1
|
Jin R, Wu CHD, Giuliani M, Doll C, Ringash J, Lavigne D, Ingledew PA. Evaluation of a National Radiation Oncology Research and Mentorship Program. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00465-6. [PMID: 38582234 DOI: 10.1016/j.ijrobp.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/09/2024] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE The Canadian Association of Radiation Oncology Annual Scientific Meeting Medical Student Research and Mentorship Award was established in 2020 to support medical students pursuing radiation oncology (RO) research and RO as a career. This study is an evaluation of the effect of this national research and mentorship award on medical students, resident mentors, and research supervisors over 3 iterations. METHODS AND MATERIALS Three separate surveys were created for medical student mentees, RO resident mentors, and attending research supervisors. These surveys were developed using best practice strategies for medical education surveys and circulated for peer review among experts in oncology medical education. The surveys were sent to the 52 individuals (18 students, 18 residents, 16 supervisors) who participated in 3 cycles of Canadian Association of Radiation Oncology ASM MSRMA (2020-21, 2021-22, 2022-23). After anonymization, quantitative answers were analyzed using descriptive statistics, and narrative responses were evaluated using a grounded theory approach. RESULTS There was a 90% survey response rate. For medical student mentees, the award maintained (71%) or increased (24%) interest in pursuing an RO career. Students reported receiving helpful tips for residency applications and insight into RO residency, research, and career planning advice. Only the first student cohort currently has matching results for residency, with approximately 50% matching to RO. All resident mentor respondents felt the program either maintained or increased motivation to mentor students in RO. Research project supervisors unanimously enjoyed their role in this program and would recommend and participate in this program again. CONCLUSIONS A national research and mentorship award for medical students has shown a positive effect on participants. Medical students felt this award program motivated them to continue pursuing oncology research and a potential career in RO. The program also enhanced mentorship skills in residents and research supervisors, which encourages further RO mentorship, teaching, and exposure for future generations of students.
Collapse
Affiliation(s)
- Ruijia Jin
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Che Hsuan David Wu
- Department of Radiation Oncology, BC Cancer, Victoria, British Columbia, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, British Columbia, Canada; University of Toronto, Temerty Faculty of Medicine, Toronto, British Columbia, Canada
| | - Corinne Doll
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Hospital and University Health Network, Toronto, British Columbia, Canada; Division of Radiation Oncology, University of Toronto, Temerty Faculty of Medicine, Toronto, British Columbia, Canada
| | - Danny Lavigne
- Department of Radiation Oncology, Université de Montréal, Montreal, Quebec, Canada
| | - Paris Ann Ingledew
- Department of Radiation Oncology, BC Cancer, Victoria, British Columbia, Canada; Department of Surgery, Division of Radiation Oncology, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.
| |
Collapse
|
2
|
Chai BS, Giuliani M, Alfieri J, Cao J, Bezjak A, Kim M, Wu CHD, Malik N, Mak DY, Ingledew PA. A Qualitative Analysis of Medical Student Reflections Following Participation in a Canadian Radiation Oncology Studentship. J Cancer Educ 2024; 39:153-159. [PMID: 38057504 DOI: 10.1007/s13187-023-02388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/08/2023]
Abstract
Exposure to radiation oncology in medical school curricula is limited; thus, mentorship and research opportunities like the Dr. Pamela Catton Summer Studentship Program attempt to bridge this gap and stimulate interest in the specialty. In 2021, the studentship was redesigned as virtual research, mentorship, and case-based discussions due to the COVID-19 pandemic. This study explores the impact of COVID-19 on the studentship, on students' perceptions of the program, and on medical training and career choice. Fifteen studentship completion essays during 2021-2022 were obtained and anonymized. Thematic analysis was performed to interpret the essays with NVivo. Two independent reviewers coded the essays. Themes were established by identifying connections between coded excerpts. Consensus was achieved through multiple rounds of discussion and iteratively reviewing each theme. Representative quotes were used to illustrate the themes. The themes confirmed the studentship was feasible during the pandemic. Perceived benefits of the program included mentorship and networking opportunities; gaining practical and fundamental knowledge in radiation oncology; developing clinical and research skills; and creating positive attitudes towards radiation oncology and the humanistic aspect of the field. The studentship supported medical specialty selection by helping define student values, shaping perceptions of the specialty, and promoting self-reflection upon students' personal needs. This study informs future iterations of the studentship to promote radiation oncology in Canadian medical school curricula. It serves as a model for studentships in other specialties that have limited exposure and similar challenges with medical student recruitment.
Collapse
Affiliation(s)
- Brandon S Chai
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Joanne Alfieri
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Jeffrey Cao
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Andrea Bezjak
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Michael Kim
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Che Hsuan David Wu
- Department of Radiation Oncology, BC Cancer Agency- Victoria, Victoria, BC, Canada
| | - Nauman Malik
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - David Y Mak
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Paris-Ann Ingledew
- Department of Surgery, Division of Radiation Oncology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
- Department of Radiation Oncology, BC Cancer- Vancouver, Vancouver, BC, Canada.
| |
Collapse
|
3
|
Rami-Porta R, Nishimura KK, Giroux DJ, Detterbeck F, Cardillo G, Edwards JG, Fong KM, Giuliani M, Huang J, Kernstine KH, Marom EM, Nicholson AG, Van Schil PE, Travis WD, Tsao MS, Watanabe SI, Rusch VW, Asamura H. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groups in the Forthcoming (Ninth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2024:S1556-0864(24)00079-0. [PMID: 38447919 DOI: 10.1016/j.jtho.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The TNM classification of lung cancer is periodically revised. The International Association for the Study of Lung Cancer collected and analyzed a new database to inform the forthcoming ninth edition of the TNM classification. The results are herewith presented. METHODS After exclusions, 76,518 patients from a total of 124,581 registered patients were available for analyses: 58,193 with clinical stage, 39,192 with pathologic stage, and 62,611 with best stage NSCLC. The proposed new N2 subcategories (N2a, involvement of single ipsilateral mediastinal or subcarinal nodal station, and N2b, involvement of multiple ipsilateral mediastinal nodal stations with or without involvement of the subcarinal nodal station) and the new M1c subcategories (M1c1, multiple extrathoracic metastases in one organ system, and M1c2, multiple extrathoracic metastases in multiple organ systems) were considered in the survival analyses. Several potential stage groupings were evaluated, using multiple analyses, including recursive partitioning, assessment of homogeneity within and discrimination between potential groups, clinical and statistical significance of survival differences, multivariable regression, and broad assessment of generalizability. RESULTS T1N1, T1N2a, and T3N2a subgroups are assigned to IIA, IIB, and IIIA stage groups, respectively. T2aN2b and T2bN2b subgroups are assigned to IIIB. M1c1 and M1c2 remain in stage group IVB. Analyses reveal consistent ordering, discrimination of prognosis, and broad generalizability of the proposed ninth edition stage classification of lung cancer. CONCLUSIONS The proposed stages for the ninth edition TNM improve the granularity of nomenclature about anatomic extent that has benefits as treatment approaches become increasingly differentiated and complex.
Collapse
Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.
| | | | | | | | - Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy; UniCamillus-Saint Camillus International University of Health Science, Rome, Italy
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
| | - Kwun M Fong
- Department of Thoracic Medicine, University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia
| | - Meredith Giuliani
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kemp H Kernstine
- Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, Texas
| | - Edith M Marom
- The Chaim Sheba Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Edegem (Antwerp), Belgium
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ming S Tsao
- Department of Pathology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Valerie W Rusch
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
4
|
Ringash J, Dunphy C, Avery L, Chahin R, Chang E, Davis AM, Jones J, Martino R, Moody L, Giuliani M, McEwen S. Efficacy of the Rehabilitation Planning Consult for Survivors of Head and Neck Cancer: A Phase 2 Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2024; 118:759-769. [PMID: 37820770 DOI: 10.1016/j.ijrobp.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Survivors of head and neck cancer may have significant lasting impairments and poor access to rehabilitation. To address this, our group developed and evaluated a rehabilitation planning consult (RPC). The RPC is conducted through an initial consultation and a single follow-up session with a rehabilitation professional. During the initial consultation, rehabilitation needs are determined and the survivor sets individualized goals and plans. They then implement their plans independently and are facilitated to evaluate and modify plans as necessary during the follow-up session. METHODS AND MATERIALS We used a waitlist control design to compare the proportion of participants attaining a minimally importantly different change in quality of life (QOL) on the Short Form 36 Physical Health Summary Score from baseline to 3 months after study enrollment, between patients randomized to receive (n = 77) or wait 14 ± 3 weeks to receive (n = 76) the RPC. Additional outcomes included goal attainment indicators measured using the Brief Rehabilitation Assessment for Survivors of Head and Neck Cancer (BRASH). RESULTS Of 153 participants recruited, 95 (62%) completed the intervention; 57 were in the immediate (RPC) group and 38 were in the waiting list control (WLC) group. No significant between-group differences were seen in the proportion of patients achieving a minimally important improvement (2.5 units) on the Physical Health Summary Score from baseline to 3 months after recruitment. No between-group differences were seen on any secondary QOL indicators. Among the 67 (RPC n = 42, WLC n = 22) participants who set individualized rehabilitation goals, BRASH scores on goal performance and satisfaction with goal performance were significantly better in the RPC group. CONCLUSIONS Our results suggest that the RPC may provide benefit in patients' individualized domains of choice among those who set goals, without affecting overall QOL. Future work could refine the subset of patients who benefit and explore the optimal timing and intensity of the intervention.
Collapse
Affiliation(s)
- Jolie Ringash
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
| | - Colleen Dunphy
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Lisa Avery
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Rehab Chahin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Eugene Chang
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | | | - Jennifer Jones
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | | | - Lesley Moody
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Sara McEwen
- Selkirk College, Castlegar, British Columbia, Canada
| |
Collapse
|
5
|
Owen D, Salama JK, Daly ME, Kruser TJ, Giuliani M. In Reply to Burton and Hardcastle. Int J Radiat Oncol Biol Phys 2024; 118:867. [PMID: 38340773 DOI: 10.1016/j.ijrobp.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Timothy J Kruser
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Tavares W, Sockalingam S, Valanci S, Giuliani M, Davis D, Campbell C, Silver I, Charow R, Jeyakumar T, Younus S, Wiljer D. Performance Data Advocacy for Continuing Professional Development in Health Professions. Acad Med 2024; 99:153-158. [PMID: 37824840 DOI: 10.1097/acm.0000000000005490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
ABSTRACT Efforts to optimize continuing professional development (CPD) are ongoing and include advocacy for the use of clinician performance data. Several educational and quality-based frameworks support the use of performance data to achieve intended improvement outcomes. Although intuitively appealing, the role of performance data for CPD has been uncertain and its utility mainly assumed. In this Scholarly Perspective, the authors briefly review and trace arguments that have led to the conclusion that performance data are essential for CPD. In addition, they summarize and synthesize a recent and ongoing research program exploring the relationship physicians have with performance data. They draw on Collins, Onwuegbuzie, and Johnson's legitimacy model and Dixon-Woods' integrative approach to generate inferences and ways of moving forward. This interpretive approach encourages questioning or raising of assumptions about related concepts and draws on the perspectives (i.e., interpretive work) of the research team to identify the most salient points to guide future work. The authors identify 6 stimuli for future programs of research intended to support broader and better integration of performance data for CPD. Their aims are to contribute to the discourse on data advocacy for CPD by linking conceptual, methodologic, and analytic processes and to stimulate discussion on how to proceed on the issue of performance data for CPD purposes. They hope to move the field from a discussion on the utility of data for CPD to deeper integration of relevant conceptual frameworks.
Collapse
|
7
|
Ugas M, Giuliani M, Papadakos J. When is good, good enough? On considerations of machine translation in patient education. J Cancer Educ 2024:10.1007/s13187-024-02401-4. [PMID: 38263349 DOI: 10.1007/s13187-024-02401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Mohamed Ugas
- Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
| | - Meredith Giuliani
- Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
- The Institute for Education Research, University Health Network, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada.
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Institute for Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| |
Collapse
|
8
|
Sherwood M, Papadakos J, Kulasegaram K, Martimianakis MA, Kucharski E, Giuliani M. Exploring Family Physician Training Needs to Improve Cancer Patient Care. J Cancer Educ 2023; 38:1834-1844. [PMID: 37452226 DOI: 10.1007/s13187-023-02339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
Family physicians have multifaceted roles in cancer patient care and oncology education among this group is unfortunately inadequate. This study explored the needs and perspectives of family physicians regarding their oncology training and experiences. As well, physician cancer care experiences, knowledge use, and continuing education practices were elucidated. The authors employed a qualitative approach with family physicians participating in semi-structured interviews. General practitioners in oncology were excluded. Purposeful sampling was used, with recruitment through Ontario regional primary cancer care leads and social media. Interviews were transcribed, and thematic analysis was conducted. Thirteen participants were interviewed-1.6:1 female: male, ages 30-39, practicing for an average of 9 years (0.5-30 years), with urban and suburban practices. Most trained in Canada as undergraduates and completed their residency in Ontario; 62% had participated in at least one oncology continuing medical education session. Three major themes emerged: delineation of roles, oncology knowledge and education, and palliative care. Participants reported role uncertainty after cancer diagnosis, with oncology teaching at all levels described as lacking relevance. Palliative care rotations were an avenue for oncology education and where participants returned to cancer care. Changing existing teaching, information access, and avenues of oncology experiences may be the next step to supporting successful cancer care by family physicians.
Collapse
Affiliation(s)
- Marissa Sherwood
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada
| | | | - Maria A Martimianakis
- Wilson Centre for Research in Education, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Edward Kucharski
- Department of Family and Community Medicine, Toronto, Ontario, Canada
- Casey House Hospital, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
- The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada.
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
9
|
Schellenberg D, Gabos Z, Duimering A, Debenham BJ, Fairchild A, Huang F, Rowe L, Severin DM, Giuliani M, Bezjak A, Lok BH, Raman S, Chung P, Zhao Y, Ho C, Lock MI, Louie A, Lefresne S, Carolan H, Liu MC, Yau V, Ye AY, Olson RA, Mou B, Mohamed IG, Petrik DW, Dosani M, Pai HH, Valev B, Gaede S, Warner A, Palma DA. Stereotactic Ablative Radiotherapy for Oligo-Progressive Cancers: Results of the Randomized Phase II STOP Trial. Int J Radiat Oncol Biol Phys 2023; 117:S58. [PMID: 37784530 DOI: 10.1016/j.ijrobp.2023.06.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the metastatic setting, there is uncertain benefit to localized eradication of one or more lesions that are progressing despite systemic therapy. This randomized phase II trial examined if patients with ≤5 sites of oligoprogression benefited from the addition of stereotactic ablative radiotherapy (SABR) to standard of care (SOC) systemic therapy. MATERIALS/METHODS Eligibility criteria included age ≥18 years, ECOG performance status 0-2, and oligoprogressive disease, defined as 1-5 lesions actively progressing while on systemic therapy. Patients were required to have at least 3 months of disease stability/response on systemic therapy prior to oligoprogression. After stratifying by type of systemic therapy (cytotoxic vs. non-cytotoxic), patients were randomized 2:1 to SABR to all progressing lesions plus SOC (SABR arm) vs. SOC alone (SOC arm). The trial began exclusive to non-small cell lung cancer but did not meet accrual goals and was expanded in 2019 to include all non-hematologic malignancies. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), lesional control, quality of life (QOL), toxicity, and duration of current systemic agent post-SABR. RESULTS Between February 2017 and June 2021, 90 patients with 125 oligoprogressive metastases were enrolled across 8 Canadian institutions, with 59 patients randomized to SABR and 31 to SOC. Median age was 67 years (IQR: 61-73 years) and 39 (43%) were female. The most common primary sites were lung (44% of patients), genitourinary (23%) and breast (13%), with the most common oligo-progressive locations being lung (43%), bone (19%), lymph nodes (14%), and liver (13%). In the SABR arm, the most common fractionations were 35 Gy/5 (38% of lesions) and 50 Gy/5 (18%). Protocol adherence in the SOC arm was suboptimal: 3 patients (10%) withdrew immediately after randomization, and 7 additional patients (23%) received high-dose or ablative therapies. Median follow-up was 31 months. There was no difference in PFS between arms (median PFS 8.4 months in the SABR arm vs. 4.3 months in the SOC arm; however, the curves cross and 2-year PFS was 9% vs. 24% respectively, p = 0.91). Median OS was 31.2 months vs. 27.4 months, respectively (p = 0.22). Lesional control with SABR was 71% vs. 39% with SOC (p = 0.002). Median duration of post-randomization first-line systemic therapy was 10.3 months vs. 7.6 months, respectively (p = 0.71). Treatment was well-tolerated with 2 (3.4%) grade 3 treatment-related toxicities in the SABR arm and no grade 4/5 related events in either arm. QOL did not differ between arms. CONCLUSION Despite being a well-tolerated treatment providing superior lesional control, SABR for oligoprogression did not improve PFS or OS. Results may have been impacted by withdrawals and desire for ablative treatments on the SOC arm, and this lack of equipoise may make accrual to phase III trials difficult, although larger studies in select sub-populations are desired. (NCT02756793).
Collapse
Affiliation(s)
| | - Z Gabos
- University of Alberta, Edmonton, AB, Canada
| | | | | | | | - F Huang
- University of Alberta, Edmonton, AB, Canada
| | - L Rowe
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - D M Severin
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - M Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Bezjak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - B H Lok
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - P Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Y Zhao
- Dalhousie University, Halifax, NS, Canada
| | - C Ho
- BC Cancer - Fraser Valley, Surrey, BC, Canada
| | - M I Lock
- London Health Sciences Centre, London, ON, Canada
| | - A Louie
- Sunnybrook Odette Cancer Centre, TORONTO, ON, Canada
| | - S Lefresne
- BC Cancer Vancouver, Vancouver, BC, Canada
| | | | - M C Liu
- Department of Radiation Oncology, BC Cancer - Vancouver Centre, Vancouver, BC, Canada
| | - V Yau
- BC Cancer - Centre for the North, Prince George, BC, Canada
| | - A Y Ye
- University of British Columbia, Kelowna, BC, Canada
| | - R A Olson
- BC Cancer - Prince George, Prince George, BC, Canada
| | - B Mou
- BC Cancer - Kelowna, Kelowna, BC, Canada
| | | | | | - M Dosani
- BC Cancer - Victoria, Victoria, BC, Canada
| | - H H Pai
- BC Cancer - Victoria, Victoria, BC, Canada
| | - B Valev
- BC Cancer - Victoria, Victoria, BC, Canada
| | - S Gaede
- Department of Medical Physics, Western University, London, ON, Canada
| | - A Warner
- London Health Sciences Centre, London, ON, Canada
| | - D A Palma
- Department of Oncology, Western University, London, ON, Canada
| |
Collapse
|
10
|
Palma DA, Bahig H, Hope AJ, Harrow S, Debenham BJ, Louie A, Vu T, Filion EJ, Bezjak A, Campeau MP, Duimering A, Giuliani M, Laba JM, Lang P, Lok BH, Qu MX, Raman S, Rodrigues G, Goodman C, Gaede S, Morisset J, Warner A, Dhaliwal I, Ryerson C. Assessment of Precision Irradiation in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease (ASPIRE-ILD): Primary Analysis of a Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:S28-S29. [PMID: 37784467 DOI: 10.1016/j.ijrobp.2023.06.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The use of stereotactic ablative radiotherapy (SABR) in patients with fibrotic interstitial lung disease (ILD) has been associated with an increased risk of toxicity, but patients with ILD and lung cancer may have no other options for curative-intent treatment. The goal of the ASPIRE-ILD trial was to assess the benefits and toxicities of SABR in patients with fibrotic ILD. MATERIALS/METHODS We enrolled patients with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgery. All patients were centrally reviewed prior to enrollment to confirm the presence and subtype of ILD. After stratification by the ILD-GAP score (a measure of ILD severity and prognosis), patients were treated with SABR to a dose of 50 Gy in 5 fractions EOD (BED = 100 Gy10), with a built-in de-escalation protocol in case of unacceptable toxicity. The primary endpoint was overall survival (OS), powered to distinguish 1-year OS >70% vs. an unacceptable rate of ≤50%. Secondary endpoints included toxicity (CTC-AE version 4.0), progression-free survival (PFS), local control (LC), patient-reported outcomes (FACT-L quality of life and cough severity), and changes in pulmonary function tests (PFTs). The study pre-specified that SABR would be considered worthwhile if median OS was >1 year, with a grade 3-4 toxicity risk <35% and a grade 5 toxicity risk <15%. Target accrual was 39 treated patients. RESULTS Thirty-nine patients were enrolled and treated with SABR between March 2019 and January 2022, all to a dose of 50 Gy in 5 fractions, at 5 institutions in Canada and 1 in Scotland. Median age was 78 years (interquartile range: 67-83), 59% were male, and 92% had a history of smoking (median 43 pack-years). At baseline, 70% reported dyspnea, median FEV1 was 80% predicted and median DLCO was 49% predicted. ILD-GAP scores were as follows: ≤2 (i.e., best ILD status): n = 14; 3-5: n = 23; ≥6 (i.e., worst ILD status): n = 2. Median follow-up was 19 months. OS at 1-year was 78.9% (p<0.001 by binomial test vs. the unacceptable rate). Median OS was 25 months, median PFS was 19 months, and 2-year LC was 92%. AE rates (possibly, probably or definitely related) were as follows (highest grade per patient): grade 1-2: n = 12 (31%); grade 3: n = 4 (10%); grade 4; n = 0; grade 5 n = 3 (7.7%, all due to respiratory deterioration). AE rates did not differ by ILD-GAP category or ILD subtype. FACT-L scores trended downward over time (p = 0.07), and cough severity scale scores worsened over time (p = 0.02). Comparing last-available PFTs with baseline, DLCO declined (median: -4%; p = 0.046), FVC trended downward (median: -2.5%; p = 0.11), and FEV1 remained stable (median change: 0%). CONCLUSION The use of SABR in patients with ILD met the pre-specified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. Further studies exploring pharmacologic options to reduce toxicity may be beneficial in this population. ().
Collapse
Affiliation(s)
- D A Palma
- Department of Oncology, Western University, London, ON, Canada
| | - H Bahig
- Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - A J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Harrow
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | | | - A Louie
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - T Vu
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - E J Filion
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - A Bezjak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M P Campeau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - M Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J M Laba
- London Health Sciences Centre, London, ON, Canada
| | - P Lang
- Department of Oncology, Western University, London, ON, Canada
| | - B H Lok
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M X Qu
- London Regional Cancer Centre, London, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - G Rodrigues
- London Health Sciences Centre, London, ON, Canada
| | - C Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - S Gaede
- Department of Medical Physics, Western University, London, ON, Canada
| | - J Morisset
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - A Warner
- London Health Sciences Centre, London, ON, Canada
| | - I Dhaliwal
- London Health Sciences Centre, London, ON, Canada
| | - C Ryerson
- University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
11
|
Bacon H, McNeil N, Patel T, Welch M, Ye XY, Bezjak A, Lok BH, Raman S, Giuliani M, Cho J, Sun A, Lindsay P, Liu G, Kandel S, McIntosh C, Tadic T, Hope A. Association of Artificial Intelligence-Screened Interstitial Lung Disease with Radiation Pneumonitis and Mortality in Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e4-e5. [PMID: 37785334 DOI: 10.1016/j.ijrobp.2023.06.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation pneumonitis (RP) is a common and dose-limiting toxicity following radiotherapy for non-small cell lung cancer (NSCLC). Patients with interstitial lung disease (ILD) are believed to be at increased risk of developing complications including RP, ILD progression, or death. An automated method to identify patients prior to radiotherapy at high risk of developing toxicities or death may allow clinicians to mitigate risk through informed treatment planning and careful patient monitoring. MATERIALS/METHODS All locally advanced NSCLC patients treated with definitive radiation from 2006-2021 with a minimum 1 year of follow-up were assessed. RP and mortality data were prospectively collected and retrospectively reviewed. A convolutional neural network (CNN) was previously developed and validated to identify patients with radiographic ILD using planning computed tomography (CT) images, with an accuracy of 0.82. Planning CT scans for the retrospective cohort were used as input to the CNN, with artificial intelligence-screened ILD (AI-ILD) score as an output. AI-ILD scores above our established threshold were labeled as AI-ILD+. The association between AI-ILD score, AI-ILD+/-, mean lung dose (MLD), and the primary outcome of grade ≥2 (G2+) RP or mortality, as well as the secondary outcomes of G2+ RP and mortality were assessed using Wilcoxon rank sum test, univariate and multivariable logistic regression, and Kaplan-Meier survival analysis. RESULTS Of 799 patients reviewed, 745 eligible patients were included in the analysis; grade 0-5 RP was reported in 51.3%, 27.1%, 16.9%, 4.0%, 0.1%, and 0.5% of patients respectively. Overall, 22.9% of patients were AI-ILD+, and therefore at high risk (>20% chance) of having true ILD. On UVA, AI-ILD score, AI-ILD+ and MLD were significantly associated with the primary outcome of G2+ RP or mortality, as well as the secondary outcome of mortality. However, only MLD was significantly associated with the secondary outcome of G2+ RP. On MVA, both AI-ILD+ (OR 1.42, 95% CI 1.02-1.97, p = 0.04) and MLD (OR 1.13, 95% 1.05-1.21, p = 0.008) were significantly associated with G2+ RP or mortality. On Kaplan-Meier analysis, the median toxicity-free survival (TFS) time for AI-ILD+ and AI-ILD- patients were 1.7 and 3.4 years respectively, with a 2-year TFS of 48.3% vs. 59.3% (log-rank test: p = 0.02). There was no significant difference in rates of G2+ RP. CONCLUSION The AI-ILD algorithm can detect high risk patients with significantly decreased TFS following definitive treatment for NSCLC. AI-ILD classification was not associated with a significant difference in rates of RP when accounting for MLD. Future work will focus on improving the classification algorithm, expert radiologist validation of this dataset, and exploring reasons for the mortality difference in AI-ILD+ patients.
Collapse
Affiliation(s)
- H Bacon
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - N McNeil
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - T Patel
- Techna Institute, University Health Network, Toronto, ON, Canada
| | - M Welch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - X Y Ye
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - A Bezjak
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - B H Lok
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S Raman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J Cho
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Sun
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - P Lindsay
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - G Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S Kandel
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - C McIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - T Tadic
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Hope
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
12
|
Owen D, Siva S, Salama JK, Daly M, Kruser TJ, Giuliani M. Some Like It Hot: The Value of Dose and Hot Spots in Lung Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:1-5. [PMID: 37574234 DOI: 10.1016/j.ijrobp.2023.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Center, Victoria, Australia
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Megan Daly
- Department of Radiation Oncology, University of California, Davis, California
| | - Timothy J Kruser
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Li ZHJ, MacDonald K, Preston K, Giuliani M, Leung B, Melosky B, Simmons C, Hamilton S, Tinker A, Ingledew PA. Evaluating the childcare needs of cancer patients undergoing radiation therapy. Support Care Cancer 2023; 31:463. [PMID: 37439947 DOI: 10.1007/s00520-023-07923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE About one-fifth of newly diagnosed cancer patients are parents to young children. These patients are at higher risk of psychosocial stress and inability to attend treatment due to having to balance their own healthcare needs with childcare duties. This study aims to explore the impact of childcare on cancer parents and elicit their perspectives on potential supports. The results could help inform the implementation of suitable childcare programs to remove this barrier in accessing care. METHODS Patients at a large Canadian cancer treatment center were screened by oncologists for having minor children at home. Secure electronic surveys were then distributed to consenting participants. Domains surveyed included patient demographics, childcare burden, impact on treatment, and preference for childcare supports. RESULTS The mean age of correspondents was 43.9 (range 33-54), 46 patients (92%) were female, and breast cancer was the most common primary tumor. The median number of children per correspondent was two, and their mean age was 8.4. Balancing childcare with cancer treatment had a significant impact on self-reported stress levels for most correspondents. Twenty (40%) participants had to reschedule and 7 (14%) participants missed at least one appointment due to childcare conflicts. During the COVID-19 pandemic, access to childcare resources decreased while childcare responsibilities increased. Three-quarters of correspondents reported that a flexible childcare would make it easier for them to adhere to appointment schedules. CONCLUSION Childcare is a significant psychosocial barrier for patients accessing cancer care. Our results indicate that most parents undergoing treatment may benefit from hospital-based childcare services.
Collapse
Affiliation(s)
- Zhang Hao Jim Li
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - Kenzie MacDonald
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Preston
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meredith Giuliani
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Bonnie Leung
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbara Melosky
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christine Simmons
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Hamilton
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - Anna Tinker
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paris-Ann Ingledew
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada.
- BC Cancer, Vancouver, British Columbia, Canada.
| |
Collapse
|
14
|
Giannopoulos E, McBain S, Giuliani M, Wang J, Zwicker V, Fox C, Papadakos J. Health Literacy and Radiation Therapy: a Current State Assessment of Patient Education Materials. J Cancer Educ 2023; 38:924-930. [PMID: 35921064 DOI: 10.1007/s13187-022-02208-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 06/02/2023]
Abstract
In order to mitigate low levels of health literacy among patients, there is need to evaluate patient education (PE) materials and to ensure that the information is readily accessible to patients. The quality and comprehensiveness of radiation therapy materials were evaluated at fourteen cancer centres. To assess quality, PE leaders independently conducted readability, actionability and understandability assessments of materials. To evaluate comprehensiveness, an assessment was conducted of the scope of symptoms covered in extant materials, and the modality they were produced in (e.g. pamphlet, video). A total of 555 PE materials were reviewed for comprehensiveness and modality and seventy underwent evaluation against health literacy best practice standards. Most materials (n = 64, 91%) had a reading grade level above the recommended grade 6 ([Formula: see text] = 9, range = 4-12). Under half (n = 34, 49%) scored at or above the 80% threshold for understandability ([Formula: see text] = 74%, 33-100%) and just over half (n = 36, 51%) scored at or above the 80% target for actionability ([Formula: see text] = 71%, 33-100%). Only two cancer centres (n = 2/14, 14%) had PE materials covering the breadth of symptoms related to radiation therapy and the vast majority of materials were pamphlets (89%). Findings indicate that most radiation therapy PE materials used in cancer centres do not meet health literacy best practices, and there is a disparity between cancer centres in the topics that are available to patients and family. This evaluation highlights the need to better incorporate health literacy best practices into the development of radiation therapy PE materials and strategies to improve accessibility of such health information.
Collapse
Affiliation(s)
- Eleni Giannopoulos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
| | - Sarah McBain
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, M5G 2L7, Canada
| | - Meredith Giuliani
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, M5T 1P5, Canada
| | - Jenney Wang
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, M5G 2L7, Canada
| | - Victoria Zwicker
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, M5G 2L7, Canada
| | - Colleen Fox
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, M5G 2L7, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada.
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, M5G 2L7, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, M5T 3M6, Canada.
| |
Collapse
|
15
|
Giannopoulos E, Agarwal A, Croke J, Golden DW, Hirsch AE, Jimenez RB, Malik NH, Papadakos J, Quartey NK, Samoil D, Wu CHD, Ingledew PA, Giuliani M. Exploring the Perceived Educational Impact of COVID-19 on Postgraduate Training in Oncology. J Cancer Educ 2023; 38:829-836. [PMID: 35726080 PMCID: PMC9208832 DOI: 10.1007/s13187-022-02192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 06/02/2023]
Abstract
This study sought to report the degree to which postgraduate trainees in radiation oncology perceive their education has been impacted by the COVID-19 pandemic. A cross-sectional online survey was administered from June to July 2020 to trainee members of the Canadian Association of Radiation Oncology (CARO) (n = 203). Thirty-four trainees responded with a 17% response rate. Just under half of participants indicated that COVID-19 had a negative/very negative impact on training (n = 15; 46%). The majority agreed/strongly agreed that they feared family/loved ones would contract COVID-19 (n = 29, 88%), felt socially isolated from friends and family because of COVID-19 (n = 23, 70%), and had difficulty concentrating on tasks because of concerns about COVID-19 (n = 17, 52%). Changes that had a negative/very negative impact on learning included limitations to travel and networking (n = 31; 91%) and limited patient contact (n = 19; 58%). Virtual follow-ups (n = 25: 76%) and in-patient care activities (n = 12; 36%) increased. Electives were cancelled in province (n = 10; 30%), out-of-province (n = 16; 49%), and internationally (n = 15; 46%). Teaching from staff was moderately reduced to completely suppressed (n = 23, 70%) and teaching to medical students was moderately reduced to completely suppressed (n = 27, 82%). Significant changes to radiation oncology training were wrought by the pandemic, and roughly half of trainees perceive that these changes had a negative impact on training. Innovations in training delivery are needed to adapt to these new changes.
Collapse
Affiliation(s)
| | - Ankit Agarwal
- Western Radiation Oncology/El Camino Health, Mountain View, CA, USA
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Daniel W Golden
- Department of Radiation Oncology, University of Chicago, Chicago, IL, USA
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA, USA
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Nauman H Malik
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Janet Papadakos
- Cancer Education, Princess Margret Cancer Centre, Toronto, ON, Canada
- Cancer Care Ontario, Ontario Health, Toronto, ON, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Diana Samoil
- Cancer Education, Princess Margret Cancer Centre, Toronto, ON, Canada
| | | | - Paris-Ann Ingledew
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margret Cancer Centre, Toronto, ON, Canada.
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
16
|
Li ZHJ, Kim I, Giuliani M, Ingledew PA. Navigating Radiation Therapy During COVID-19 Using YouTube as a Source of Information. J Cancer Educ 2023; 38:412-418. [PMID: 35028927 PMCID: PMC8758466 DOI: 10.1007/s13187-022-02133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 05/20/2023]
Abstract
The COVID-19 pandemic brought considerable change to the practice of radiotherapy. In the meantime, patients are increasingly turning to online resources for health information, with YouTube being one of the biggest platforms. However, little is known about what information is being disseminated to cancer patients about radiotherapy in the context of COVID-19. Therefore, this study aims to characterize and assess YouTube videos on radiotherapy during COVID-19. A YouTube search using the terms "Radiation therapy COVID-19", "Radiation therapy coronavirus", "Radiotherapy COVID-19", and "Radiotherapy coronavirus" was completed using a clear-cache web browser. The top 50 videos were collected from each search. After applying pre-determined exclusion criteria, each video was assessed for general parameters, source, and content. Two raters were used to ensure interrater reliability. One hundred five unique videos resulted from the four searches. Ninety-eight per cent were published in the last year. The median video length was 6 min and 54 s, and the median number of views was 570. Most videos were from the USA (58%). The majority of videos were published by a commercial channel (31%), non-profit organization (28%), or healthcare facility (26%). Forty-two per cent of the videos covered a topic related to radiotherapy during the pandemic. Bias was identified in 6% of videos. YouTube information on radiotherapy during COVID-19 is non-specific and can be misleading. The results of this study highlight the need for healthcare providers to proactively address patient information needs and guide them to appropriate sources of information.
Collapse
Affiliation(s)
- Zhang Hao Jim Li
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, V6T 1Z3, Canada
| | - Inhwa Kim
- Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, B3H 4R2, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, 149 College St #504, Toronto, M5T 1P5, Canada
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Paris-Ann Ingledew
- Division of Radiation Oncology, Department of Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, V5Z 1M9, Canada.
- BC Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, V5Z 4E6, Canada.
| |
Collapse
|
17
|
Abstract
The lung parenchyma and adjacent tissues are one of the most common sites of metastatic disease. Traditionally, the approach to treatment of a patient with lung metastases has been with systemic therapy, with radiotherapy being reserved for palliative management of symptomatic disease. The concept of oligo metastatic disease has paved the way for more radical treatment options, administered either alone or as local consolidative therapy in addition to systemic treatment. The modern-day management of lung metastases is guided by a number of factors, including the number of lung metastases, extra-thoracic disease status, overall performance status, and life expectancy, which all help determine the goals of care. Stereotactic body radiotherapy (SBRT) has emerged as a safe and effective method in locally controlling lung metastases, in the oligo metastatic or oligo-recurrent setting. This article outlines the role of radiotherapy in multimodality management of lung metastases.
Collapse
|
18
|
Affiliation(s)
- John Van Aerde
- University of Alberta, Alberta, Canada
- Canadian Society of Physician Leaders, Ontario, Canada
| | - Marcio M Gomes
- University of Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Canada
| | | | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
- Royal College of Physicians and Surgeons of Canada, Canada
| | | |
Collapse
|
19
|
Thoma B, Karwowska A, Samson L, Labine N, Waters H, Giuliani M, Chan TM, Atkinson A, Constantin E, Hall AK, Gomez-Garibello C, Fowler N, Tourian L, Frank J, Anderson R, Snell L, Van Melle E. Emerging concepts in the CanMEDS physician competency framework. Can Med Educ J 2023; 14:4-12. [PMID: 36998506 PMCID: PMC10042782 DOI: 10.36834/cmej.75591] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies. Methods Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted. Results 1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanism; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts. Conclusion This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025.
Collapse
Affiliation(s)
- Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Anna Karwowska
- University of Ottawa, Ontario, Canada
- Association of Faculties of Medicine of Canada, Ontario, Canada
| | - Louise Samson
- Université de Montréal, Quebec, Canada
- Collège des médecins du Québec, Quebec, Canada
| | | | | | | | | | - Adelle Atkinson
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- University of Toronto, Ontario, Canada
| | | | - Andrew K Hall
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- University of Ottawa, Ontario, Canada
| | | | - Nancy Fowler
- McMaster University, Ontario, Canada
- College of Family Physicians of Canada, Ontario, Canada
| | | | | | - Rob Anderson
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- NOSM University, Ontario, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- McGill University, Quebec, Canada
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- Queen’s University, Ontario, Canada
| |
Collapse
|
20
|
Sherwood M, Giannopoulos E, Papadakos J, Martimianakis MA, Kulasegaram K, Giuliani M. Clinical Objectives of the Canadian Licensing Examination: Exploring the Representation of Oncology. J Cancer Educ 2023; 38:255-259. [PMID: 34708392 DOI: 10.1007/s13187-021-02108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 06/13/2023]
Abstract
Every physician should be comfortable caring for cancer patients, yet medical education in oncology is known as inadequate. Our study explored this issue from an assessment perspective, by determining the representation of oncology and other health priorities in the clinical learning objectives for the Medical Council of Canada Qualifying Examination Part 1 (MCCQE Part 1). The Medical Council of Canada lists objectives for the MCCQE Part 1, based on CanMEDS roles for medical graduate competency. These objectives guide exam question development and can be used as a study guide for learners. Our study focused on the Medical Expert role and mapped the clinical objectives for oncologic, cardiovascular, cerebrovascular and chronic lower respiratory disease. The clinical objectives contained 190 topics under the Medical Expert role. Oncology content was found in 57 (30%), cardiovascular disease in 56 (29.5%), cerebrovascular disease in 21 (11%) and chronic lower respiratory disease in 7 (3.7%). In objectives with oncology content, gastrointestinal cancer (16, 28%), non-specific indicators of cancer (7, 12%) and genitourinary/musculoskeletal cancers (6, 10.5%) were most frequent. Content coding had inter-rater agreement greater than 99%, with kappas from 0.73 to 1.00. Oncology was highly represented in the clinical objectives listed for the MCCQE Part 1. With existing research showing limited oncology content on examinations and in medical curricula, our results were unexpected. This finding could signal the efficacy of initiatives seeking to improve oncology education and emphasizes the importance of continuing improvements in oncology education to meet patient and healthcare system needs.
Collapse
Affiliation(s)
- Marissa Sherwood
- Department of Radiation Oncology, University of Toronto, Toronto, Canada.
- Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON, M5G 1Z5, Canada.
| | - Eleni Giannopoulos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Maria A Martimianakis
- Wilson Centre for Research in Education, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Kulamakan Kulasegaram
- Wilson Centre for Research in Education, Toronto, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON, M5G 1Z5, Canada
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| |
Collapse
|
21
|
Barry A, Elliott M, Loewen S, Alfieri J, Bowes D, Croke J, Debenham B, Keyes M, Papadakos J, Quartey NK, Stuckless T, Lajkosv K, Weiss J, Giuliani M. The Impact of Parent and Family Caregiver Roles Among Canadian Radiation Oncologists. Int J Radiat Oncol Biol Phys 2022; 116:280-289. [PMID: 36563908 DOI: 10.1016/j.ijrobp.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/15/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Working parents, and a rising number of adults delivering care for aging relatives, experience numerous challenges in their personal, family, professional, and financial lives owing to multiple responsibilities. This study describes the experiences of Canadian radiation oncologist (RO) parents and family caregivers, reporting challenges that may exist in providing family care with clinical and academic work commitments. METHODS AND MATERIALS Canadian ROs, via RO heads of departments in cancer centers across Canada, and physician members of the Canadian Association of Radiation Oncology were invited to participate in an anonymous online survey between November 2021 and January 2022. The survey focused on demographics, experiences of pregnancy and leave, parenting and adult caregiving responsibilities, and self-care. RESULTS A total of 103 staff ROs (38%) completed the survey and 78 (75.7%) identified as having a parental (76 [89.7%]) and/or other family caregiver (8 [10.3%]) role; 41% were female and 59% were male, with no difference between genders in the number of children (median, 2; interquartile range, 1-3; P = .17). More female respondents took parental leave for their first child compared with male respondents (mean, 29 vs 6 weeks; P < .001). Of male respondents who started caring for their first child during residency, 27% took parental leave, compared with 77% who started caring for their first child as a staff member (P = .003). The majority of respondents described "always/usually" having collegial support for each pregnancy and parental leave. Both genders described parental responsibilities as negatively affecting attendance at conferences (male, 65%; female, 77%; P = .31) and early or late work-related meetings (male, 76%; female, 79%; P = 1.0). More female respondents described parental responsibilities as negatively affecting their career (50% vs 29%; P = .085). Of female respondents, 52% (vs 26% of male respondents; P = .044) identified a physician mentor or positive role model around parenting issues. CONCLUSIONS Parental and other family caregiving responsibilities are not gender unique in Canadian ROs, but competing work and family roles may affect genders differently.
Collapse
Affiliation(s)
- Aisling Barry
- Princess Margaret Cancer Centre, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Canada.
| | - Mary Elliott
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shaun Loewen
- Division of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Joanna Alfieri
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Québec, Canada
| | - David Bowes
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer Croke
- Princess Margaret Cancer Centre, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Brock Debenham
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Mira Keyes
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, and Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Naa Kwarley Quartey
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Teri Stuckless
- Department of Radiation Oncology, Cancer Care Program of Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Katherine Lajkosv
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Weiss
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Princess Margaret Cancer Centre, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Canada
| |
Collapse
|
22
|
Herbst RS, Hatsukami D, Acton D, Giuliani M, Moushey A, Phillips J, Sherwood S, Toll BA, Viswanath K, Warren NJH, Warren GW, Alberg AJ. Electronic Nicotine Delivery Systems: An Updated Policy Statement From the American Association for Cancer Research and the American Society of Clinical Oncology. J Clin Oncol 2022; 40:4144-4155. [PMID: 36287017 DOI: 10.1200/jco.22.01749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report. In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use. A major concern is ENDS use by youth and adults who never previously used tobacco. While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development. Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system. The magnitude of long-term health risks will remain unknown until longitudinal studies are completed. ENDS have been billed as a promising tool for combustible tobacco cessation, but further evidence is needed to assess their potential efficacy for adults who smoke. Of concern, epidemiological studies estimate that approximately 15%-42% of adults who use ENDS have never used another tobacco product, and another 36%-54% dual use both ENDS and combustible tobacco. This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health. Importantly, we call for an immediate ban on all non-tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco. Concurrently, evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations. We also recognize there is an urgent need for research to understand the relationship between ENDS and tobacco-related disparities.
Collapse
Affiliation(s)
- Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT
| | | | - Dana Acton
- American Association for Cancer Research, Washington, DC
| | | | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | | | | | | | - Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| |
Collapse
|
23
|
Robin G, Brown E, Davis CA, Bird L, Wilson L, Halperin R, Brundage M, Croke J, Harper C, Giuliani M, Caissie A. Patient Engagement: an Assessment of Canadian Radiotherapy Programs' Current Practices, Perceived Barriers, and Facilitators. J Cancer Educ 2022; 37:1834-1841. [PMID: 34518991 DOI: 10.1007/s13187-021-02049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Patient engagement and education have been mandated across Canadian radiation oncology programs (ROP). Guidance documents include the 2014 Canadian Association of Radiation Oncology (CARO) Radiation Therapy Patient Charter, the 2016 Canadian Partnership for Quality Radiotherapy (CPQR) Patient Engagement Guidelines (PEG) for Canadian Radiation Treatment Programs, and Accreditation Canada's 2017 refresh of Cancer Care Standards. Since little is known regarding uptake of these guidance statements, Canadian ROP were surveyed to assess current patient engagement and education practices. An e-survey was sent to Canadian ROP (n = 44). The survey focused on awareness and uptake of the CARO Patient Charter, CPQR PEG, and patient education practices. Survey development was guided by these documents and expert consensus, including CARO's Quality and Standards Patient Education/Engagement working group. Many (71%) responding ROP were familiar with the CARO Patient Charter, while 24% reported use. More than half (53%) of ROP were aware of the CPQR PEG, but approximately third (37%) had previously completed a self-audit. Most (88%) ROP view a pan-Canadian, evidence-based approach to educational materials beneficial and feasible (80%), with the majority (89%) willing to share their best practices across the radiotherapy community. Patient engagement and education are nationally mandated and supported by guidance documents. However, gaps have been identified across ROP for awareness and use of available tools, as well as uptake of their processes critical to quality of care. Understanding current practices will inform CPQR/CARO-supported pan-Canadian initiatives to optimize uptake, including development of CPQR Patient Education Guidance for Canadian Radiation Treatment Programs.
Collapse
Affiliation(s)
- Gabrielle Robin
- Dalhousie University, Halifax, NB & NS, Canada.
- CARO Quality and Standards Working Group, Markham, ON, Canada.
| | - Erika Brown
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Carol-Anne Davis
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Louise Bird
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Lianne Wilson
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Ross Halperin
- CARO Quality and Standards Working Group, Markham, ON, Canada
- BC Cancer Agency, Vancouver, BC, Canada
| | - Michael Brundage
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Jennifer Croke
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Cody Harper
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
| | - Meredith Giuliani
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Amanda Caissie
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| |
Collapse
|
24
|
Herbst RS, Hatsukami D, Acton D, Giuliani M, Moushey A, Phillips J, Sherwood S, Toll BA, Viswanath K, Warren NJH, Warren GW, Alberg AJ. Electronic Nicotine Delivery Systems: An Updated Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology. Clin Cancer Res 2022; 28:4861-4870. [PMID: 36287033 DOI: 10.1158/1078-0432.ccr-22-2429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/01/2022] [Indexed: 01/24/2023]
Abstract
Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report. In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use. A major concern is ENDS use by youth and adults who never previously used tobacco. While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development. Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system. The magnitude of long-term health risks will remain unknown until longitudinal studies are completed. ENDS have been billed as a promising tool for combustible tobacco cessation, but further evidence is needed to assess their potential efficacy for adults who smoke. Of concern, epidemiological studies estimate that approximately 15% to 42% of adults who use ENDS have never used another tobacco product, and another 36% to 54% "dual use" both ENDS and combustible tobacco. This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health. Importantly, we call for an immediate ban on all non-tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco. Concurrently, evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations. We also recognize there is an urgent need for research to understand the relationship between ENDS and tobacco-related disparities.
Collapse
Affiliation(s)
- Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | | | - Dana Acton
- American Association for Cancer Research, Washington, D.C
| | | | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, Virginia
| | | | | | - Benjamin A Toll
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Graham W Warren
- Medical University of South Carolina, Charleston, South Carolina
| | - Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
25
|
Turner S, Benstead K, Millar BA, Morris L, Seel M, Leech M, Eriksen JG, Giuliani M. A new wave of leaders: Early evaluation of the interdisciplinary Foundations of Leadership in Radiation Oncology (FLiRO) program. Tech Innov Patient Support Radiat Oncol 2022; 24:94-100. [PMID: 36338012 PMCID: PMC9633739 DOI: 10.1016/j.tipsro.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Effective leadership across all areas of radiation oncology (RO) is vital to fully realise the benefits of radiation therapy in cancer care. We report outcomes of a novel interdisciplinary leadership program designed for RO professionals under a global joint society initiative. METHODS The Foundations of Leadership in RO (FLiRO) program was designed for aspiring RO leaders. Initially delivered in a blended learning format, it was adapted to fully virtual in 2021. It comprised a webinar tutorial, on-line modules and homework followed by 'live' in-person/virtual workshops over an approximately 6-week period. Topics included personal awareness, effective teamwork, quality improvement skills, leading change and conflict management. An immediate post-program online survey was performed using Likert scales to measure self-reported educational value, interaction with others and the likely application of learning to practice. Open comments were invited. RESULTS 170 participants from 36 countries and 6 continents took part from 2018 to 2021 (99 doctors, 36 physicists, 32 radiation therapists/RTTs and 3 others). 141 (83%) participants responded to the post-program survey. Average weightings for responders' views on whether pre-determined learning objectives were met ranged from 4.30 to 4.61 on a 5-point scale (1 = 'not met at all' and 5 = completely met). For the question addressing potential value of learning for application to their workplace, 124 of 130 (95%) of responders indicated that FLIRO would be 'very useful' or 'extremely useful'. CONCLUSION Initial evaluation of the FLiRO program supports its continuation and expansion with ongoing evolution based on emerging evidence around leadership education and participant feedback.
Collapse
Affiliation(s)
- Sandra Turner
- Sydney West Radiation Oncology Network, Westmead, NSW, Australia,University of Sydney, Faculty of Health Sciences and Medicine, NSW, Australia,Corresponding author at: Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Hawksbury and Darcy Rds, Westmead NSW 2145, Australia.
| | - Kim Benstead
- Gloucestershire Hospitals NHS Foundation Trust, United Kingdom
| | - Barbara-Ann Millar
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | | | | | - Michelle Leech
- Applied Radiation Therapy Trinity, Trinity St. James’s Cancer Institute, Discipline of Radiation Therapy, Trinity College, Dublin, Ireland
| | - Jesper G Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| |
Collapse
|
26
|
Afzal H, Raman S, Kwon C, Seo C, Waqar A, Xu Y, Waddell T, Cypel M, Giuliani M, Tadic T, Chan T, Aleman D, Letourneau D. 123: Image-Based Machine Learning Classifier to Predict Lung Metastases Treatment: A Feasibility Study. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Zhu Y(M, Kriegler C, Duimering A, Giuliani M, Loewen S, Debenham B, Hill J. 85: Ten-Year Trends in Canadian Female Medical Student Interest in Radiation Oncology. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
28
|
Busca I, Giuliani M, Weiss J, Jones J, Quartey NK, Huang SH, Toulany A, Papadakos J, Ringash J. 23: Long Term Results of a Longitudinal Study of Unmet Survivorship Needs in Patients with Head and Neck Cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
Kriegler C, Zhu YM, Giuliani M, Duimering A, Debenham B, Hill J, Loewen SK. Ten-year trends in Canadian female medical student interest in radiation oncology: an analysis of data from the Canadian Resident Matching Service (2012-2021). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Jin R, Ingledew PA, Wu CHD, Giuliani M. Does a mentorship award in radiation oncology inspire medical students to pursue the specialty? A survey analysis of medical students, resident mentors, and research project supervisors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
Owen D, Siva S, Salama JK, Robinson C, Kruser TJ, Giuliani M. If at First You Don't Succeed-Stereotactic Body Radiation Therapy for Recurrent Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2022; 114:5-9. [PMID: 35964631 DOI: 10.1016/j.ijrobp.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Center, Victoria, Australia
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Timothy J Kruser
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
32
|
Ghatasheh H, Hui Huang S, Su J, Xu W, Bratman SV, Cho J, Giuliani M, Hahn E, Hope A, Kim J, O'Sullivan B, Ringash J, Waldron J, Chepeha DB, Irish JC, Goldstein DP, Spreafico A, Tong L, de Almeida JR, Hosni A. Evaluation of risk-tailored individualized selection of radiation therapy target volume for Head and Neck Carcinoma of Unknown Primary. Radiother Oncol 2022; 175:56-64. [PMID: 35905781 DOI: 10.1016/j.radonc.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Intensity-modulated radiation therapy (IMRT) has enabled risk-tailored approach to elective mucosal and nodal clinical target volumes (CTVs) in treatment of head and neck carcinoma of unknown primary (HNCUP). This study report outcomes following such approach. METHODS HNCUP patients treated with definitive IMRT between 2005 and 2018 were reviewed. Local failure (LF), regional failure (RF), distant metastasis (DM), overall survival (OS) and grade ≥3 late toxicity (LT) were analyzed. Multivariable analysis (MVA) was used to identify OS predictors for entire cohort and cN2-3 subgroup. RESULTS A total of 203 patients were eligible: cN1 (7%), cN2a (14%), cN2b (46%), cN2c (14%) and cN3 (19%). Among 118 patients with known HPV status (by p16 staining), 81 (68%) were positive. IMRT target volume spared contralateral tonsil (55%), bilateral or contralateral sides of hypopharynx (72%), nasopharynx (72%), larynx (87%) and contralateral uninvolved neck (21%). Median follow-up was 5 years. Five-year LF, RF, DM, OS, and LT were 3%, 14%, 10%, 79%, and 7% respectively. Four patients developed mucosal recurrence: 3 within and 1 at the margin of the elective mucosal CTV. None of ipsilateral neck irradiation patients failed in the contralateral uninvolved neck. MVA identified cN2c-N3, HPV-negative status and older age as predictors for inferior OS. Within cN2-3 subgroup (n=189): cN2c-N3, HPV-negative status and older age predicted lower OS, while concurrent chemotherapy was associated with better OS. CONCLUSION Definitive IMRT with risk-adaptive radiation volume de-escalation for HNCUP resulted in high probability of tumor control with acceptable rate of late toxicity.
Collapse
Affiliation(s)
- Hamza Ghatasheh
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Ontario, Canada
| | - Jie Su
- Biostatistics, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Biostatistics, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Ontario, Canada
| | - Anna Spreafico
- Department of Medical Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Li Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
33
|
Wong RK, Liu ZA, Barry A, Rogalla P, Bezjak A, Brierley JD, Dawson LA, Giuliani M, Kim J, Ringash J, Sun A, Chung P, Hope A, Shessel A, Lindsay P. Patient Reported and Clinical Outcomes from 5 Fraction SBRT for Oligometastases - a Prospective Single Institution Study. Int J Radiat Oncol Biol Phys 2022; 114:1000-1010. [PMID: 35901981 DOI: 10.1016/j.ijrobp.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To describe the long-term outcomes of a five-fraction normal tissue tolerance adapted strategy for the management of oligometastases (OM). METHODS & MATERIALS Patients with histologically confirmed solid tumors, ≤5 extra-cranial metastases, suitable for a definitive approach for all metastatic lesions, at least one lesion suitable for SBRT, ECOG ≤2 were eligible. Treatment intervention was a 5-fraction (25- 55Gy) normal tissue adapted dosing strategy. The primary outcome was cumulative local progression rate at 12 months. RESULTS Between Mar 2013- Jan 2018, 137 patients started SBRT. Median FU was 35.7 months. 107 (78%) patients had a solitary OM. The mean PTV D95 was 39.6 [SD 8.8]; BED10 70.8) Gy. Mean PTV D95 was highest for lung lesions [48.7 (SD4.7); BED10 96.1] Gy, but was <40Gy for all other anatomical sites. Two Grade 3 toxicities (GI bleed) were observed with stomach D0.05 30.3Gy and 30.4Gy. The cumulative local progression rate at 12/36 months was 16.1 (95% CI 10-22)% and 38.3 (95% CI 30-46.7) %; OS was 90% and 37%, and PFS was 58% and 19% respectively. Mean Symptom burden (Edmonton Symptom Assessment Total Score) worsened in patients with progressive disease (+8.8) at 12 months and was paralleled by changes in mean EORTC QLQ30 Summary Score and Global Health Quality of Life Score. Systemic therapy was initiated in 55% of patients at an average of 12.7 (SD12.4) months. CONCLUSIONS If long term PFS is the primary goal of therapy, SBRT for OM achieved this in less than 20% of patients attributable to a high risk of distant failure. Favorable local progression free survival is accompanied by preservation of QoL, avoidance of symptom progression and reduced need of antineoplastic therapies at 12 months. Information on symptom burden, QoL, as well as pattern of antineoplastic therapy use following progressive disease is useful to support conversations between patients, families and health care providers. Strategies to improve patient selection and reduce distant progression rate remain a priority for further study.
Collapse
Affiliation(s)
- Rebecca Ks Wong
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada..
| | - Zhihui Amy Liu
- Princess Margaret Cancer Center, University Health Network; Dalla Lana School of Public Health, University of Toronto. Toronto. Ontario. Canada
| | - Aisling Barry
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - Patrik Rogalla
- Joint Department of Medical Imaging, University of Toronto. Toronto. Ontario. Canada
| | - Andrea Bezjak
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - James D Brierley
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - Laura A Dawson
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - Meredith Giuliani
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - John Kim
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - Jolie Ringash
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - Alexander Sun
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - Peter Chung
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - Andrew Hope
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| | - Andrea Shessel
- Princess Margaret Cancer Center, University Health Network; Toronto. Ontario. Canada
| | - Patricia Lindsay
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto. Toronto. Ontario. Canada
| |
Collapse
|
34
|
Scarafia C, Vaiarelli A, Cimadomo D, Amendola M, Colamaria S, Argento C, Giuliani M, Ferrero S, Gennarelli G, Revelli A, Benedetto C, Alviggi C, Capalbo A, Rienzi L, Ubaldi F. P-621 Different gonadotrophins adopted for controlled ovarian stimulation do not affect metaphase-II oocyte competence. A matched case-control study on 351 patients and 2258 oocytes. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Do different gonadotrophins for controlled-ovarian-stimulation (COS) affect metaphase-II (MII) oocyte competence?
Summary answer
Euploid blastocyst rate (EBR) per cohort of MII-oocytes, live-birth-rate (LBR) per first vitrified-warmed euploid single-embryo-transfer (SET) and cumulative-LBR are independent from the gonadotrophins used.
What is known already
Controlled-ovarian-stimulation (COS) is a cornerstone of IVF. Its purpose is maximizing ovarian reserve exploitation and obtaining ≥1 euploid blastocyst to transfer. Indeed, ovarian reserve decreases and blastocyst aneuploidy rates increase with increasing maternal age, making this task quite complicated in advanced maternal age. Old-fashioned studies suggested an association between COS and embryonic aneuploidy rates. Conversely, recent studies excluded an impact of COS dosage, duration, ovarian response, and ovulation trigger, on blastocyst aneuploidy rate. An aspect, though, needs more clarity: do different gonadotropins impact oocyte competence after COS, comprehensively defined as EBR per cohort of MII-oocytes?
Study design, size, duration
Out of 3169 PGT cycles with ³1 MII oocyte conducted between 2014-2018, we excluded (i)PGT-M/-SR, (ii)women<35yr, (iii)severe-male-factor, (iv)DuoStim or long-active FSH, (v)culture with sequential-media, and (v)multiple cycles. Among the 784 cycles left, a propensity-score-matching (PSM) based on the number of inseminated MII-oocytes was adopted to match patients using recFSH [without (N = 57; 337 MII-oocytes)/with recLH (N = 55; 374 MII-oocytes)] and Human-Menopausal-Gonadotrophin (HMG; N = 127; 835 MII-oocytes). The patients using recFSH+HMG were all included (N = 112; 712 MII-oocytes).
Participants/materials, setting, methods
Only GnRH-antagonist COS, ICSI with fresh MII-oocytes, single culture in continuous-media, trophectoderm biopsy without assisted-hatching, comprehensive-chromosome-testing to assess full-chromosome non-mosaic aneuploidies and vitrified-warmed euploid SET were conducted. Oocyte competence was comprehensively defined as EBR per cohort of MII-oocytes with all intermediate outcomes (fertilization, blastulation and euploidy). LBR per first vitrified-warmed euploid SET and cumulative-LBR per retrieval were also assessed. Generalized-linear-models and multivariate regressions were adopted to adjust the results for confounders. All cycles were concluded.
Main results and the role of chance
Patients using recFSH+recLH and recFSH+HMG (40.7 yr) were older than patients using recFSH-only or HMG-only (40 yr; ANOVA<0.01). No other difference was reported in the 4 patient populations. The overall gonadotrophins dosage (2615±977, 3601±1889, 3818±946 and 2892±911 IU in the recFSH-only, recFSH+recLH, recFSH+HMG and HMG-only groups, respectively) and duration of COS (9.7±1.9, 9.4±1.5, 9.9±1.8 and 10.2±1.8 days) were different (Kruskal-Wallis tests=0.02). The number of cumulus-oocyte-complexes (9.2±6.5) and MII-oocytes collected (6.4±4.4) were instead well-matched across the groups. The EBR per cohort of inseminated MII-oocytes was different in the four groups (20.7±27.1%, 9.6±12.9%, 12.4±18.5% and 16.9±21.8%, respectively), but, when adjusted for maternal age in a generalized-linear-model, the gonadotrophin used for COS did not show any significant association with this outcome (partial-eta2=0.02, p = 0.1, power=0.6). All intermediate embryological outcomes were also similar. The LBR per first vitrified-warmed euploid SET was comparable in the four groups [N = 14/33 (42%), N = 9/22 (41%), N = 26/62 (45%), N = 24/55 (44%), respectively], as confirmed by the logistic regression adjusted for blastocyst quality (multivariate-OR: 0.97, 95%CI 0.73-1.31, adjusted-p=0.9). Lastly, the cumulative-LBRs per retrieval were equivalent [N = 17/57 (30%), N = 14/55 (26%), N = 34/127 (27%), and N = 33/112 (30%), respectively], as confirmed by the logistic regression adjusted for maternal age (multivariate-OR: 1.01, 95%CI 0.8-1.3, adjusted-p=0.9).
Limitations, reasons for caution
The gonadotrophins were chosen based on patient compliance to their administration route and gynecologist judgement, and only qualitative outcomes were assessed. Therefore, randomized-controlled-trials and cost-effectiveness analysis investigating the efficiency in oocyte recruitment and cumulative-LBR per intention-to-treat are needed.
Wider implications of the findings
Different gonadotrophins might not affect MII-oocyte competence. This information is key since, in view of the optimization of follicle recruitment through personalized-COS, it allows more flexibility in the choice of the most suitable protocol. Therefore, gynecologists might ponder also features like patient reproductive history and compliance to different administration routes.
Trial registration number
none
Collapse
Affiliation(s)
- C Scarafia
- Sant' Anna Hospital- University of Turin, Obstetrics and Gynecology 1U- Physiopathology of Reproduction and IVF Unit- Department of Surgical Sciences , Turin, Italy
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - M.G Amendola
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - S Colamaria
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - C Argento
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - M Giuliani
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - S Ferrero
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | | | - A Revelli
- Livet, GeneraLife IVF , Turin, Italy
| | - C Benedetto
- Sant' Anna Hospital- University of Turin, Obstetrics and Gynecology 1U- Physiopathology of Reproduction and IVF Unit- Department of Surgical Sciences , Turin, Italy
| | - C Alviggi
- University of Naples Federico II, Department of Neuroscience- Reproductive Science and Odontostomatology , Naples, Italy
| | - A Capalbo
- Igenomix, Igenomix Italy , Marostica, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F.M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| |
Collapse
|
35
|
Ashram S, Bahig H, Barry A, Blanchette D, Celinksi A, Chung P, Darko J, Donath D, Doucet R, Erickson A, Giuliani M, Gopaul D, Hipwell S, Javor J, Kuk J, Lindsay P, Millman B, Oliver M, Pearce A, Russell C, Senthi S, Vu T, Warner A, Gaede S, Palma DA. Planning Trade-offs for Stereotactic Ablative Radiotherapy in Patients with 4-10 Metastases: A Sub-study of the SABR-COMET-10 randomized trial. Int J Radiat Oncol Biol Phys 2022; 114:1011-1015. [PMID: 35667527 DOI: 10.1016/j.ijrobp.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of stereotactic ablative radiotherapy (SABR) for metastases often involves trade-offs, balancing adequate target coverage with the need to maintain a safe dose to organs at risk (OARs). Very few studies have evaluated this complexity in patients with >3 oligometastases. To explore these trade-offs, we analyzed planning outcomes from the first 60 patients enrolled on a randomized trial of SABR in patients with 4-10 metastases. METHODS Radiation plans for patients enrolled on the BLINDED-FOR-REVIEW randomized trial were analyzed. Data abstracted included target locations and sizes, dose prescriptions and target coverage, and OAR doses, and these parameters were evaluated based on target location to identify locations where compromise of planning constraints was required. RESULTS SABR was planned for 332 lesions in 296 separate PTVs. The median PTV size was 9.0 cc per lesion (interquartile range [IQR]: 5.3-24.3 cc) and 89.1 cc per patient (IQR: 37.0-177.0). The most common prescriptions were 30-35 Gy in 5 fractions (43% of lesions) and 20-24 Gy in 1 fraction (33% of lesions). The maximum dose within the PTV was a median of 124% of prescription (IQR: 117-130%). Only 3.3% of lesions had a dose to 95% of the PTV (D95) <95% of prescription; this was more common for spinal (25%) and lymph node (8.4%) targets (p<0.001), translating to median D95 values of 100.5% (IQR: 99.6%-101.5%) and 100.0% (IQR: 84.6%-100.5%), respectively. All OARs constraints were met in 95.2% of patients, with the only exceptions being lymph node targets (n=3). CONCLUSIONS SABR planning for patients with 4-10 metastases was achievable without dosimetric compromise in the large majority of patients. Nodal and spinal targets were most likely to lead to compromise of target coverage or OAR constraints. Further research is needed to determine how to best balance these trade-offs.
Collapse
Affiliation(s)
- Samaher Ashram
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | | | - Anders Celinksi
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Johnson Darko
- Grand River Cancer Centre, Kitchener, Ontario, Canada
| | - David Donath
- Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Robert Doucet
- Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Abigail Erickson
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Darin Gopaul
- Grand River Cancer Centre, Kitchener, Ontario, Canada
| | - Scott Hipwell
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Joanna Javor
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Joda Kuk
- Grand River Cancer Centre, Kitchener, Ontario, Canada
| | - Patricia Lindsay
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Barbara Millman
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | | | - Toni Vu
- Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Warner
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Stewart Gaede
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada.
| |
Collapse
|
36
|
Brual J, Abdelmutti N, Agarwal A, Arisz A, Benea A, Lord B, Massey C, Giuliani M, Stuart-McEwan T, Papadakos J. Developing an Education Pathway for Breast Cancer Patients Receiving Rapid Diagnostic Testing: Investigating Informational and Supportive Care Needs. J Cancer Educ 2022; 37:568-577. [PMID: 32737830 DOI: 10.1007/s13187-020-01847-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Several studies have examined the informational needs of patients undergoing the breast diagnostic process where needs are highest during testing and prior to receiving a diagnosis. To aid in the development of an education pathway, we identified patient information needs. A multi-method approach to identify areas of need and to understand when and how information should be provided to patients was undertaken. The methods included an environmental scan of consumer health information, ethnographic observation of the patient clinical experience, key informant interviews, and a needs assessment survey. The data collected from the environmental scan, ethnography, and interviews were used to develop the items in the survey. The survey was developed around four domains: (1) Medical Procedures and Tests, (2) Understanding the Rapid Diagnostic Process, (3) Breast Cancer and Other Breast Conditions, and (4) Support and Coping. A total of 101 patients completed the survey. Mean importance scores were significantly different between domains of information need (p < .0001) and significantly higher for the 'Medical Procedures and Tests' domain compared with all others. Multivariate analysis suggested that participants with higher levels of education (p = .02) and a preference to speak English at home (p = .009) tended to rate the importance of 'Support and Coping' information lower than other participants. Information about medical procedures and tests are most important for the patients undergoing rapid diagnostic testing in our sample. Education materials that are tailored to patient needs should be provided to patients during this stage of the cancer journey to help meet informational needs.
Collapse
Affiliation(s)
- Janette Brual
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nazek Abdelmutti
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Arnav Agarwal
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela Arisz
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Internal Medicine Residency Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Aronela Benea
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, Canada
| | - Bridgette Lord
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, Canada
- Gattuso Rapid Diagnostic Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Christine Massey
- Biostatistics Department, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Radiation Oncology Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Terri Stuart-McEwan
- Gattuso Rapid Diagnostic Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
37
|
Papadakos T, Gospodarowicz M, Giuliani M. Why Leadership? The Intersectionality of Leadership and Health Equity. Int J Radiat Oncol Biol Phys 2022; 113:37-39. [PMID: 35427558 DOI: 10.1016/j.ijrobp.2022.01.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Tina Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Mary Gospodarowicz
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Meredith Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
| |
Collapse
|
38
|
Stingone C, Latini A, Gianserra L, Salvi M, Donà MG, Giuliani E, Lesnoni La Parola I, Mussi A, Cameli N, Garelli V, Giuliani M, Buonomini AR, Vujovic B, Cerimele M, Morrone A. Author Correction: Features of fragile people with SARS-CoV-2 infection in isolation in a COVID-19 hotel in Rome, Italy. Eur Rev Med Pharmacol Sci 2022; 26:3407. [PMID: 35647819 DOI: 10.26355/eurrev_202205_28832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Correction to: European Review for Medical and Pharmacological Sciences 2022; 26 (7): 2631-2638-DOI: 10.26355/eurrev_202204_28501-PMID: 35442479, published online on 15 April 2022. After publication, at the request of the Italian Ministry of Health, the authors asked to insert the following statement in the Acknowledgments section: "This research was funded by the Italian Ministry of Health (RC 2022)". There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/28501.
Collapse
Affiliation(s)
- C Stingone
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Makhoul I, Anders M, Siegel R, Chiang A, Markham MJ, Chen RC, Mougalian S, Arnaoutakis K, Giuliani M, Im A, Kozlik MMP, Crist STS, Garrett-Mayer E, Kamal A. Hematology/Oncology Fellowship Programs' Participation in the Quality Oncology Practice Initiative. JCO Oncol Pract 2022; 18:e1209-e1218. [PMID: 35467961 DOI: 10.1200/op.21.00807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In the first decade of this millennium, ASCO pioneered a quality measurement tool, the Quality Oncology Practice Initiative (QOPI). Despite an Accreditation Council for Graduate Medical Education (ACGME) requirement since 2012 for oncology fellows to participate in quality improvement (QI) projects, the uptake of QOPI remains modest. METHODS This study examined reasons for low QOPI participation by surveying participating and nonparticipating HemOnc Fellowship Programs. The survey elicited views toward QI and QOPI as well as ideas about making the program more helpful. RESULTS Among 69 fellowship programs, only 39% (n = 27) participated in QOPI. Other findings were that (1) the majority of programs considered their fellows' QI projects beneficial but were not fulfilling the ACGME standard for all fellows' QI participation; (2) nonparticipating programs were unfamiliar with but interested in QOPI; (3) participating programs tended to view QI as easier to conduct and more beneficial than nonparticipating programs; and (4) programs that withdrew from QOPI and participating programs alike were dissatisfied with the educational benefit and data abstraction burden for fellows. CONCLUSION Academic oncology programs generally valued QI but many have not fully engaged in it. Fellows in programs participating in QOPI may have had less difficulty conducting QI and their projects may have been more beneficial than that of nonparticipating programs. However, perceived lack of educational benefits for fellows and the burden of manual data abstraction from the electronic medical record are impediments to satisfaction with the program. Higher faculty involvement and longitudinal reports for each fellow may significantly increase participation.
Collapse
Affiliation(s)
- Issam Makhoul
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Michael Anders
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Robert Siegel
- Bon Secours St Francis Cancer Center, Greenville, SC
| | - Anne Chiang
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT
| | | | | | - Sarah Mougalian
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT
| | | | | | - Annie Im
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | | |
Collapse
|
40
|
Id Said B, Ailles L, Karamboulas C, Meens J, Huang SH, Xu W, Keshavarzi S, Bratman SV, Cho BCJ, Giuliani M, Hahn E, Kim J, O’Sullivan B, Ringash J, Waldron J, Spreafico A, de Almeida JR, Chepeha DB, Irish JC, Goldstein DP, Hope A, Hosni A. Development and Validation of an Oral Cavity Cancer Outcomes Prediction Score Incorporating Patient-Derived Xenograft Engraftment. JAMA Otolaryngol Head Neck Surg 2022; 148:342-349. [PMID: 35238880 PMCID: PMC8895316 DOI: 10.1001/jamaoto.2022.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Patient-derived xenografts (PDXs) offer the opportunity to identify patients with oral cavity squamous cell carcinoma (OSCC) who are at risk for recurrence and optimize clinical decision-making. OBJECTIVE To develop and validate a prediction score for locoregional failure (LRF) and distant metastases (DM) in OSCC that incorporates PDX engraftment in addition to known clinicopathological risk factors. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, PDX models were generated from patients with OSCC treated with curative intent at Princess Margaret Cancer Centre (Toronto, Canada) between 2006 and 2018. The cohort included 288 patients (aged ≥18 years) with a new diagnosis of nonmetastatic (M0) OSCC whose tumor samples were available for engraftment under the skin of xenograft mice. Patients were scored as a nonengrafter if PDX formation did not occur within 6 months. Data analysis was performed between August 2006 and May 2018. INTERVENTIONS All patients received up-front curative-intent surgery followed by either observation or postoperative radiation with or without concurrent chemotherapy based on institutional guidelines. MAIN OUTCOMES AND MEASURES Main outcomes were LRF, DM, and overall survival (OS). Multivariable analysis (MVA) was used to identify predictors of LRF and DM. Factors retained in the final MVA were used to construct a prediction score and classify patients into risk groups. RESULTS Overall, 288 patients (mean [SD] age at diagnosis, 63.3 [12.3] years; 112 [39%] women and 176 [61%] men) with OSCC were analyzed. The MVA identified pT3-4, pathologic extranodal extension, and engraftment as predictors of LRF and DM. Patients whose tumors engrafted (n = 198) were more likely to develop LRF (hazard ratio [HR], 1.98; 95% CI, 1.24-3.18) and DM (HR, 2.64; 95% CI, 1.21-5.75) compared with nonengrafters. A prediction score based on the aforementioned variables identified patients at high risk and low risk for LRF (43.5% vs 26.5%), DM (38.2% vs 8.4%), and inferior OS (34% vs 66%) at 5 years. Additionally, rapid engraftment was shown to be similarly prognostic, with rapid engrafters demonstrating higher rates of relapse and poor OS. CONCLUSIONS In this cohort study, a prediction score using OSCC PDX engraftment, in conjunction with pT3-4 and pathologic extranodal extension, was associated with improved prognostic utility of existing clinical models and predicted patients at risk for LRF, DM, and poor survival.
Collapse
Affiliation(s)
- Badr Id Said
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laurie Ailles
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Christina Karamboulas
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jalna Meens
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada,Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada,Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Scott V. Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - B. C. John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O’Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada,Department of Otolaryngology—Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John R. de Almeida
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Douglas B. Chepeha
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David P. Goldstein
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
41
|
Stingone C, Latini A, Gianserra L, Salvi M, Donà MG, Giuliani E, Lesnoni La Parola I, Mussi A, Cameli N, Garelli V, Giuliani M, Buonomini AR, Vujovic B, Cerimele M, Morrone A. Features of fragile people with SARS-CoV-2 infection in isolation in a COVID-19 hotel in Rome, Italy. Eur Rev Med Pharmacol Sci 2022; 26:2631-2638. [PMID: 35442479 DOI: 10.26355/eurrev_202204_28501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Temporary COVID-19 hotels have been established in Italy to assist the homeless people that test positive for SARS-CoV-2 and require isolation. This observational study aimed to investigate the characteristics of the subjects who were isolated at the Casa tra Noi COVID-19 hotel in Rome between October 2020 and May 2021 and to estimate the duration of SARS-CoV-2 positivity according to their main socio-demographic, behavioural and clinical features. SUBJECTS AND METHODS Socio-demographic data, clinical history, and anamnestic data of guests were collected by the clinicians reviewing the medical documentation and face-to-face interviewing. Nasopharyngeal swabs were performed every 7 days and the presence of SARS-CoV-2 was assessed by RT-PCR. Median duration of SARS-CoV-2 positivity according to socio-demographic, behavioral factors and clinical condition was calculated. RESULTS The 196 guests (161 males, 82.1%) had a median age of 41 years (IQR: 30-53), and were mostly African (87, 44.4%). Only asymptomatic/paucisymptomatic infections were observed. Almost half of the individuals (84, 42.9%) were affected by at least one co-morbidity, the frequency of which was higher among women (57.1% vs. 39.8%, p=0.06). The date of the negative SARS-CoV-2 molecular test was known for 144 guests (73.5%). Among these, the median duration of positivity was 21 days (IQR: 14-26) and did not significantly vary with age, country of origin, smoking status, alcohol or drug abuse. Among the co-morbidities, only infectious diseases significantly modified the duration of positivity, which increased from 21 to 34 days (p=0.013). CONCLUSIONS Hotel guests were frequently affected by physical/mental co-morbidities. Duration of SARS-CoV-2 positivity was significantly prolonged only in individuals affected by an infectious disease.
Collapse
Affiliation(s)
- C Stingone
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Wang MH, Loewen SK, Giuliani M, Fairchild A, Yee D, Debenham BJ. Clinical Learning, Didactic Education, and Research Experiences of Radiation Oncology Resident Physicians in Canada. J Cancer Educ 2022; 37:155-162. [PMID: 32621072 DOI: 10.1007/s13187-020-01799-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Changes in the field of radiation oncology (RO) impacts residency training. Assessing trainee experiences is essential to inform curriculum development. We aim to explore gaps and strengths in current Canadian RO training, as we move towards competency-based medical education (CBME). An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 66 open-ended, Likert-scale, matrix-style, and multiple-choice questions, and assessed clinical exposure, didactic teaching, professional relationships, and research experiences. Statistics were calculated from anonymized, aggregate responses. Out of 128 eligible residents, 53 responded (41% response rate). Of these, 57% were male, and 77% were Canadian medical graduates. Senior residents (PGY-4 to PGY-5) perceived insufficient exposure to lymphoma and ocular malignancies, brachytherapy for breast and esophagus malignancies, and stereotactic radiotherapy of the pancreas, prostate, and adrenal gland. Half (51%) had training on image-guided radiotherapy (IGRT) challenges, and 43% had a formal staff mentor. Most residents presented at least one research project at conferences (77%) and authored ≥ 1 publications (66%) during residency. Canadian RO residents are satisfied with their clinical training and educational experience in high-volume tumor sites and high-volume brachytherapy procedures. Areas identified for potential improvement are (1) low-volume tumor sites; (2) low-volume brachytherapy procedures; (3) low-volume stereotactic radiotherapy sites; (4) IGRT challenges; and (5) mentorship opportunities. These findings will inform future CBME curriculum revisions.
Collapse
Affiliation(s)
- Michael H Wang
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada.
- Division of Radiation Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada.
| | - Shaun K Loewen
- Division of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Alysa Fairchild
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - Don Yee
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - Brock J Debenham
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
43
|
Malik NH, Li GJ, Giuliani M, Brundage M, Caissie A, Cao JQ, Halperin R, Ingledew PA, Vigneault E, Bezjak A. Mapping the Current State of Canadian Medical School Oncology Interest Groups. J Cancer Educ 2022; 37:203-209. [PMID: 32594313 DOI: 10.1007/s13187-020-01803-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Cancer is the leading cause of mortality in Canada. Undergraduate medical education therefore must ensure adequate oncology education for all physicians and inspire some to make oncology their career specialty, in an effort to ensure public care needs are met in the future. Medical student-led oncology interest groups (OIGs) are a subset of specialty interest groups that supplement formal didactic and clinical learning to increase exposure to oncology and access to mentors. We conducted a survey of OIG leaders to ascertain their goals, activities, barriers, future directions, and perceptions about employment prospects. OIG leaders from 12/17 Canadian medical schools responded. Medical oncology was the most represented specialty in OIGs. Half of OIGs had faculty mentors. Self-reported goals were to increase exposure to oncology disciplines (n = 12), assist students with career selection (n = 11) and finding mentors (n = 7), and enhance oncology education (n = 10). OIGs held on average 5 events per year (range 1-12). Reported barriers were finding time to plan events, declining student interest over academic year, and limited funding. Many OIGs showed interest in more standardized resources about oncology disciplines (n = 9), access to presentations (n = 10), more funding (n = 7), and collaboration (n = 7). Employment in many oncology specialties was perceived poorly, and the most important career selection considerations were ease of employment, practice location, and partner/family preference. Our survey highlights common goals, barriers, and perceptions in OIG medical student leaders across Canada and provides guidance for future interventions.
Collapse
Affiliation(s)
- Nauman H Malik
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - George J Li
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Brundage
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Amanda Caissie
- Department of Radiation Oncology, Dalhousie University, Saint John, NB, Canada
| | - Jeffrey Q Cao
- Department of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - Ross Halperin
- BC Cancer - Centre for the Southern Interior, Kelowna, BC, Canada
| | - Paris-Ann Ingledew
- Department of Radiation Oncology, BC Cancer-Vancouver, Vancouver, BC, Canada
| | - Eric Vigneault
- Cancer Research Centre, University of Laval, QC, Québec, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| |
Collapse
|
44
|
Li JZH, Giuliani M, Ingledew PA. Characteristics Assessment of Online YouTube Videos on Radiotherapy for Lung Cancer. Cureus 2021; 13:e19150. [PMID: 34868784 PMCID: PMC8629691 DOI: 10.7759/cureus.19150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The internet has become a mainstay source of health information for cancer patients. Online patient education videos are common; however, there have been no studies examining the quality of publicly available videos on radiotherapy for lung cancer (one of the most common forms of cancer). To fill this knowledge gap, we aim to systematically map and objectively assess videos discussing radiotherapy for lung cancer on YouTube. Methods The terms “radiotherapy for lung cancer,” “radiation for lung cancer,” “radiation therapy for lung cancer,” and “radiation treatment for lung cancer” were searched on YouTube using a clear-cache browser. Results were sorted by relevance and the top 50 English-language results for each search were recorded. After removing duplicates, each video was assessed for length, Video Power Index (VPI, which is the product of a video’s average daily views and like and dislike ratio), source, content, comment moderation, and misinformation. Two raters were used to ensure consistency. Results were evaluated using descriptive and inferential statistics. Results A total of 88 unique videos resulted from the search. The median video length was 4 minutes and 5 seconds. The average VPI was 10.9 (95% CI: 1.5-20.4) and the median number of views was 954.5. All videos were published between July 8, 2009 and November 18, 2020. Of the videos, 44% were published within the past two years. A total of 61% of the videos were from the USA, 14% were from the UK, 6% from Australia, 5% each from Canada and India, and other countries make up the remaining 10%. Most of the videos were published by healthcare facilities (39%) and non-profit organizations (31%). Content-wise, 95% of videos contain information specific to lung cancer. A total of 46 videos (52%) were targeted toward patient education. Of which, 37 covered radiotherapy for lung cancer, 12 covered side effects for radiotherapy, and 11 covered both. The other 42 videos (48%) were designed for a professional audience. Stereotactic body radiation therapy (SBRT)/stereotactic ablative radiotherapy (SABR) was the most commonly described radiotherapy modality (42%), and the physician interview was the most common format, being used in 59% of videos. Out of the 38 videos with at least one comment, only two (5%) were moderated by the host channel. None of the videos featured misleading information. Conclusions This study comprehensively surveyed YouTube videos pertaining to radiotherapy for lung cancer to provide a high-level overview of the information that patients may find online. Although nearly half of the videos describe lung cancer radiotherapy for patients, only a small proportion comprehensively cover both radiotherapy and its side effects. The results of our study can help guide the development of patient education tools and encourage healthcare providers to recognize the limitations of online health information and proactively address patient questions regarding radiotherapy. Future research could examine videos on other lung cancer treatment options or radiotherapy for other cancers.
Collapse
Affiliation(s)
- Jim Zhang Hao Li
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Faculty of Medicine, Vancouver, CAN
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, CAN
| | - Paris-Ann Ingledew
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Faculty of Medicine, Vancouver, CAN
| |
Collapse
|
45
|
Jacinto J, Huang S, Su J, Kim J, O'Sullivan B, Ringash J, Cho J, Hope A, Bratman S, Giuliani M, Hosni A, Hahn E, Spreafico A, Hansen A, Goldstein D, Tong L, Perez-Ordonez B, Weinreb I, Xu W, Waldron J. Clinical Behavior and Outcome of HPV-Positive Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
46
|
Kordlouie S, David B, Strang B, Croke J, Giuliani M, Ingledew P, Alfieri J. Creation of a National In-Training Examination in Radiation Oncology ― Impact Evaluation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
47
|
Chin O, Yu E, O'Sullivan B, Su J, Tellier A, Siu L, Waldron J, Kim J, Hansen A, Hope A, Cho J, Giuliani M, Ringash J, Spreafico A, Bratman S, Hosni A, Hahn E, Tong L, Xu W, Huang SH. Prognostic importance of radiologic extranodal extension in nasopharyngeal carcinoma treated in a Canadian cohort. Radiother Oncol 2021; 165:94-102. [PMID: 34718052 DOI: 10.1016/j.radonc.2021.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To confirm the prognostic value of radiologic extranodal extension (rENE) and its role in clinical-N classification in nasopharyngeal carcinoma (NPC) treated in a western institution. METHODS AND MATERIALS NPC treated between 2010 and 2017 were included. Pre-treatment MRI were reviewed for unequivocal rENE and its grade: grade-1: tumour invading through any nodal capsule but confined to perinodal fat; grade-2: ≥2 adjacent nodes forming a coalescent nodal mass; grade-3: tumour extending beyond perinodal fat to invade/encase adjacent structures. Overall survival (OS) and disease-free survival (DFS) were compared between rENE-positive (rENE+) and rENE-negative (rENE-) patients. Multivariable analysis (MVA) confirmed the prognostic importance of rENE and its grade. Staging schemas including rENE in N-classification were proposed and their performance evaluated. RESULTS A total of 274 patients were eligible (43 cN0; 231 cN-positive). rENE was identified in 83/231 (36%) cN-positive, including grade 1/2/3 rENE in 14/58/11 cases. Compared to rENE-, rENE+ patients had a lower OS (68% vs 89%, p < 0.001) and DFS (58% vs 80%, p < 0.001). MVA confirmed the prognostic importance of grade-2 [HR: OS: 2.85 (p = 0.005); DFS: 2.89 (p < 0.001)] and grade-3 rENE [HR: OS 5.28 (p = 0.004); DFS 3.86 (p = 0.005)], with a trend for grade-1 vs rENE- [HR: OS 2.63 (p = 0.13); DFS 1.49 (p = 0.520)]. We evaluated classifying any rENE as cN3 (Proposal-I) or any grade-2/grade-3 rENE as cN3 (Proposal-II). The stage schema with Proposal-I cN-classification ranked the highest in the performance evaluation. CONCLUSIONS rENE is an important prognostic factor in this western NPC cohort. We propose classifying any unequivocal rENE as cN3.
Collapse
Affiliation(s)
- Olivia Chin
- Department of Neuroradiology, University of Toronto, Canada
| | - Eugene Yu
- Department of Neuroradiology, University of Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Anais Tellier
- Department of Neuroradiology, University of Toronto, Canada
| | - Lillian Siu
- Division of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Aaron Hansen
- Division of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Anna Spreafico
- Division of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Li Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada.
| |
Collapse
|
48
|
Papadakos CT, Stringer T, Papadakos J, Croke J, Embleton A, Gillan C, Miller K, Weiss A, Wentlandt K, Giuliani M. Effectiveness of a Multiprofessional, Online and Simulation-Based Difficult Conversations Training Program on Self-Perceived Competence of Oncology Healthcare Provider Trainees. J Cancer Educ 2021; 36:1030-1038. [PMID: 32140967 DOI: 10.1007/s13187-020-01729-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Effective communication between healthcare providers (HCPs) and patients is important for HCP well-being, patient engagement, and health outcomes. Yet, HCPs do not receive adequate communication skills training and report feeling unprepared for difficult conversations. A needs assessment of 64 cancer HCP trainees in Toronto, Canada, found that a majority of trainees rated themselves with low competency in communication skills to support patients through difficult conversations, while nearly all rated these skills as important to their practice. A blended multiprofessional communications program was developed including online theoretical learning and reflective practice in addition to in-person simulation with standardised patient actors. Since communication skills mastery is highly unlikely to occur at the termination of a single training program, the goal of the program was to stimulate participants' motivational beliefs about difficult conversations communication skills in order to deepen their commitment to learning and mastery. The motivational beliefs assessed included self-efficacy (self-perceived competence), intent to use techniques learned, and confidence in task mastery. After completing the course, participants' self-perceived competence in dealing with difficult conversations significantly increased by an average of 25 points (p < 0.001) on a rating scale of 1-100 (n = 40). Participants' intent to use techniques did not change significantly and remained high with an overall average of 89 points. After the course, participants rated their confidence in mastering techniques learned at an average score of 71 points. Multiprofessional, simulation-based training is an effective way to improve HCP trainees' motivational beliefs around having difficult conversations.
Collapse
Affiliation(s)
- Christine Tina Papadakos
- Department of Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
- Patient Education, Cancer Care Ontario, Toronto, Canada
| | - Tylar Stringer
- Department of Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
| | - Janet Papadakos
- Department of Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
- Patient Education, Cancer Care Ontario, Toronto, Canada
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anne Embleton
- Practice Based Education, Collaborative Academic Practice, Princess Margaret Cancer Centre, Toronto, Canada
| | - Caitlin Gillan
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kim Miller
- Department of Supportive Care, Division of Psychosocial Oncology, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Weiss
- Department of Supportive Care, Division of Palliative Care, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Canada
| | - Kirsten Wentlandt
- Department of Supportive Care, Division of Palliative Care, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Canada
| | - Meredith Giuliani
- Department of Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada.
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada.
| |
Collapse
|
49
|
Wang MH, Loewen SK, Giuliani M, Fairchild A, Yee D, Debenham BJ. Motivations, Well-Being, and Career Aspirations of Radiation Oncology Resident Physicians in Canada. J Cancer Educ 2021; 36:933-940. [PMID: 32140969 DOI: 10.1007/s13187-020-01717-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prior Pan-Canadian surveys of Radiation Oncology (RO) residents reveal a decrease in Canadian RO employment opportunities. Canadian RO resident levels increased from 130 in 2003, peaked at 209 in 2009, then decreased to 130 in 2017. Recognizing that RO has entered another period of transition, we re-examined resident motivations and perspectives on the job market and explored well-being and career aspirations among a contemporary cohort of Canadian RO residents. An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 75 open-ended, Likert-scale, matrix-style, and multiple-choice questions. Student's t test compared subgroups, with statistical significance at p ≤ 0.05. Out of 128 eligible residents, 84 completed the survey (66% response rate) with representative sampling from each training year. Demographics reveal 53% male, and 85% Canadian registry-funded. Top training-related stressors were exam performance, job prospects, and physical/psychological demands of residency. Most intend to pursue fellowship post-residency (80%) and practice in Canada (88%). Few believe they can obtain staff positions treating preferred tumor sites (38%) or at preferred geographic locations (28%). Residents view job market being less competitive than 5 years ago (40%) and predict it will be less competitive in 5 years (60%). Canadian RO residents feel adequately trained, and most pursue post-residency fellowships. Current perceptions of the Canadian job market remain guarded, but appear more optimistic about the future. This update provides insights into current RO training and identifies areas that could be addressed by incoming competency-based medical education models for RO.
Collapse
Affiliation(s)
- Michael H Wang
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada.
| | - Shaun K Loewen
- Division of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Alysa Fairchild
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Don Yee
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Brock J Debenham
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| |
Collapse
|
50
|
Said BI, Laurie A, Karamboulas C, Meens J, Huang SH, Xu W, Keshavarzi S, Bratman SV, Cho BJ, Giuliani M, Hahn E, Kim J, O’Sullivan B, Ringash J, Waldron J, Spreafico A, de Almeida JR, Chepeha DB, Irish JC, Goldstein DP, Hope A, Hosni A. 45: Patient-Derived Xenograft Engraftment Predicts Oral Cavity Cancer Outcomes. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|