unclear how the historical exclusion of women and racial and ethnic minority groups from medical training, and therefore the oncologic subspecialties, has contributed to rates of faculty diversity among oncology departments over time. Oncologic faculty diversity is an important initiative to help improve care and address health disparities for an increasingly diverse US population with cancer. Objectives To report trends in academic faculty representation by sex and by race and ethnicity for radiation oncology (RO) and medical oncology (MO) departments and to describe comparisons with the general US population, medical students, RO and MO trainees, clinical department chairs, and faculty in other departments. Design, Setting, and Participants This cross-sectional analysis used data from the Association of American Medical Colleges to analyze trends by sex and by race and ethnicity among full-time US faculty in RO and MO departments from 1970 through 2019. Data were analyzed between October 2020 and April 2021. Main Outcomes and Measures Proportions of women and individuals from underrepresented in medicine (URM) racial and ethnic groups (Black, Hispanic, and Indigenous individuals) were calculated among RO and MO academic departments; trends were analyzed over 5 decades. These proportions were compared with cohorts already described. In addition, proportions of women and URM individuals were calculated by faculty rank among RO and MO departments. Results In 1970, there were 119 total faculty in RO (10 women [8.4%] and 2 URM [1.7%]) and 87 total faculty in MO (11 women [12.6%] and 7 URM [8.0%]). In 2019, there were 2115 total faculty in RO (615 women [29.1%] and 108 URM [5.1%]) and 819 total faculty in MO (312 women [38.1%] and 47 URM [5.7%]). Total faculty numbers increased over time in both RO and MO. Faculty representation of URM women proportionally increased by 0.1% per decade in both RO (95% CI, 0.005%-0.110%; P <. 001 for trend) and MO (95% CI, -0.03% to 0.16%; P = .06 for trend) compared with non-URM women faculty, which increased by 0.4% (95% CI, 0.25%-0.80%) per decade in RO and 0.7% (95% CI, 0.47%-0.87%) per decade in MO (P < .001 for trend for both). Faculty representation of URM men did not significantly change for RO (0.03% per decade [95% CI, -0.008% to 0.065%]; P = .09 for trend) or MO (0.003% per decade [95% CI, -0.13% to 0.14%]; P = .94 for trend). Representation of both women and URM individuals among both specialties was lower than their representation in the US population in both 2009 and 2019. Across all cohorts studied, RO faculty had the lowest URM representation in 2019 at 5.1%. At every rank in 2019, the number of total URM faculty represented among both MO and RO remained low (MO: instructor, 2 of 44 [5%]; assistant professor, 18 of 274 [7%]; associate professor, 13 of 177 [7%]; full professor, 13 of 276 [5%]; and RO: instructor, 9 of 147 [6%]; assistant professor, 57 of 927 [6%]; associate professor, 20 of 510 [4%]; full professor, 18 of 452 [4%]). Conclusions and Relevance This cross-sectional study suggests that RO and MO academic faculty have increased the representation of women over time, while URM representation has lagged. The URM trends over time need further investigation to inform strategies to improve URM representation in RO and MO.
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Affiliation(s)
- Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia
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Owoyemi O, Aakhus E. Underrepresentation in Oncology: Identifying and Addressing Structural Barriers. Oncologist 2021; 26:630-634. [PMID: 33797155 PMCID: PMC8342590 DOI: 10.1002/onco.13771] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/12/2021] [Indexed: 11/06/2022] Open
Abstract
Underrepresentation of minority groups in the oncology physician workforce is a pressing issue that may contribute to disparities in cancer research, clinical care, and patient outcomes. To address this, we highlight the role of medical culture and institutions in perpetuating a range of barriers that lead to the persistent underrepresentation of minority medical trainees and physicians. These barriers include an exclusionary medical culture, bias in measures of merit, financial barriers to medical subspecialty training, underrecognition of achievement, and poor representation and satisfaction among underrepresented faculty. Furthermore, we suggest a more intentional approach to diversity that values both recruitment of underrepresented undergraduates and early medical students and retention of internal medicine trainees, hematology-oncology fellows, and faculty. To counteract deeply embedded structural racism that hampers diversity efforts, this multifaceted approach will require cultural transformation of our medical institutions at all levels, including increased institutional transparency, mandatory evidence-based bias training, acknowledgment of varied achievements, changes in recruitment practices, and reinvigoration of pipeline development programs with a focus on financial support. Taken in combination, programs should recognize the scope of deterrents to representation and develop program-specific, longitudinal interventions to promote more successful diversity initiatives within the field of oncology. IMPLICATIONS FOR PRACTICE: The medical profession recognizes the value of physician workforce diversity in improving the quality of both medical education and patient care. In return, medical schools and training programs invest in recruitment programs focused on candidates who are underrepresented in medicine. In the field of oncology, where stark racial and ethnic disparities in care and health outcomes are well-defined, measures of minority physician representation remain especially stagnant. This study clearly defines the barriers that limit the effectiveness of such programs and provides recommendations to achieve the necessary workforce diversity in oncology.
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Affiliation(s)
- Olutosin Owoyemi
- Perelman School of Medicine, The University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erin Aakhus
- Perelman School of Medicine, The University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Morrison ZD, Reyes-Ferral C, Mansfield SA, Alemayehu H, Bowen-Jallow K, Tran S, Santos MC, Bischoff A, Perez N, Lopez ME, Langham MR, Newman EA. Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association. J Pediatr Surg 2021; 56:641-647. [PMID: 33309300 DOI: 10.1016/j.jpedsurg.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 01/10/2023]
Affiliation(s)
| | | | | | - Hanna Alemayehu
- Children's and Women's Hospital, University of South Alabama Health System, Mobile, AL, USA
| | | | - Sifrance Tran
- University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Numa Perez
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Erika A Newman
- CS Mott Children's Hospital, The University of Michigan, Ann Arbor, MI, USA.
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Abusanad A, Bensalem A, Shash E, Mula-Hussain L, Benbrahim Z, Khatib S, Abdelhafiz N, Ansari J, Jradi H, Alkattan K, Jazieh AR. Burnout in oncology: Magnitude, risk factors and screening among professionals from Middle East and North Africa (BOMENA study). Psychooncology 2021; 30:736-746. [PMID: 33427352 DOI: 10.1002/pon.5624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Burnout (BO) among oncology professionals (OP) is increasingly being recognized. Early recognition and intervention can positively affect the quality of care and patient safety. This study investigated the prevalence, work and lifestyle factors affecting BO among OPs in the Middle East and North Africa (MENA). METHODS An online survey was conducted among MENA OPs between 10 February and 15 March 2020, using the validated Maslach Burnout Inventory of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA), including questions regarding demography/work-related factors and attitudes towards oncology. Data were analysed to measure BO prevalence and risk factors and explore a screening question for BO. RESULTS Of 1054 respondents, 1017 participants (64% medical oncologists, 77% aged less than 45 years, 55% female, 74% married, 67% with children and 40% practiced a hobby) were eligible. The BO prevalence was 68% with high levels of EE and DP (35% and 57% of participants, respectively) and low PA scores (49%). BO was significantly associated with age less than 44 years, administrative work greater than 25% per day and the thought of quitting oncology (TQ). Practising a hobby, enjoying oncology communication and appreciating oncology work-life balance were associated with a reduced BO score and prevalence. North African countries reported the highest BO prevalence. Lack of BO education/support was identified among 72% of participants and TQ-predicted burnout in 77%. CONCLUSIONS This is the largest BO study in MENA. The BO prevalence was high and several modifiable risk factors were identified, requiring urgent action. TQ is a simple and reliable screening tool for BO.
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Affiliation(s)
- Atlal Abusanad
- Department of Medical Oncology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Assia Bensalem
- Oncology Department, CHU Dr Benbadis, Constantine, Algeria
| | - Emad Shash
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Layth Mula-Hussain
- Radiation Oncology Department, University of Ottawa, Ottawa, Ontario, Canada
| | - Zineb Benbrahim
- Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah
| | - Sami Khatib
- Department of Oncology, Private Sector, Amman, Jordan
| | - Nafisa Abdelhafiz
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Jawaher Ansari
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Hoda Jradi
- Public Health Faculty, Department of public health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khaled Alkattan
- Thoracic surgery department, King Faisal Specialist Hospital and Research Center (KFSH-RC), Alfaisal University, Riyadh, Saudi Arabia
| | - Abdul R Jazieh
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Ellis KR, Black KZ, Baker S, Cothern C, Davis K, Doost K, Goestch C, Griesemer I, Guerrab F, Lightfoot AF, Padilla N, Samuel CA, Schaal JC, Yongue C, Eng E. Racial Differences in the Influence of Health Care System Factors on Informal Support for Cancer Care Among Black and White Breast and Lung Cancer Survivors. FAMILY & COMMUNITY HEALTH 2020; 43:200-212. [PMID: 32427667 PMCID: PMC7265975 DOI: 10.1097/fch.0000000000000264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This retrospective, secondary qualitative analysis investigates whether health system factors influence social support among Black and white breast and lung cancer survivors and racial differences in support. These data come from race- and cancer-stratified focus groups (n = 6) and interviews (n = 2) to inform a randomized controlled trial utilizing antiracism and community-based participatory research approaches. Findings indicate social support was helpful for overcoming treatment-related challenges, including symptom management and patient-provider communication; racial differences in support needs and provision were noted. Resources within individual support networks reflect broader sociostructural factors. Reliance on family/friends to fill gaps in cancer care may exacerbate racial disparities.
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Affiliation(s)
| | - Kristin Z. Black
- College of Health and Human Performance, East Carolina University
| | | | - Carol Cothern
- Greensboro Health Disparities Collaborative, Greensboro, North Carolina
| | - Kia Davis
- School of Medicine, Washington University
| | - Kay Doost
- Greensboro Health Disparities Collaborative, Greensboro, North Carolina
| | - Christina Goestch
- Greensboro Health Disparities Collaborative, Greensboro, North Carolina
| | - Ida Griesemer
- Department of Health Behavior, University of North Carolina
| | - Fatima Guerrab
- Department of Health Behavior, University of North Carolina
| | - Alexandra F. Lightfoot
- Department of Health Behavior, University of North Carolina
- Center for Health Promotion and Disease Prevention, University of North Carolina
| | - Neda Padilla
- Department of Health Policy and Management, University of North Carolina
| | - Cleo A. Samuel
- Department of Health Policy and Management, University of North Carolina
| | | | - Christina Yongue
- Department of Public Health Education, University of North Carolina at Greensboro
| | - Eugenia Eng
- Department of Health Behavior, University of North Carolina
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14
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Vengaloor Thomas T, Perekattu Kuruvilla T, Holliday E, Bhanat E, Parr A, Albert AA, Page B, Schuster J, Chapman C, Vijayakumar S. Cross-Sectional Gender Analysis of US Radiation Oncology Residency Programs in 2019: More Than a Pipeline Issue? Adv Radiat Oncol 2020; 5:1099-1103. [PMID: 33305070 PMCID: PMC7718546 DOI: 10.1016/j.adro.2020.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The purpose of this study is to assess the current status of gender disparities in academic radiation oncology departments in the United States and the associated factors. METHODS AND MATERIALS The data were collected from publicly available resources, including websites of individual radiation oncology programs, the Fellowship and Residency Electronic Interactive Database, the Accreditation Council for Graduate Medical Education, and the Association of American Medical Colleges. We collected data on the gender information of residents in each year (postgraduate years 2-5) and of the faculty (attendings, program director, and chair) during the academic year 2018 to 2019. Spearman's rho test, Pearson's chi-squared test, and Fisher exact tests were used for evaluating the correlation among variables using SPSS version 24. RESULTS Women constituted 30.8% of radiation oncology residents in the United States in 2019. Eight programs (12.5%) did not have any female residents in their programs, whereas 6 programs (9%) had women constituting more than half of their resident class. The fraction of female medical students applying to radiation oncology over the last 7 years varied between 27% and 33%. Female attending physicians accounted for 30.5% of all the attending physicians in the academic programs. In the leadership positions of the department, the gender gap was wider where only 19 (20%) and 11 (12%) of programs had female program director or chair, respectively. There was a positive correlation between the number of attending physicians and the number of female residents in programs (P = .01). CONCLUSIONS A significant gender disparity continues to exist among the residents and physicians in the academic radiation oncology departments in the US. This disparity is pronounced in the leadership positions. The results of this study could be used as a benchmark to evaluate the progress that has been made by the efforts to improve gender disparities in radiation oncology.
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Affiliation(s)
| | | | - Emma Holliday
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eldrin Bhanat
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Amy Parr
- University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Brandi Page
- Johns Hopkins University, Baltimore, Maryland
| | - Jessica Schuster
- University of Wisconsin School of Medicine and Public Health, Madison, Wsconsin
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15
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Kamran SC, Yerramilli D, Vapiwala N. No Talent Left Behind: A Silver Lining for Diversity in Radiation Oncology in the Post-Coronavirus Disease 2019 (COVID-19) Era. Int J Radiat Oncol Biol Phys 2020; 108:472-474. [PMID: 32890536 PMCID: PMC7462790 DOI: 10.1016/j.ijrobp.2020.05.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Divya Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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16
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White MJ, Wyse RJ, Ware AD, Deville C. Current and Historical Trends in Diversity by Race, Ethnicity, and Sex Within the US Pathology Physician Workforce. Am J Clin Pathol 2020; 154:450-458. [PMID: 32785661 DOI: 10.1093/ajcp/aqaa139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study assessed historical and current gender, racial, and ethnic diversity trends within US pathology graduate medical education (GME) and the pathologist workforce. METHODS Data from online, publicly available sources were assessed for significant differences in racial, ethnic, and sex distribution in pathology trainees, as well as pathologists in practice or on faculty, separately compared with the US population and then each other using binomial tests. RESULTS Since 1995, female pathology resident representation has been increasing at a rate of 0.45% per year (95% confidence interval [CI], 0.29-0.61; P < .01), with pathology now having significantly more females (49.8%) compared to the total GME pool (45.4%; P < .0001). In contrast, there was no significant trend in the rate of change per year in black or American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander (AI/AN/NH/PI) resident representation (P = .04 and .02). Since 1995, underrepresented minority (URM) faculty representation has increased by 0.03% per year (95% CI, 0.024-0.036; P < .01), with 7.6% URM faculty in 2018 (5.2% Hispanic, 2.2% black, 0.2% AI/AN/NH/PI). CONCLUSIONS This assessment of pathology trainee and physician workforce diversity highlights significant improvements in achieving trainee gender parity. However, there are persistent disparities in URM representation, with significant underrepresentation of URM pathologists compared with residents.
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Affiliation(s)
- Marissa J White
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rhea J Wyse
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Michigan State University College of Human Medicine Grand Rapids Campus, Grand Rapids
| | - Alisha D Ware
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Curtiland Deville
- Department Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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17
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Deville C, Cruickshank I, Chapman CH, Hwang WT, Wyse R, Ahmed AA, Winkfield KM, Thomas CR, Gibbs IC. I Can't Breathe: The Continued Disproportionate Exclusion of Black Physicians in the United States Radiation Oncology Workforce. Int J Radiat Oncol Biol Phys 2020; 108:856-863. [PMID: 32668279 PMCID: PMC7354371 DOI: 10.1016/j.ijrobp.2020.07.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/05/2022]
Abstract
Purpose Black physicians remain disproportionately underrepresented in certain medical specialties, yet comprehensive assessments in radiation oncology (RO) are lacking. Our purpose was to report current and historical representation trends for Black physicians in the US RO workforce. Methods and Materials Public registries were used to assess significant differences in 2016 representation for US vs RO Black academic full-time faculty, residents, and applicants. Historical changes from 1970 to 2016 were reported descriptively. Linear regression was used to assess significant changes for Black residents and faculty from 1995 to 2016. Results In 2016, Black people represented 3.2% vs 1.5% (P < .001), 5.6% vs 3.2% (P = .005), and 6.5% vs 5.4% (P = .352) of US vs RO faculty, residents, and applicants, respectively. Although RO residents nearly doubled from 374 (1974) to 720 (2016), Black residents peaked at 31 in 1984 (5.9%; 31 of 522) and fell to 23 (3.2%; 23 of 720) in 2016 across 91 accredited programs; Black US graduate medical education trainees nearly doubled over the same period: 3506 (1984) to 6905 (2016). From 1995 to 2016, Black US resident representation significantly increased by 0.03%/y, but decreased significantly in RO by –0.20%/y before 2006 and did not change significantly thereafter. Over the same period, Black US faculty representation significantly increased by 0.02%/y, whereas Black RO faculty significantly increased by 0.07%/y before 2006, then decreased significantly by –0.16%/y thereafter. The number of Black RO faculty peaked at 37 in 2006 (3.1%; 37 of 1203) and was 27 (1.5%; 27 of 1769) in 2016, despite the nearly 1.5-fold increase in the number of both RO faculty and Black US faculty overall (4169 in 2006 and 6047 in 2016) during that period. Conclusions Black physicians remain disproportionately underrepresented in RO despite an increasing available pipeline in the US physician workforce. Deliberate efforts to understand barriers to specialty training and inclusion, along with evidence-based targeted interventions to overcome them, are needed to ensure diversification of the RO physician workforce.
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Affiliation(s)
- Curtiland Deville
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University, Baltimore, Maryland.
| | | | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Wei-Ting Hwang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rhea Wyse
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Awad A Ahmed
- Department of Radiation Oncology, MercyOne Waterloo Medical Center, Waterloo, Iowa
| | - Karen M Winkfield
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University, Stanford, California
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Riaz IB, Siddiqi R, Zahid U, Durani U, Fatima K, Sipra QUAR, Raina AI, Farooq MZ, Chamberlain AM, Wang Z, Go RS, Marshall AL, Khosa F. Gender Differences in Faculty Rank and Leadership Positions Among Hematologists and Oncologists in the United States. JCO Oncol Pract 2020; 16:e507-e516. [DOI: 10.1200/op.19.00255] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Gender disparity persists in academic medicine. Female faculty are underrepresented in leadership positions and have lower research output. We studied gender differences in faculty rank and departmental leadership and contributing factors among academic hematologists and oncologists in the United States. METHODS: For clinical faculty at 146 hematology or oncology fellowship programs listed in the Fellowship and Residency Electronic Interactive Database, we collected data on demographics, academic rank, and research output using the Doximity and Scopus databases. We compared unadjusted characteristics of men and women by using 2-sided t tests and χ2 tests where appropriate. To predict probability of full professorship or leadership position among men versus women, we performed multivariable logistic regression analysis adjusted for clinical experience in years, number of publications, h-index, clinical trial investigator status, National Institutes of Health funding, and workplace ranking (top 20 v not). RESULTS: Two thousand one hundred sixty academic hematologists and oncologists were included. Women composed 21.9% (n = 142) of full professors, 35.7% (n = 169) of associate professors, and 45.4% (n = 415) of assistant professors. Thirty percent (n = 70) of departmental leaders were women. Female faculty, compared with male faculty, had a lower mean h-index (12.1 v 20.9, respectively; P < .001) and fewer years of professional experience since fellowship (10 v 16 years, respectively; P < .001). After adjusting for duration of clinical experience, academic productivity, and workplace ranking, the odds of obtaining professorship (odds ratio [OR], 1.05; 95% CI, 0.71 to 1.57; P = .85) or divisional leadership (OR, 0.57; 95% CI, 0.20 to 1.58; P = .28) for female physicians were not different compared with male physicians. CONCLUSION: Gender disparity exists in senior ranks of academic hematology and oncology; however, gender is not a significant predictor in achieving professorship or department leadership position.
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Affiliation(s)
- Irbaz Bin Riaz
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Umar Zahid
- Department of Medicine, John Hopkins, Baltimore, MD
| | - Urshila Durani
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kaneez Fatima
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ammad I. Raina
- Department of Internal Medicine, Midwestern University, Glendale, AZ
| | | | - Alanna M. Chamberlain
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Zhen Wang
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ronald S. Go
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ariela L. Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
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19
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Chowdhary M, Chowdhary A, Royce TJ, Patel KR, Chhabra AM, Jain S, Knoll MA, Vapiwala N, Pro B, Marwaha G. Women's Representation in Leadership Positions in Academic Medical Oncology, Radiation Oncology, and Surgical Oncology Programs. JAMA Netw Open 2020; 3:e200708. [PMID: 32159809 PMCID: PMC7066474 DOI: 10.1001/jamanetworkopen.2020.0708] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Women are underrepresented in medical leadership positions; however, representation of women among academic oncology leadership is unknown. OBJECTIVES To evaluate representation of women overall and in leadership positions in academic medical oncology (MO), radiation oncology (RO), and surgical oncology (SO) programs and to examine the association of women leadership with overall faculty representation of women per program. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, MO, RO, and SO training program websites were queried from October 2018 through June 2019. All faculty from 265 of 273 accredited MO, RO, and SO training programs (97.1%) were included. EXPOSURE Gender. MAIN OUTCOMES AND MEASURES Observed proportions of women in leadership positions compared with the expected proportion of overall women faculty in MO, RO, and SO were assessed. Rates of representation of women across each MO, RO, and SO program's faculty based on the presence or absence of a woman in a leadership position were compared. RESULTS Of 6030 total faculty, only 2164 (35.9%) were women. Total representation of women among MO, RO, and SO faculty was 37.1% (1563 of 4215), 30.7% (389 of 1269), and 38.8% (212 of 546), respectively. Women composed only 21.7% (30 of 138), 11.7% (11 of 94), and 3.8% (1 of 26) of MO, RO, and SO chair positions, respectively. The observed proportion of women in chair positions was significantly lower than the expected proportion for MO, RO, and SO. In all, 47.9%, 33%, and 18.5% of MO, RO, and SO programs, respectively, had at least 1 woman in a leadership position (program director or chair). Programs with 1 or more women in a leadership position were associated with a higher mean (SD) percentage of women faculty than those without at least 1 woman leader in MO (40.7% [12.5%] vs 33.1% [11.0%]; P < .001) and RO (36.2% [13.3%] vs 23.4% [12.3%]; P < .001) but not SO (40.2% [15.4%] vs 31.4% [16.9%]; P = .29). CONCLUSIONS AND RELEVANCE Gender disparity exists in academic MO, RO, and SO faculty, which is magnified at the chair level. Programs in MO and RO with a woman physician in a leadership position were associated with a higher percentage of women faculty, but this was not true for SO. These data will serve as a benchmark to monitor progress toward a more balanced workforce.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Akansha Chowdhary
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Medical Oncology, Northwestern University, Chicago, Illinois
| | - Trevor J. Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill
| | - Kirtesh R. Patel
- Department of Radiation Oncology, Kaiser Permanente, Atlanta, Georgia
| | - Arpit M. Chhabra
- Department of Radiation Oncology, New York Proton Center, New York
| | - Shikha Jain
- Division of Hematology, Oncology and Stem Cell Transplant, Rush University Medical Center, Chicago, Illinois
| | - Miriam A. Knoll
- John Theurer Cancer Center, Department of Radiation Oncology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia
| | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Medical Oncology, Northwestern University, Chicago, Illinois
| | - Gaurav Marwaha
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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20
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Collins CM, Carrasco GA, Lopez OJ. Participation in Active Learning Correlates to Higher Female Performance in a Pipeline Course for Underrepresented Students in Medicine. MEDICAL SCIENCE EDUCATOR 2019; 29:1175-1178. [PMID: 34457600 PMCID: PMC8368703 DOI: 10.1007/s40670-019-00794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study was designed to explore the relationship between participation (measured by percentage of time spoken) in team-based learning (TBL) exercises and final examination in a 4-week medical microbiology course for college students from backgrounds underrepresented in medicine (URM). A significant correlation was found between participation and examination scores in lower performing students. Although male participation was higher, a significant correlation between participation and examination scores was found only in females. These data suggest that female participation is based on knowledge of the subject under discussion and that affirmation in TBL positively reinforces self-confidence, increasing student's efficiency during peer teaching.
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Affiliation(s)
| | | | - Osvaldo J. Lopez
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ USA
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21
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Agawu A, Fahl C, Alexis D, Diaz T, Harris D, Harris MC, Aysola J, Cronholm PF, Higginbotham EJ. The Influence of Gender and Underrepresented Minority Status on Medical Student Ranking of Residency Programs. J Natl Med Assoc 2019; 111:665-673. [PMID: 31668360 DOI: 10.1016/j.jnma.2019.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/25/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Physician diversity is linked to improved quality of care of diverse patient populations. The transition from medical school to residency is an opportunity to improve and increase workforce diversity in all specialties. However, there is limited published literature on the factors contributing to the ranking of residency programs on women and underrepresented minorities (URMs). OBJECTIVE To characterize factors medical students used to rank residency programs and describe any differences based on race/ethnicity or gender. METHODS A mixed-methods study consisting of a web-based survey and semi-structured interviews with National Resident Matching Program (NRMP) participating graduates over a two-year period. The survey assessed demographics and a 6-point Likert scale rating of various factors used to rank residency programs. Unpaired student t-tests were used to compare means. A subset of students was interviewed and a modified grounded theory approach identified decision-making themes as well as the role of gender and URM status. RESULTS Out of a total of 316 invitations sent, 148 completed the survey (46.8% response rate), of which 21% of respondents self-identified as URMs. The majority of respondents graduated in 2014 (53%), and were male (51%). Participants ranked program atmosphere, reputation, location, and proximity to family the highest. URM students ranked patient population (p < 0.01), revisit opportunities (p = 0.04), gender diversity (p < 0.01), and ethnic diversity (p < 0.01) significantly higher than non-URM students. Female students ranked patient population (p < 0.01) and gender diversity (p < 0.01) significantly higher than males. Qualitative findings revealed differences in perceptions by URMs and non-URMs of patient population, revisit opportunities, gender diversity, and ethnic diversity. CONCLUSIONS While all students prioritized pragmatic factors, women and URM students assess and weigh additional factors related to culture, inclusion, and diversity more than others. By tailoring recruitment strategies to meet the expectations of women and URMs, residency programs can better meet goals in becoming more diverse and inclusive.
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Affiliation(s)
- Atu Agawu
- General Pediatrics/Emergency Department, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Corrinne Fahl
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dominique Alexis
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tomas Diaz
- Resident in Emergency Medicine at the University of California - San Francisco, San Francisco General Hospital, San Francisco, CA, USA
| | - Diana Harris
- Department of Philosophy, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary C Harris
- Pediatrics and Advisory Dean, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaya Aysola
- Department of Medicine and Pediatrics, Perelman School of Medicine, University of Pennsylvania, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Eve J Higginbotham
- Inclusion and Diversity, Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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22
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Rao AD, Nicholas SE, Kachniarz B, Hu C, Redmond KJ, Deville C, Wright JL, Page BR, Terezakis S, Viswanathan AN, DeWeese TL, Fivush BA, Alcorn SR. Association of a Simulated Institutional Gender Equity Initiative With Gender-Based Disparities in Medical School Faculty Salaries and Promotions. JAMA Netw Open 2018; 1:e186054. [PMID: 30646313 PMCID: PMC6324345 DOI: 10.1001/jamanetworkopen.2018.6054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite progress in narrowing gender-based salary gaps, notable disparities persist in the scientific community. The significance of pay difference may be underestimated, with little data evaluating its effect on lifetime wealth after accounting for factors like time to promotion and savings. OBJECTIVES To characterize gender disparities in salary and assess the outcomes associated with a gender equity initiative (GEI). DESIGN, SETTING, AND PARTICIPANTS Quality improvement study with simulations of salary and additional accumulated wealth (AAW) using retrospectively reviewed Johns Hopkins University School of Medicine annual salary and promotion data. All academic faculty were included in the faculty salary analysis from 2005 (n = 1481) and 2016 (n = 1885). MAIN OUTCOMES AND MEASURES Salary and longitudinal promotion data from 2005 to 2016 were used to estimate gender-based differences in salary and time to promotion. The effect of these differences on total salary and AAW, including retirement and salary-based investments, was simulated for a representative male and female faculty member over a 30-year career in 3 scenarios: (1) pre-GEI, (2) post-GEI, and (3) in real time for GEI, beginning with and progressing through these initiatives. RESULTS Analyses of salaries of 1481 faculty (432 women) in 2005 and 1885 faculty (742 women) in 2016 revealed that a decade after GEI implementation, the overall mean (SE) salary gap by gender decreased from -2.6% (1.2%) (95% CI, -5.6% to -0.3%) to -1.9% (1.1%) (95% CI, -4.1% to 0.3%). Simulation of pre-GEI disparities correlated with male faculty collecting an average lifetime AAW of $501 416 more than the equivalent woman, with disparities persisting past retirement. The AAW gap decreased to $210 829 in the real-time GEI simulation and to $66 104 using post-GEI conditions, reflecting success of GEI efforts. CONCLUSIONS AND RELEVANCE Even small gender-based salary gaps are associated with substantial differences in lifetime wealth, but an institutional commitment to achieving equitable promotion and compensation for women can appreciably reduce these disparities. The findings of this study support broad implementation of similar initiatives without delay, as results may take more than a decade to emerge. A modifiable version of the simulation is provided so that external users may assess the potential disparities present within their own institutions.
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Affiliation(s)
- Avani D. Rao
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah E. Nicholas
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bartlomiej Kachniarz
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Hu
- Department of Oncology—Biostatistics and Bioinformatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin J. Redmond
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Curtiland Deville
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean L. Wright
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandi R. Page
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Terezakis
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Akila N. Viswanathan
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Theodore L. DeWeese
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara A. Fivush
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara R. Alcorn
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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23
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Winkfield KM, Flowers CR, Mitchell EP. Making the Case for Improving Oncology Workforce Diversity. Am Soc Clin Oncol Educ Book 2018; 37:18-22. [PMID: 28561643 DOI: 10.1200/edbk_100010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Karen M Winkfield
- From the Department of Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, NC; Department of Hematology and Oncology, Winship Cancer Institute at Emory University, Atlanta, GA; Department of Medical Oncology, The Sidney Kimmel Cancer Center at Jefferson University Hospitals, Philadelphia, PA
| | - Christopher R Flowers
- From the Department of Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, NC; Department of Hematology and Oncology, Winship Cancer Institute at Emory University, Atlanta, GA; Department of Medical Oncology, The Sidney Kimmel Cancer Center at Jefferson University Hospitals, Philadelphia, PA
| | - Edith P Mitchell
- From the Department of Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, NC; Department of Hematology and Oncology, Winship Cancer Institute at Emory University, Atlanta, GA; Department of Medical Oncology, The Sidney Kimmel Cancer Center at Jefferson University Hospitals, Philadelphia, PA
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McClelland S, Page BR, Jaboin JJ, Chapman CH, Deville C, Thomas CR. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 1: African-American patients. Adv Radiat Oncol 2017; 2:523-531. [PMID: 29204518 PMCID: PMC5707425 DOI: 10.1016/j.adro.2017.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 01/05/2023] Open
Abstract
Introduction African Americans experience the highest burden of cancer incidence and mortality in the United States and have been persistently less likely to receive interventional care, even when such care has been proven superior to conservative management by randomized controlled trials. The presence of disparities in access to radiation therapy (RT) for African American cancer patients has rarely been examined in an expansive fashion. Methods and materials An extensive literature search was performed using the PubMed database to examine studies investigating disparities in RT access for African Americans. Results A total of 55 studies were found, spanning 11 organ systems. Disparities in access to RT for African Americans were most prominently study in cancers of the breast (23 studies), prostate (7 studies), gynecologic system (5 studies), and hematologic system (5 studies). Disparities in RT access for African Americans were prevalent regardless of organ system studied and often occurred independently of socioeconomic status. Fifty of 55 studies (91%) involved analysis of a population-based database such as Surveillance, Epidemiology and End Result (SEER; 26 studies), SEER-Medicare (5 studies), National Cancer Database (3 studies), or a state tumor registry (13 studies). Conclusions African Americans in the United States have diminished access to RT compared with Caucasian patients, independent of but often in concert with low socioeconomic status. These findings underscore the importance of finding systemic and systematic solutions to address these inequalities to reduce the barriers that patient race provides in receipt of optimal cancer care.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
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Ahmed AA, Hwang WT, Holliday EB, Chapman CH, Jagsi R, Thomas CR, Deville C. Female Representation in the Academic Oncology Physician Workforce: Radiation Oncology Losing Ground to Hematology Oncology. Int J Radiat Oncol Biol Phys 2017; 98:31-33. [PMID: 28587049 DOI: 10.1016/j.ijrobp.2017.01.240] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/11/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Our purpose was to assess comparative female representation trends for trainees and full-time faculty in the academic radiation oncology and hematology oncology workforce of the United States over 3 decades. METHODS AND MATERIALS Simple linear regression models with year as the independent variable were used to determine changes in female percentage representation per year and associated 95% confidence intervals for trainees and full-time faculty in each specialty. RESULTS Peak representation was 48.4% (801/1654) in 2013 for hematology oncology trainees, 39.0% (585/1499) in 2014 for hematology oncology full-time faculty, 34.8% (202/581) in 2007 for radiation oncology trainees, and 27.7% (439/1584) in 2015 for radiation oncology full-time faculty. Representation significantly increased for trainees and full-time faculty in both specialties at approximately 1% per year for hematology oncology trainees and full-time faculty and 0.3% per year for radiation oncology trainees and full-time faculty. Compared with radiation oncology, the rates were 3.84 and 2.94 times greater for hematology oncology trainees and full-time faculty, respectively. CONCLUSION Despite increased female trainee and full-time faculty representation over time in the academic oncology physician workforce, radiation oncology is lagging behind hematology oncology, with trainees declining in recent years in radiation oncology; this suggests a de facto ceiling in female representation. Whether such issues as delayed or insufficient exposure, inadequate mentorship, or specialty competitiveness disparately affect female representation in radiation oncology compared to hematology oncology are underexplored and require continued investigation to ensure that the future oncologic physician workforce reflects the diversity of the population it serves.
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Affiliation(s)
- Awad A Ahmed
- Sylvester Comprehensive Cancer Center University of Miami Health System, Miami, Florida
| | - Wei-Ting Hwang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emma B Holliday
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
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Graduate Medical Education. Respir Med 2017. [DOI: 10.1007/978-3-319-43447-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Higgins MC, Hwang WT, Richard C, Chapman CH, Laporte A, Both S, Thomas CR, Deville C. Underrepresentation of Women and Minorities in the United States IR Academic Physician Workforce. J Vasc Interv Radiol 2016; 27:1837-1844.e2. [DOI: 10.1016/j.jvir.2016.06.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/12/2016] [Accepted: 06/13/2016] [Indexed: 11/16/2022] Open
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Bluhm M, Connell CM, De Vries RG, Janz NK, Bickel KE, Silveira MJ. Paradox of Prescribing Late Chemotherapy: Oncologists Explain. J Oncol Pract 2016; 12:e1006-e1015. [DOI: 10.1200/jop.2016.013995] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: The value of chemotherapy for patients with cancer in the last weeks of life warrants examination. Late chemotherapy may not improve survival or quality of life but typically precludes hospice enrollment and may result in additional symptoms, increased use of other aggressive treatments, and worsening quality of life. Few studies have explored oncologists’ rationales for administering chemotherapy near death. This study examines the self-reported factors that influence oncologists’ decisions about late chemotherapy. Methods: In-depth individual interviews were conducted with 17 oncologists through a semistructured interview guide. Interviews were audio recorded and transcribed verbatim. Transcripts were coded and analyzed using conventional content analysis, a qualitative method that allows the detection and analysis of patterns in the data. Results: Clinical factors take priority in determining late chemotherapy decisions when clear treatment choices exist. When clinical factors are ambiguous, emotion becomes a highly salient influence. Oncologists view late chemotherapy to be patient driven and use it to palliate emotional distress and maintain patient hope even when physical benefit is unexpected. Oncologists experience unique and difficult challenges when caring for dying patients, including emotionally draining communication, overwhelming responsibility for life/death, limitations of oncology to heal, and prognostic uncertainty. These challenges are also eased by offering late chemotherapy. Conclusion: The findings reveal a nuanced understanding of why oncologists find it difficult to refuse chemotherapy treatment for patients near death. Optimal end-of-life treatment decisions require supportive interventions and system change, both of which must take into account the challenges oncologists face.
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Affiliation(s)
- Minnie Bluhm
- Eastern Michigan University, Ypsilanti; University of Michigan, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Cathleen M. Connell
- Eastern Michigan University, Ypsilanti; University of Michigan, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Raymond G. De Vries
- Eastern Michigan University, Ypsilanti; University of Michigan, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Nancy K. Janz
- Eastern Michigan University, Ypsilanti; University of Michigan, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Kathleen E. Bickel
- Eastern Michigan University, Ypsilanti; University of Michigan, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Maria J. Silveira
- Eastern Michigan University, Ypsilanti; University of Michigan, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
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Close to Home: Employment Outcomes for Recent Radiation Oncology Graduates. Int J Radiat Oncol Biol Phys 2016; 95:1017-1021. [DOI: 10.1016/j.ijrobp.2016.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/01/2016] [Indexed: 11/21/2022]
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Hamel LM, Chapman R, Malloy M, Eggly S, Penner LA, Shields AF, Simon MS, Klamerus JF, Schiffer C, Albrecht TL. Critical Shortage of African American Medical Oncologists in the United States. J Clin Oncol 2015; 33:3697-700. [PMID: 26392105 DOI: 10.1200/jco.2014.59.2493] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Lauren M Hamel
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Robert Chapman
- Josephine Ford Cancer Institute/Henry Ford Health System, Detroit, MI
| | - Mary Malloy
- Michigan Society of Hematology and Oncology, Detroit, MI
| | - Susan Eggly
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Louis A Penner
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | | | - Michael S Simon
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
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