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Senger A, Venetis MK, Greene K, Catona D, Devine KA. Healthcare provider assessments of caregiver communication behaviors during gynecologic Cancer treatment appointments. PEC Innov 2024; 4:100259. [PMID: 38347863 PMCID: PMC10859277 DOI: 10.1016/j.pecinn.2024.100259] [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] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/28/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
Objective Caregivers often accompany patients to cancer-related medical appointments. Limited research exists on healthcare providers' (HCPs) evaluation of how caregiver communication influences interactions between healthcare providers and patients, particularly during gynecologic treatment visits. HCPs may perceive caregiver communication as helpful or challenging, and these triadic interactions may influence patient outcomes. Methods Interviews with ten cancer specialist HCPs (medical assistants/technicians, nurse practitioners/registered nurses, oncologists) addressed experiences interacting with patients and caregivers. Results Analyses revealed two themes concerning helpful communication: caregivers managing information and managing patient emotions. Three challenging themes include caregiver communication unsettling healthcare interactions, caregiver presence limiting patient communication, and caregiver engagement challenges. Conclusion HCPs evaluate caregiver communication as helpful and challenging. Findings suggest benefits of communication training for gynecologic cancer patients such as requesting privacy when interacting with HCPs, for caregivers to promote awareness of effects of their behavior, and for HCPs to help manage triadic interactions while supporting patient needs. Innovation HCP assessment of caregiver communication during gynecologic treatment visits offers unique insights regarding helpful and challenging behaviors contributing to implications for patient care and well-being. Applications may extend to other triadic interactions and cancer settings.
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Affiliation(s)
- Angela Senger
- Rutgers, The State University of New Jersey, Department of Communication, 4 Huntington Street, New Brunswick, NJ 08901, USA
- Rutgers Cancer Institute of New Jersey, Department of Pediatric Population Science, Outcomes, and Disparities Research, 195 Little Albany Street, New Brunswick, NJ 08901, USA
| | - Maria K. Venetis
- Rutgers, The State University of New Jersey, Department of Communication, 4 Huntington Street, New Brunswick, NJ 08901, USA
| | - Kathryn Greene
- Rutgers, The State University of New Jersey, Department of Communication, 4 Huntington Street, New Brunswick, NJ 08901, USA
| | - Danielle Catona
- University of Maryland, School of Public Health, 4200 Valley Drive, Suite 2242, College Park, MD 20742-2611, USA
| | - Katie A. Devine
- Rutgers Cancer Institute of New Jersey, Department of Pediatric Population Science, Outcomes, and Disparities Research, 195 Little Albany Street, New Brunswick, NJ 08901, USA
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Ranniger RL, Lamaita RM, D’Abreu BF, Tolentino MR, Cândido EB, Andrade WP, Nogueira-Rodrigues A, Silva-Filho AL. Fertility preservation in female cancer patients in Brazil: perceptions and attitudes of infertility specialists. Rev Bras Ginecol Obstet 2024; 46:e-rbgo25. [PMID: 38765513 PMCID: PMC11075391 DOI: 10.61622/rbgo/2024rbgo25] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/12/2023] [Indexed: 05/22/2024] Open
Abstract
Objective Fertility preservation is a priority in oncology for female cancer patients. However, there is a lack of communication between infertility specialists and oncologists. This study aimed to evaluate infertility specialists' perceptions and experiences regarding fertility preservation. Methods Conduct an online survey to profile infertility specialists. Participants were infertility affiliated with the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO). The specialists received an online survey, which response rate were 30.9%, most of whom were in southern and southeastern. The survey consisted on 14 questions about the infertility specialists' location, techniques in clinical practice, treatment successful rate, patients idea, etc. Results The average experience in human reproduction were 15.5 ± 10.2 years (mean ± standard deviation, range 1-40). Among reproductive-aged female cancer patients recommended for fertility preservation, 60.3 ± 28.8% (range 10-100%) underwent preservation procedures. Main barriers were cost (41%), oncologists' knowledge or acceptance (35%) and accessibility (9%). Most infertility specialists (58%) considered 40 years the limit for fertility preservation. Leukemia, lymphoma, breast and ovarian cancers were prioritized for fertility preservation, while lung, thyroid, gastric, and brain cancers were less relevant. Conclusion This is the first Brazilian study about infertility specialists' perceptions on oncology patients access to fertility preservation. These patients primarily receive treatment in the public health system, while infertility specialists mainly work in the private healthcare. This healthcare mode is currently fragmented, but integrating these experts is enhancing patient access to fertility preservation. Studies on this topic are still warranted.
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Affiliation(s)
- Renata Lack Ranniger
- Universidade Estadual Paulista "Júlio de Mesquita Filho"Faculdade de Medicina de BotucatuDepartment of GynecologyBotucatuSPBrazilDepartment of Gynecology, Obstetrics and Mastology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil.
| | - Rívia Mara Lamaita
- Universidade Federal de Minas GeraisDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
- Mater DeiDepartment of Assisted ReproductionBelo HorizonteMGBrazilDepartment of Assisted Reproduction, Mater Dei, Belo Horizonte, MG, Brazil.
| | - Bárbara Flecha D’Abreu
- Universidade Federal de Minas GeraisDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Mariana Rodrigues Tolentino
- Mater DeiDepartment of Assisted ReproductionBelo HorizonteMGBrazilDepartment of Assisted Reproduction, Mater Dei, Belo Horizonte, MG, Brazil.
| | - Eduardo Batista Cândido
- Universidade Federal de Minas GeraisDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Warne Pedro Andrade
- Universidade Estadual Paulista "Júlio de Mesquita Filho"Faculdade de Medicina de BotucatuDepartment of GynecologyBotucatuSPBrazilDepartment of Gynecology, Obstetrics and Mastology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil.
| | - Angélica Nogueira-Rodrigues
- Universidade Federal de Minas GeraisDepartment of Internal MedicineBelo HorizonteMGBrazilDepartment of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Agnaldo Lopes Silva-Filho
- Universidade Estadual Paulista "Júlio de Mesquita Filho"Faculdade de Medicina de BotucatuDepartment of GynecologyBotucatuSPBrazilDepartment of Gynecology, Obstetrics and Mastology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil.
- Universidade Federal de Minas GeraisDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Ebaid NY, Ahmed RN, Assy MM, Amin MI, Alaa Eldin AM, Alsowey AM, Abdelhay RM. Diagnostic validity and reliability of BT-RADS in the management of recurrent high-grade glioma. J Neuroradiol 2024:S0150-9861(24)00111-1. [PMID: 38492800 DOI: 10.1016/j.neurad.2024.03.001] [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: 12/19/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND AND PURPOSE BT-RADS is a new framework system for reporting the treatment response of brain tumors. The aim of the study was to assess the diagnostic performance and reliability of the BT-RADS in predicting the recurrence of high-grade glioma (HGG). MATERIALS AND METHODS This prospective single-center study recruited 81 cases with previously operated and pathologically proven HGG. The patients underwent baseline and follow-up contrast-enhanced MRI (CE-MRI). Two neuro-radiologists with ten years-experience in neuroimaging independently analyzed and interpreted the MRI images and assigned a BT-RADS category for each case. To assess the diagnostic accuracy of the BT-RADS for detecting recurrent HGG, the reference standard was the histopathology for BT-RADS categories 3 and 4, while neurological clinical examination and clinical follow up were used as a reference for BT-RADS categories 1 and 2. The inter-reader agreement was assessed using the Cohen's Kappa test. RESULTS The study included 81 cases of HGG, of which 42 were recurrent and 39 were non-recurrent HGG cases based on the reference test. BT-RADS 3B was the best cutoff for predicting recurrent HGG with a sensitivity of 90.5 % to 92.9 %, specificity of 76.9 % to 84.6 %, and accuracy of 83.9 % to 88.9 %, based on both readers. The BT-RADS showed a substantial inter-reader agreement with a K of 0.710 (P = 0.001). CONCLUSIONS The BT-RADS is a valid and reliable framework for predicting recurrent HGG. Moreover, BT-RADS can help neuro-oncologists make clinical decisions that can potentially improve the patient's outcome.
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Affiliation(s)
- Noha Yahia Ebaid
- Department of Radiology, Faculty of medicine, Zagazig University, Zagazig, Egypt; Negida academy LLC, Arlington, MA, USA
| | - Rasha Nadeem Ahmed
- Department of Surgery, College of medicine, Ninevah University, Mosul, Iraq
| | - Mostafa Mohamad Assy
- Department of Radiology, Faculty of medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Ibrahim Amin
- Department of Radiology, Faculty of medicine, Zagazig University, Zagazig, Egypt
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Commaroto S, Camacho-Rivera M, Guo Y, Hong YR, Turner K, Islam IK, Rivera A, Islam JY. Racial and ethnic disparities in knowledge, attitudes, and invitation to participate in clinical trials among cancer survivors in the United States: An analysis of the 2020 U.S. HINTS. Prev Med Rep 2024; 37:102564. [PMID: 38205172 PMCID: PMC10776641 DOI: 10.1016/j.pmedr.2023.102564] [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] [Received: 10/13/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Background Despite the use of clinical trials to provide gold-standard evidence of cancer treatment and intervention effectiveness, racial/ethnic minorities are frequently underrepresented participants. Our objective was to evaluate racial/ethnic differences in knowledge and attitudes towards clinical trials among U.S. cancer survivors. Methods We leveraged the 2020 Health Informational National Trends Survey (HINTS) data (February-June 2020), which is a weighted, nationally representative survey of 3865 adults (≥18 years), including cancer survivors. We descriptively evaluated cancer survivor's (n = 553) knowledge of clinical trials, and trusted sources of information regarding clinical trials. Using Poisson regression, we estimated predictors of self-reported knowledge of clinical trials. Results Among cancer survivors, 82 % were NH-White and 60 % self-reported to at least have some knowledge about clinical trials. When asked about factors that would influence their decision to participate in clinical trials, participants across racial groups frequently chose "I would want to get better" and "If the standard care was not covered by my insurance." NH-White (76 %), NH-Black (78 %), and Hispanic/Latinx (77 %) cancer survivors reported their trusted source of information about clinical trials was their health care provider; NH-Asian cancer survivors reported their health care provider (51 %) as well as government health agencies (30 %) as trusted sources. Cancer survivors with only a high school degree were less likely to have any knowledge of clinical trials compared to those with a Baccalaureate degree or more (aPR:0.61;95 % CI:0.45-0.83). Conclusion Health care providers are a trusted source of clinical trial information.
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Affiliation(s)
- Sarah Commaroto
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 36635, USA
- University of South Florida Morsani College of Medicine, USA
| | - Marlene Camacho-Rivera
- Department of Community Health, SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- UF Health Cancer Center, Gainesville, FL, USA
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 36635, USA
- Department of Oncologic Sciences, Morsani School of Medicine, University of South Florida, Tampa, FL, 33635, USA
| | - Imran K. Islam
- College of Letters and Science, University of Wisconsin Oshkosh, Oshkosh, WI, USA
| | - Argelis Rivera
- Department of Hospital Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Jessica Y. Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 36635, USA
- Department of Oncologic Sciences, Morsani School of Medicine, University of South Florida, Tampa, FL, 33635, USA
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Pierre-Victor D, Martin IK, Adjei B, Shaw-Ridley M, Rapkin B, Good M, Germain DS, Parker B, Pinsky PF, McCaskill-Stevens W. Oncologists' perceived confidence and attitudes toward managing pre-existing chronic comorbidities during patients' active cancer treatment. J Natl Med Assoc 2023; 115:377-384. [PMID: 37248119 DOI: 10.1016/j.jnma.2023.05.002] [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: 01/13/2023] [Revised: 04/05/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE To examine practicing oncologists' perceived confidence and attitudes toward management of pre-existing chronic conditions(PECC) during active cancer treatment(ACT). METHODS In December 2018, oncologists in the National Cancer Institute's Community Oncology Research Program (NCORP) were invited to complete a was pilot-tested, IRB-approved online survey about their perceived confidence in managing PECC. Pearson chi-square test was used to identify oncologists' differences in perceived confidence to manage PECC and attitudes toward co-management of patients' PECC with non-oncologic care providers. Perceived confidence and attitudes were analyzed as a function of medical specialty while controlling demographic and medical practice variables. RESULTS A total of 391 oncologists responded to the survey, 45.8% stated medical oncology as their primary specialty, 15.1% hematology oncology, 15.1% radiation oncology, 6.9% surgical oncology, and 17.1% other specialties such as gynecology oncology. Overall, 68.3% agreed (agree/strongly agree) that they were confident to manage PECC in the context of standard of care. However, only 46.6% and 19.7% remained confident when managing PECC previously managed by a primary care physician (PCP) and by a non-oncology subspecialist, respectively. Most oncologists (58.3%) agreed that patients' overall care was well coordinated, and 63.7% agreed that patients had optimal cancer and non-cancer care when PECC was co-managed with a non-oncology care provider. CONCLUSION Most oncologists felt confident to manage all PECC during patients' ACT, but their perceived confidence decreased for PECC previously managed by PCPs or by non-oncology subspecialists. Additionally, they had positive attitudes toward co-management of PECC with non-oncologic care providers. These results indicate opportunities for greater collaboration between oncologists and non-oncology care providers to ensure comprehensive and coordinated care for cancer patients with PECC.
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Affiliation(s)
| | - Iman K Martin
- National Human Genome Research Institute, NIH, United States of America
| | - Brenda Adjei
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, United States of America
| | - Mary Shaw-Ridley
- Department of Behavioral & Environmental Health, Jackson State University, United States of America
| | - Bruce Rapkin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, United States of America
| | - Marjorie Good
- Division of Cancer Prevention, National Cancer Institute, NIH, United States of America
| | - Diane St Germain
- Division of Cancer Prevention, National Cancer Institute, NIH, United States of America
| | - Bernard Parker
- Division of Cancer Prevention, National Cancer Institute, NIH, United States of America
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, NIH, United States of America
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Salgado TM, Radwan RM, Hickey Zacholski E, Mackler E, Buffington TM, Musselman KT, Irvin WJ, Perkins JM, Le TN, Dixon DL, Farris KB, Sheppard VB, Jones RM. Oncologists' responsibility, comfort, and knowledge managing hyperglycemia in patients with cancer undergoing chemotherapy: a cross sectional study. Support Care Cancer 2023; 31:450. [PMID: 37421495 DOI: 10.1007/s00520-023-07927-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To assess oncologists' responsibility, comfort, and knowledge managing hyperglycemia in patients undergoing chemotherapy. METHODS In this cross-sectional study, a questionnaire collected oncologists' perceptions about professionals responsible for managing hyperglycemia during chemotherapy; comfort (score range 12-120); and knowledge (score range 0-16). Descriptive statistics were calculated including Student t-tests and one-way ANOVA for mean score differences. Multivariable linear regression identified predictors of comfort and knowledge scores. RESULTS Respondents (N = 229) were 67.7% men, 91.3% White and mean age 52.1 years. Oncologists perceived endocrinologists/diabetologists and primary care physicians as those responsible for managing hyperglycemia during chemotherapy, and most frequently referred to these clinicians. Reasons for referral included lack of time to manage hyperglycemia (62.4%), belief that patients would benefit from referral to an alternative provider clinician (54.1%), and not perceiving hyperglycemia management in their scope of practice (52.4%). The top-3 barriers to patient referral were long wait times for primary care (69.9%) and endocrinology (68.1%) visits, and patient's provider outside of the oncologist's institution (52.8%). The top-3 barriers to treating hyperglycemia were lack of knowledge about when to start insulin, how to adjust insulin, and what insulin type works best. Women (ß = 1.67, 95% CI: 0.16, 3.18) and oncologists in suburban areas (ß = 6.98, 95% CI: 2.53, 11.44) had higher comfort scores than their respective counterparts; oncologists working in practices with > 10 oncologists had lower comfort scores (ß = -2.75, 95% CI: -4.96, -0.53) than those in practices with ≤ 10. No significant predictors were identified for knowledge. CONCLUSION Oncologists expected endocrinology or primary care clinicians to manage hyperglycemia during chemotherapy, but long wait times were among the top barriers cited when referring patients. New models that provide prompt and coordinated care are needed.
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Affiliation(s)
- Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, and Massey Cancer Center, Virginia Commonwealth University, PO Box 98053, 410 N. 12th Street, Richmond, VA, 23298, USA.
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA.
| | - Rotana M Radwan
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Erin Hickey Zacholski
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Emily Mackler
- Michigan Oncology Quality Consortium (MOQC) and Michigan Institute for Care Management and Transformation (MICMT), 4251 Plymouth Road Arbor Lakes, Building 3, Floor 3, Ann Arbor, MI, 48105, USA
| | - Tonya M Buffington
- Bon Secours Mercy Health, 611 Watkins Centre Parkway, Suite 250, Midlothian, Richmond, VA, 23114, USA
| | - Kerri T Musselman
- Emcara Health and PopHealthCare, 113 Seaboard Lane, Suite B200, Franklin, TN, 37067, USA
| | - William J Irvin
- Bon Secours Cancer Institute, Bon Secours Mercy Health, 14051 St Francis Blvd Suite 2210, Midlothian, VA, 23114, United States
| | - Jennifer M Perkins
- Division of Endocrinology, University of California San Francisco Medical Center, Endocrinology Clinic at Parnassus 400 Parnassus Ave., Suite A-550, San Francisco, CA, 94143, USA
| | - Trang N Le
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, 1101 E. Marshall St. Sanger Hall Suite 1-030, Richmond, VA, 23298, USA
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Karen B Farris
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Population Health, and Massey Comprehensive Cancer Center, Virginia Commonwealth University, 830 East Main Street, Richmond, VA, 23219, USA
| | - Resa M Jones
- Department of Epidemiology & Biostatistics, College of Public Health, and Fox Chase Cancer Center, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th Floor, Suite 917, Philadelphia, PA, 19122, USA
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Song JH, Son SY, Han SU. What is the role of surgical oncologist in the treatment of gastric cancer? J Minim Invasive Surg 2023; 26:47-50. [PMID: 37347104 PMCID: PMC10280105 DOI: 10.7602/jmis.2023.26.2.47] [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] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
Surgical oncologist plays a pivotal role in treating patients with cancer in the era of precision medicine. In this article, we summarized traditional roles of surgical oncologists and suggested further additional ones for the modern day in the multidisciplinary approach to gastric cancer treatment.
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Affiliation(s)
- Jeong Ho Song
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Nunes Filho P, Albuquerque C, Pilon Capella M, Debiasi M. Immune Checkpoint Inhibitors in Breast Cancer: A Narrative Review. Oncol Ther 2023. [PMID: 36917399 DOI: 10.1007/s40487-023-00224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
Breast cancer is the most frequently diagnosed malignancy in patients worldwide and the main cause of cancer-related death. Though still incurable, metastatic breast cancer's prognosis has been considerably improved in the past 10 years due to the introduction of new targeted agents, such as immune checkpoint inhibitors (ICI). However, these medications are associated with unique side effects known as immune-mediated adverse events (irAE). In this paper, we review the clinical evidence for the use of ICIs in breast cancer, in both the metastatic as well as neoadjuvant/adjuvant setting, followed by a review of irAE most commonly seen, and the medications used to treat them. Our opinion is that any cancer specialist treating patients with breast cancer should be aware of these side effects for early detection and management, and oncologists should be the leaders of the multidisciplinary team that will take care of them.
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Bos-van den Hoek DW, van Laarhoven HWM, Ali R, Bakker SD, Goosens A, Hendriks MP, Pepels MJAE, Tange D, de Vos FYFL, van de Wouw AJ, Smets EMA, Henselmans I. Blended online learning for oncologists to improve skills in shared decision making about palliative chemotherapy: a pre-posttest evaluation. Support Care Cancer 2023; 31:184. [PMID: 36820944 DOI: 10.1007/s00520-023-07625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To improve shared decision making (SDM) with advanced cancer patients, communication skills training for oncologists is needed. The purpose was to examine the effects of a blended online learning (i.e. e-learning and online training session) for oncologists about SDM in palliative oncological care and to compare this blended format with a more extensive, fully in-person face-to-face training format. METHODS A one-group pre-posttest design was adopted. Before (T0) and after (T2) training, participants conducted simulated consultations (SPAs) and surveys; after the e-learning (T1), an additional survey was filled out. The primary outcome was observed SDM (OPTION12 and 4SDM). Secondary outcomes included observed SDM per stage, SPA duration and decision made as well as oncologists' self-reported knowledge, clinical behavioural intentions, satisfaction with the communication and evaluation of the training. Additionally, outcomes of the blended learning were compared with those of the face-to-face training cohort. Analyses were conducted in SPSS by linear mixed models. RESULTS Oncologists (n = 17) showed significantly higher SDM scores after the blended online learning. The individual stages of SDM and the number of times the decision was postponed as well as oncologists' beliefs about capabilities, knowledge and satisfaction increased after the blended learning. Consultation duration was unchanged. The training was evaluated as satisfactory. When compared with the face-to-face training, the blended learning effects were smaller. CONCLUSION Blended online SDM training for oncologists was effective. However, the effects were smaller compared to face-to-face training. The availability of different training formats provides opportunities for tailoring training to the wishes and needs of learners.
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Zhu P, Wu B, Zheng R, Cheng F, Wang M, Pei Y, Shi L, Wu S, Wan J, Zhang L. Oncology nurses' and oncologists' experience of addressing sexual health concerns in breast cancer patients: A qualitative study. Eur J Oncol Nurs 2023; 63:102286. [PMID: 36893579 DOI: 10.1016/j.ejon.2023.102286] [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: 10/27/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE This study aimed to explore the experiences of Chinese oncology nurses and oncologists who provide sexual health education for breast cancer patients in their practical work. METHODS This was a qualitative study using semistructured face-to-face interviews. Eleven nurses and eight oncologists who provided sexual health education to breast cancer patients were purposively recruited from eight hospitals in seven provinces of China. Data were analyzed using the thematic analysis method. RESULTS Four main themes emerged: the surface of sexual health, stress and benefit finding, cultural sensitivity and communication, needs and changes. Both oncology nurses and oncologists found it difficult to solve sexual health problems, which were beyond their responsibilities and competencies. They felt helpless about the limitations of external support. Nurses hoped oncologists could participate in more sexual health education. CONCLUSIONS Oncology nurses and oncologists experienced great challenges in educating breast cancer patients about sexual health. They are eager to obtain more formal education and learning resources for sexual health education. Specific training to improve the sexual health education competence of healthcare professionals is needed. Furthermore, more support is needed to create conditions to encourage patients to reveal their sexual challenges. It is necessary for oncology nurses and oncologists to communicate on sexual health in breast cancer patients, and to promote interdisciplinary communication and share responsibility.
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Affiliation(s)
- Ping Zhu
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Bing Wu
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Ruishuang Zheng
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Hospital and Institute, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin, 300060, China
| | - Fang Cheng
- Department of Oncology Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Meixiang Wang
- Department of Oncology Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Yi Pei
- Department of Internal Medicine-Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Lingyun Shi
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Suya Wu
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Jing Wan
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Liuliu Zhang
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China.
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Konishi R, Isogai J, Mukai A, Komori K, Majima T, Ito S, Kawada K. Pharmacist perceptions of a "good death" and differences in perception between patients with cancer, oncologists, and oncology nurses: a questionnaire survey. J Pharm Health Care Sci 2023; 9:5. [PMID: 36694254 PMCID: PMC9875416 DOI: 10.1186/s40780-022-00269-4] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/08/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND For pharmacists expected to encounter the deaths of many of their patients in the near future, it is important to understand the perception of a "good death" for patients with cancer who are likely to be aware of the circumstances of their poor prognosis. In this study, we clarified pharmacists' perceptions of a "good death" and considered the differences in perception among patients with cancer, oncologists, and oncology nurses. METHODS From April to June 2022, an anonymous questionnaire survey was conducted on pharmacists working in hospitals and pharmacies and on members of the Japanese Society for Pharmaceutical Palliative Care and Sciences. The questionnaire consisted of 57 questions, called attributes, developed by Miyashita et al. to investigate the perception of "good death" in Japanese cancer medicine. The importance of those attributes was investigated using a 7-point Likert scale. RESULTS Three thousand four hundred thirty-two pharmacists were made aware of this survey, and 207 participated in the survey. The responses of pharmacists to the 57 questions were very similar to those of the oncologists. Among them, "Fighting against disease until one's last moment" and "Not making trouble for others" had very low importance, which was the most significantly different from the responses of patients with cancer. "Fighting against disease until one's last moment" tended to be significantly underestimated by pharmacists engaged in patient guidance and interview compared to that by pharmacists not engaged in the duty (p = 0.02). Also, when we compared pharmacists with or without qualifications related to cancer and palliative care, there was no significant difference in the importance of "Fighting against disease until one's last moment." However, the importance of "Not making trouble for others" for qualified pharmacists was significantly underestimated (p = 0.04). CONCLUSION Since pharmacists understand the limits of chemotherapy, they may want to be close to the patient but may not strongly agree with the "Fighting against cancer" component that patients with cancer prefer. It may be necessary to reconsider better ways of approaching the wishes and satisfaction of patients with cancer under the care of medical professionals in the field of oncology.
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Affiliation(s)
- Reiko Konishi
- grid.412493.90000 0001 0454 7765Department of Pharmacy Practice and Science, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka, 573-0101 Japan
| | - Junichi Isogai
- Department of Hospital Pharmacy, Tsushima City Hospital, 3-73 Tachibana-cho, Tsushima, Aichi 496-8537 Japan
| | - Akira Mukai
- grid.412493.90000 0001 0454 7765Department of Pharmacy Practice and Science, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka, 573-0101 Japan
| | - Koji Komori
- grid.412493.90000 0001 0454 7765Department of Pharmacy Practice and Science, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka, 573-0101 Japan
| | - Takashi Majima
- grid.472181.90000 0004 4654 0061Department of Nursing, Faculty of Allied Health Sciences, Yamato University, 2-5-1 Katayama-cho, Suita, Osaka, 564-0082 Japan
| | - Shinji Ito
- Department of Hospital Pharmacy, Tsushima City Hospital, 3-73 Tachibana-cho, Tsushima, Aichi 496-8537 Japan
| | - Kou Kawada
- grid.412493.90000 0001 0454 7765Department of Pharmacy Practice and Science, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka, 573-0101 Japan
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Mailankody S, Sherigar P, Pai A, Shenoy R, Udupa K, Lewis S, Rao SR. PENS approach for breaking bad news in the oncology outpatient setting: a real-world report. Support Care Cancer 2022; 31:13. [PMID: 36513796 DOI: 10.1007/s00520-022-07458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. METHODS This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. RESULTS Fifty patients (mean age 53.7 years, range 28-76) were included in the study. The average duration of BBN was 6.1 (range 2-11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. CONCLUSIONS The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/07/034707).
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Lin C, Nguyen TK, Sanatani M. Exploring the Inner Lens: Examining Oncology Consultants' Use of Competency and Assessment Frameworks in Clinical Teaching Settings. J Cancer Educ 2022:10.1007/s13187-022-02241-0. [PMID: 36422764 DOI: 10.1007/s13187-022-02241-0] [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] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Medical education in oncology has adopted a competency-based medical education (CBME) approach in Canada. Oncologist competencies are arranged within assessment frameworks, but it is unknown whether oncologists routinely use assessment frameworks when determining what to teach oncology trainees. Understanding oncologists' actual approaches to assessment and teaching as a form of enacted CBME could inform and focus faculty development efforts. Using a participatory action research approach, oncology faculty were interviewed regarding their teaching practices and use of assessment frameworks. Faculty suggestions regarding challenges in setting teaching goals and completing assessment within the CBME paradigm were solicited. Furthermore, teaching objectives developed by faculty in-house were assessed regarding the domains of competence targeted. Thirty-one of the 40 faculty members in the Department of Oncology, Western University, agreed to participate. Trainee factors (training level, areas of interest), faculty personal values and experience, the teaching setting, and some components of frameworks (medical expert, communicator, advocate, and professional) were articulated as determinants of teaching goals. Of the 1117 in-house objectives reviewed, 76% focused on the medical role. Faculty held widely disparate views on assessment framework features which would enable teaching and assessment. Oncology faculty members used a multifaceted approach to determine what to teach trainees. This approach contains elements both of the conventional apprenticeship models under which many faculty members themselves were trained and of the CBME paradigm. Future research should focus on exploring ways to resolve the tension between established individual teaching approaches and nationally standardized competency frameworks which are being implemented.
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Affiliation(s)
- Cindy Lin
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Timothy K Nguyen
- Department of Oncology, Division of Radiation Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Michael Sanatani
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
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Asai-Sato M, Suzuki N, Sakai H, Itani Y, Sato S, Futagami M, Yoshida Y. Perceptions and practice patterns of cancer survivorship care among Japanese gynecologic oncologists: The JGOG questionnaire survey. J Gynecol Oncol 2022; 34:e10. [PMID: 36366812 PMCID: PMC9807361 DOI: 10.3802/jgo.2023.34.e10] [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] [Received: 05/12/2022] [Revised: 07/26/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study aimed to assess gynecologic oncologists (GOs)' perceptions and attitudes toward cancer survivorship to help improve survivor care. METHODS We conducted a web-based questionnaire survey about survivorship issues for the GOs belonging to the Japan Gynecologic Oncology Group. We analyzed the proactiveness of the participants toward addressing 25 survivor issues. In addition, the practice patterns and barriers to care for survivors' long-term health issues, such as second primary cancer (SPC) and lifestyle-related diseases (LSRD), and return-to-work (RTW) support were assessed. RESULTS We received 313 responses. The respondents had a mean of 22 years of physician experience. The ratio of men to women was approximately 7:3, and 84.7% worked at facilities for multidisciplinary cancer treatment. The respondents' proactiveness for addressing psychosocial problems was significantly lower than physical and gynecological issues (p<0.01 by χ² test). However, most GOs tried to contribute to such issues according to patients' demands. Women GOs were more proactively involved in some survivorship issues than the men (p<0.05 by logistic regression analysis). The rates of the respondents who proactively discussed SPC, LSRD, and RTW were unexpectedly high (60.7%, 36.1%, and 52.4%, respectively). However, the GOs only provided verbal support for these issues in many cases. CONCLUSION The Japanese GOs were enthusiastic about survivorship care. However, their tendency to deal with survivors' problems through their own knowledge and judgments raises concerns about the quality of care. Therefore, creating survivorship care guidelines and enhancing multidisciplinary collaboration should be prioritized.
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Affiliation(s)
- Mikiko Asai-Sato
- Department of Obstetrics and Gynecology, Nihon University, Tokyo, Japan.
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hitomi Sakai
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - Yoshio Itani
- Palliative Care Center, Yao Municipal Hospital, Yao, Japan
| | - Shinya Sato
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Masayuki Futagami
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Braun M, Hershkovitz TA, Melumad NM, Goldzweig G. The paradox: guilt as an antidote to helplessness among oncologists. Support Care Cancer 2022; 30:7545-7551. [PMID: 35674794 DOI: 10.1007/s00520-022-07196-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Oncologists are exposed to suffering, loss, and death, and as a result may experience guilt. The study examined two competing hypotheses regarding the relation between locus of control (LOC) and guilt among oncologists and the mediating role of helplessness. METHOD Eighty-three oncologists answered a demographic questionnaire; the Levenson's "Internal, Powerful Others, and Chance" scale; the Guilt Inventory; and the Learned Helplessness Scale. RESULTS Oncologists reported moderate levels of guilt, high levels of internal LOC, and low levels of external LOC and helplessness. The results indicate a significant negative relationship between internal LOC and guilt and a significant positive relationship between external LOC (powerful others) and guilt, both mediated by helplessness. It seems that oncologists with external LOC feel helplessness and this metamorphoses into guilt, due to its potentially protective role against feelings of helplessness. CONCLUSIONS Oncologists are at risk for guilt. Whereas an internal LOC plays an important role as a resilience factor in terms of helplessness, an external LOC is a risk factor for helplessness and guilt. A paradoxical association between guilt and helplessness was found. The implication of which is that guilt may be produced to avoid helplessness; in other words, guilt, however painful, might be preferable to feeling helpless. Interventions focusing on oncologists' coping with uncontrolled situations in their daily work, decreasing their sense of helplessness and guilt, should be implanted.
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Affiliation(s)
- Michal Braun
- The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.
- Breast Oncology Unit, Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel.
| | | | | | - Gil Goldzweig
- The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
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Liu L, Cao Y, Su M, Zhang J, Miao Y, Yao N. Financial toxicity among older cancer survivors in China: a qualitative study of oncology providers' perceptions and practices. Support Care Cancer 2022; 30:9433-9440. [PMID: 35917024 PMCID: PMC9343566 DOI: 10.1007/s00520-022-07303-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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022]
Abstract
Objective Despite oncology providers’ significant roles in patient care, few studies have been conducted to investigate oncology providers’ understanding of financial toxicity. This study aimed to explore oncology providers’ perceptions and practices relating to the financial toxicity of older cancer survivors in China. Methods A qualitative study was conducted. Individual interviews were conducted with 14 oncology providers at four general hospitals and two cancer specialist hospitals in China. Qualitative data was analyzed using descriptive coding and thematic analysis methods. Results The perceptions of participants about the financial toxicity of older cancer survivors include (1) older adults with cancer are especially vulnerable to financial toxicity; (2) inadequate social support may lead to financial toxicity; and (3) cancer-related financial toxicity increased the risk of poor treatment outcomes. The interventions to mitigate its negative effects include (1) effective communication about the cancer-related costs; (2) improving the professional ability to care for the patient; (3) cancer education program as a way to reduce knowledge gaps; and (4) clinical empathy as an effective treatment strategy. Conclusion Oncology providers perceive that older cancer patients’ financial toxicity plays a key role in increasing the negative effects of diagnosis and treatment of cancer, as well as possibly worsening cancer outcomes. Some potential practices of providers to mitigate financial toxicity include utilizing effective cost communication, improving professional ability in geriatric oncology care, and promoting further cancer education and clinical empathy.
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Affiliation(s)
- Li Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Qilu Hospital of Shandong University, Shandong, Jinan, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Qilu Hospital of Shandong University, Shandong, Jinan, China
| | - Mingzhu Su
- Qilu Hospital of Shandong University, Shandong, Jinan, China.
- School of Public Health, Centre for Health Management and Policy Research, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China.
| | - Jinxin Zhang
- School of Public Health, Centre for Health Management and Policy Research, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Yajun Miao
- Department Oncology, Shandong Province Third Hospital, Jinan, Shandong, China
| | - Nengliang Yao
- School of Public Health, Centre for Health Management and Policy Research, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
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Fauer AJ, Ganz PA, Brauer ER. A mixed method study of medical oncologists' perceived barriers and motivators to addressing long-term effects in breast cancer survivors. Breast Cancer Res Treat 2022; 194:699-707. [PMID: 35767127 PMCID: PMC9287210 DOI: 10.1007/s10549-022-06657-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study was to identify oncologist-reported barriers and motivators in addressing long-term effects with breast cancer survivors.
Methods This study is a secondary analysis of data from a survey of U.S. medical oncologists (n = 217) about breast cancer survivorship care in clinical practice. Using both closed- and open-ended questions, we asked oncologists to report barriers and motivators they perceived in addressing long-term effects with breast cancer patients. Descriptive statistics were used to summarize and rank items endorsed by oncologists in analyses of quantitative data; content analysis was used to identify salient categories of barriers and motivators in qualitative data. Results Key barriers to managing physical long-term effects included lack of time during appointments (n = 128 oncologists, 59%) and perceived lack of evidence-based interventions (n = 89, 41%). With respect to psychosocial effects, oncologists reported lack of knowledge (n = 88, 40.6%) and challenges making referrals to mental health providers (n = 115, 53%). From the qualitative data, three distinct barrier categories emerged: “Competing priorities during brief appointments;” “Discussing long-term effects—Who? What? When?;” and “Beyond my expertise and comfort level.” Two motivator categories emerged: “I owe it to them;” and “Giving people a life worth living.” Conclusion Oncologists’ key motivators for addressing long-term effects were focused on professional values, relationships with survivors, and their commitment to prioritizing patients' quality of life. Future efforts should leverage oncologists' professional and interpersonal motivators to enhance the delivery of survivorship care for breast cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06657-6.
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Affiliation(s)
- Alex J Fauer
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Patricia A Ganz
- Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.,Center for Cancer Control and Prevention Research, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Eden R Brauer
- Center for Cancer Control and Prevention Research, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA. .,School of Nursing, UCLA, 4-234 Factor Building, Box 956900, Los Angeles, CA, 90095-6900, USA.
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Kowalczyk O, Roszkowski K, Pawliszak W, Rypel A, Roszkowski S, Kowalska J, Tylkowski B, Bajek A. Religion and Spirituality in Oncology: An Exploratory Study of the Communication Experiences of Clinicians in Poland. J Relig Health 2022; 61:1366-1375. [PMID: 34331657 PMCID: PMC8967801 DOI: 10.1007/s10943-021-01343-1] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
Communication with patients regarding oncology-related aspects is a challenging experience and requires a high level of skill from the interlocutors. The aim of this study was to verify the influence of religion/spirituality in oncological settings from the health professionals' perspectives in Poland. It assessed the role of religion/spirituality in patient-clinician communication, death or stress self-management, empathy, and breaking bad news skills. Data collection was carried out through a standardized self-administered questionnaire with varying scales. The study cohort consisted of 60 medical practitioners specializing in oncological radiotherapy treatments. It was observed that strategies used for coping with patients' death, stress reduction, empathy, communication with patients and/or their relatives, or breaking bad news skills, may be gender-specific or may depend on the length of time employed, as well as experience in a cancer-related work environment. This study shows that spirituality and religiousness can support clinicians in managing challenging or negative emotions related to their work in cancer settings. Religiousness and spirituality can also serve as a potential therapeutic strategies for those exposed to patient suffering and death.
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Affiliation(s)
- Oliwia Kowalczyk
- Research and Education Unit for Communication in Healthcare, Department of Cardiac Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, M. Sklodowskiej Curie St. 9, 85-094, Bydgoszcz, Poland.
| | - Krzysztof Roszkowski
- Department of Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Romanowskiej St. 2, 85-796, Bydgoszcz, Poland
| | - Wojciech Pawliszak
- Department of Cardiac Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, M. Sklodowskiej Curie St. 9, 85-094, Bydgoszcz, Poland
| | - Agnieszka Rypel
- Faculty of Linguistics, Kazimierz Wielki Univeristy in Bydgoszcz, Jagiellonska St. 11, 85-067, Bydgoszcz, Poland
| | - Szymon Roszkowski
- Department of Biochemistry and Biogerontology, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Debowa St. 3, 85-626, Bydgoszcz, Poland
| | - Jolanta Kowalska
- Institute of Plant Protection, National Research Institute, Wegorka St. 20, 60-318, Poznan, Poland
| | - Bartosz Tylkowski
- Chemical Unit, Eurecat, Center Tecnològic de Catalunya, Marcellí Domingo s/n, 43007, Tarragona, Spain
| | - Anna Bajek
- Department of Tissue Engineering Chair of Urology and Andrology, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Karlowicza St. 24, 85-092, Bydgoszcz, Poland
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van Meurs J, Stommel W, Leget C, van de Geer J, Kuip E, Vissers K, Engels Y, Wichmann A. Oncologist responses to advanced cancer patients' lived illness experiences and effects: an applied conversation analysis study. BMC Palliat Care 2022; 21:37. [PMID: 35300674 PMCID: PMC8928655 DOI: 10.1186/s12904-022-00917-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background An advanced cancer patient’s life is often disturbed by fear of cancer recurrence, cancer progress, approaching suffering, and fear of dying. Consequently, the role of the medical oncologist is not only to provide best quality anti-cancer treatment, but also to address the impact of disease and treatment on a patient’s life, the lived illness experience. We aimed to gain insights into whether and how medical oncologists working at an outpatient clinic identify and explore lived illness experiences raised by patients with advanced cancer, and how this influences patients’ responses. Methods Conversation Analysis was applied to analyse 16 verbatim transcribed audio-recorded consultations. Results We identified 37 fragments in which patients expressed a lived experience from 11 of the 16 consultations. We found differing responses from different oncologists. Patients continued talking about their lived experiences if the listener produced a continuer such as humming or tried to capture the experience in their own words. In contrast, a response with optimistic talking or the presentation of medical evidence prevented patients from further unfolding the experience. In consultations in which the lived illness experience was most extensively unfolded, medical oncologists and patients could constantly see each other’s facial expressions. Conclusions When a patient with advanced cancer spontaneously introduces a lived illness experience, it helps to identify and explore it when the medical oncologist produces a continuer or tries to capture this experience in their own words. Our findings can be implemented in training sessions, followed by frequent reinforcement in daily care. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00917-4.
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Affiliation(s)
- Jacqueline van Meurs
- Department of Spiritual and Pastoral Care & Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, P.O. Box 9101 (714), Nijmegen, 6500 HB, Netherlands.
| | - Wyke Stommel
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Carlo Leget
- Department of Care and Welfare, University of Humanistic Studies, Utrecht, The Netherlands
| | - Joep van de Geer
- Academic Hospice Demeter, Bilthoven & Agora, De Bilt, the Netherlands
| | - Evelien Kuip
- Department of Medical Oncology & Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Anne Wichmann
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
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Maya S, Banerjee SC, Chawak S, Parker PA, Kandikattu S, Chittem M. Oncologists' experience with discussing cancer prognosis with patients and families: perspectives from India. Transl Behav Med 2021; 11:1896-1904. [PMID: 34170321 PMCID: PMC8686106 DOI: 10.1093/tbm/ibab070] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Nondisclosure of prognosis of advanced cancer is commonly practiced in some Asian cultures including India; but research is limited. To describe experiences of Indian oncologists in discussing cancer prognosis with people with cancer and their caregivers, with a focus on barriers and facilitators of prognostic discussions. Thirty oncologists practicing in South India, Hyderabad participated in semi-structured interviews; and analyzed using Interpretative Phenomenological Analysis. Barriers included system-level, patient-level, and physician-level challenges as obstructions to open and honest interactions around cancer prognosis. Most of the barriers focused on communication-related challenges. Lack of communication skills training for providers coupled with over-reliance on use of euphemisms, hesitation in communicating with "weak" patient, and struggles to establish healthcare proxy described communication-related barriers. The study also described factors including family involvement in cancer care and empathic communication as facilitators of honest and open communication about prognosis. In particular, rapport building and getting to know the patient, use of empathic communication, engaging in gradual and individualized disclosure, and balancing hope with honesty were communication-related facilitators that aid open communication with patients with cancer and their caregivers about prognosis and plan of care. Results provide implications for development of communication skills trainings for oncology physicians in India. Adapting, delivering, and evaluating existing communication skills training programs, particularly around discussions of prognosis and goals of care is a requisite step for providing patient-centered and supportive care to patients with cancer and their caregiving families.
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Affiliation(s)
- Sravannthi Maya
- Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | | | - Shweta Chawak
- Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | | | | | - Mahati Chittem
- Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
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Platas A, Cruz-Ramos M, Mesa-Chavez F, Jasqui-Bucay A, de la Rosa-Pacheco S, Rivera F, Mohar A, Villarreal-Garza C. Communication Challenges Among Oncologists in Mexico. J Cancer Educ 2021; 36:1098-1104. [PMID: 32030611 DOI: 10.1007/s13187-020-01703-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Communication challenges related to the delivery of bad news are present in oncologists' daily practice. Hence, communication skills are essential for clinicians to handle these situations as appropriately and compassionately as possible. The aim of this study was to identify Mexican oncologists' perceptions on the most important and hardest issues to discuss with patients and their families, as well as the challenges they most commonly encounter when communicating bad news. Physicians from various oncology centers were invited to anonymously complete an electronical survey designed by our multidisciplinary oncology team. Statistical analysis was performed with the SPSS software v25; descriptive statistics were used for the analysis of the survey's answers. In total, 115 physicians were included; most were medical oncologists. Treatment objectives and prognosis were the topics most of them considered relevant to address; while end-of-life care and treatment objectives were the hardest ones to discuss. The most difficult challenges they faced when breaking bad news were being honest without taking away hope and dealing with patients' emotions. Remarkably, we detected a lack of training in delivering bad news to patients among our participants, as a minority of them had formal training in the matter. However, most desired to receive communication skills training and believed a session of 2-5 h would be sufficient. Mexican oncologists face diverse communication challenges when disclosing bad news to patients. Our findings reveal an opportunity to develop formal training programs tailored for Mexican oncologists and to ultimately improve outcomes and patient-centered care.
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Affiliation(s)
- Alejandra Platas
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Ciudad de Mexico, Mexico
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | - Marlid Cruz-Ramos
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | - Fernanda Mesa-Chavez
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Ciudad de Mexico, Mexico
- Centro de Cancer de Mama, Hospital Zambrano Hellion, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
| | - Ariel Jasqui-Bucay
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | | | - Fernanda Rivera
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | - Alejandro Mohar
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Ciudad de Mexico, Mexico
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | - Cynthia Villarreal-Garza
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Ciudad de Mexico, Mexico.
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico.
- Centro de Cancer de Mama, Hospital Zambrano Hellion, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico.
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Ochi M, Kamoshida T, Araki M, Ikegami T. Prolonged survival in patients with hand-foot skin reaction secondary to cooperative sorafenib treatment. World J Gastroenterol 2021; 27:5424-5437. [PMID: 34539142 PMCID: PMC8409165 DOI: 10.3748/wjg.v27.i32.5424] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/22/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sorafenib is an oral drug that prolongs overall survival (OS) in patients with hepatocellular carcinoma. Adverse events, including hand-foot skin reaction (HFSR), lead to permanent sorafenib discontinuation.
AIM To clarify the association between interventions for adverse events and patient prognosis.
METHODS We performed a retrospective, multicenter study of patients treated with sorafenib monotherapy between May 2009 and March 2018. We developed a mutual cooperation system that was initiated at the start of sorafenib treatment to effectively manage adverse events. The mutual cooperation system entailed patients receiving consultations during which pharmacists provided accurate information about sorafenib to alleviate the fear and anxiety related to adverse events. We stratified the patients into three groups: Group A, patients without HFSR but with pharmacist intervention; Group B, patients with HFSR and pharmacist interventions unreported to oncologists (nonmutual cooperation system); and Group C, patients with HFSR and pharmacist interventions known to oncologists (mutual cooperation system). OS and time to treatment failure (TTF) were evaluated using the Kaplan-Meier method.
RESULTS We enrolled 134 patients (Group A, n = 41; Group B, n = 30; Group C, n = 63). The median OS was significantly different between Groups A and C (6.2 vs 13.9 mo, p < 0.01) but not between Groups A and B (6.2 vs 7.7 mo, P = 0.62). Group A vs Group C was an independent OS predictor (HR, 0.41; 95%CI: 0.25-0.66; P < 0.01). In Group B alone, TTF was significantly lower and the nonadherence rate was higher (P < 0.01). In addition, the Spearman’s rank correlation coefficients between OS and TTF in each group were 0.41 (Group A; P < 0.01), 0.13 (Group B; P = 0.51), and 0.58 (Group C; P < 0.01). There was a highly significant correlation between OS and TTF in Group C. However, there was no correlation between OS and TTF in Group B.
CONCLUSION The mutual cooperation system increased treatment duration and improved prognosis in patients with HFSR. Future prospective studies (e.g., randomized controlled trials) and improved adherence could help prevent OS underestimation.
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Affiliation(s)
- Masanori Ochi
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317–0077, Japan
| | - Toshiro Kamoshida
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317–0077, Japan
| | - Masahiro Araki
- Department of Gastroenterology and Hepatology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Ibaraki 309-1793, Japan
| | - Tadashi Ikegami
- Division of Gastroenterology and Hepatology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 309-1793, Japan
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O'Rourke C, Jayaraman S, El-Maraghi RH, Singal AG, Kielar AZ. Chronic Liver Disease and Liver Cancer: What the Hepatologists, Oncologists, and Surgeons Want to Know from Radiologists. Magn Reson Imaging Clin N Am 2021; 29:269-78. [PMID: 34243916 DOI: 10.1016/j.mric.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective communication between radiologists and physicians involved in the management of patients with chronic liver disease is paramount to ensuring appropriate and advantageous incorporation of liver imaging findings into patient care. This review discusses the clinical benefits of innovations in radiology reporting, what information the various stakeholders wish to know from the radiologist, and how radiology can help to ensure the effective communication of findings.
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24
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Rashid S, Reeder C, Sahu S, Rashid S. Psychological distress and moral injury to oncologists and their patients during COVID-19 pandemic. Curr Psychol 2021; 41:8175-8180. [PMID: 34341650 PMCID: PMC8318552 DOI: 10.1007/s12144-021-02128-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 02/08/2023]
Abstract
The impact of the COVID-19 pandemic on healthcare systems has been unprecedented, and the psychological effects on cancer patients and health care professionals are likely to be significant and long-lasting. The traditional methods of face-to-face health care interactions have been replaced by virtual consultations to reduce exposure to COVID-19 infection. This has put the healthcare professional under tremendous psychological pressure and led to considerable anxiety and distress among cancer patients. Treatment decisions have had to be adjusted to account for a healthcare system that has been temporarily consumed by the care of people with COVID-19, and this has put cancer patients at risk of inferior outcomes. This has had the potential to cause moral injury and psychological distress to health care professionals as well as patients, who have had to deal with a range of stressors due to the uncertainty, sense of loss of control, reduced accessibility to medications and social support, changes to personal circumstances (e.g. financial pressures) and fear of death due to COVID-19 infection. Long term consequences also include post-traumatic responses and complex grief reactions. Cancer services in particular should gear themselves to recognize and monitor these effects and allocate adequate resources to combat them in the months and years to come.
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Affiliation(s)
- Shazia Rashid
- Centre for Medical Biotechnology, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida Campus, Sector-125, Noida, Uttar Pradesh 201313 India
| | - Clare Reeder
- Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, Stadium Rd, Woolwich, London, SE18 4QH UK
| | - Satyajit Sahu
- Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, Stadium Rd, Woolwich, London, SE18 4QH UK
| | - Sabia Rashid
- Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, Stadium Rd, Woolwich, London, SE18 4QH UK
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25
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Pareek A, Patel AA, Harshavardhan A, Kuttikat PG, Pendse S, Dhyani A, Sharma S, Agarwal N, Maji D, Reddy RG, Gupta Y, Panchal HP, Parikh S. Impact of nationwide lockdown on cancer care during COVID-19 pandemic: A retrospective analysis from western India. Diabetes Metab Syndr 2021; 15:102131. [PMID: 34186357 PMCID: PMC8105303 DOI: 10.1016/j.dsx.2021.05.004] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS COVID-19 has impacted healthcare system worldwide including cancer case. Aim of this study was to describe the experience of lockdown on cancer care concerning patient's visit and reception of treatment in western India. METHODS This is a retrospective observational study conducted in patients with cancer attending a tertiary care center pre-lockdown and during lockdown (from January to May 2020). Data related to demographic parameters, type of tumor, type of treatment received and functional status of patients were retrieved from hospital medical records of patients. RESULTS Of the 5258 patients included, 4363 visited hospital pre-lockdown (median age, 50 years) and 895 visited during the lockdown period (median age, 47 years). A total of 1168 and 106 patients visiting hospital before and during lockdown, respectively, had comorbidities. Breast cancer (25.6% and 29.7%), head and neck cancer (21.3% and 16.9%) were the most common type of solid tumors; leukemia (58.0% and 73.0%), lymphoma (18.8% and 13.5%) and multiple myeloma (18.6% and 12.2%) were the most common type of hematological malignancies observed in patients visiting pre-lockdown and during lockdown, respectively. Chemotherapy was most commonly received treatment (pre-lockdown, 71.8%; during lockdown, 45.9%). Other therapies reported includes supportive/palliative, targeted, hormonal, and immunotherapy. The majority of patients who visited the hospital pre-lockdown (68.4%) and during lockdown (62.8%) had 0 or 1 Eastern Cooperative Oncology Group (ECOG) score. CONCLUSION Overall observations highlight a substantial impact of an imposed nationwide lockdown during COVID-19 pandemic on cancer care of patients in terms of reduced patient visits and number of treatments received.
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Affiliation(s)
- Ananya Pareek
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Apurva A Patel
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India.
| | - A Harshavardhan
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Philip G Kuttikat
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Shantanu Pendse
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Aruj Dhyani
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Satish Sharma
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Nikesh Agarwal
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Debajyoti Maji
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Ramidi G Reddy
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Yuganshu Gupta
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Harsha P Panchal
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Sonia Parikh
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India
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Rallis KS, Wozniak AM, Hui S, Nicolaides M, Shah N, Subba B, Papalois A, Sideris M. Inspiring the future generation of oncologists: a UK-wide study of medical students' views towards oncology. BMC Med Educ 2021; 21:82. [PMID: 33530974 PMCID: PMC7852146 DOI: 10.1186/s12909-021-02506-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/20/2021] [Indexed: 05/18/2023]
Abstract
BACKGROUND One in 2 people born in the UK after 1960 are expected to require oncology input in their lifetime. However, only 36% of UK medical schools provide dedicated oncology placements and teaching indicating a discordance between public health impact and training. We designed a UK-wide survey to capture medical students' views on current oncology teaching and the potential role of a national undergraduate oncology symposium as an educational, networking and motivational tool. METHODS We undertook a national cross-sectional survey of UK medical students' views in oncology and satisfaction with teaching using pre-designed questionnaires. We also distributed a dedicated survey (pre and post-conference) to compare medical students' motivation towards a career in oncology after attending the national symposium. This study was prospectively approved by QMUL Ethics Committee (Reference number QMREC2348). Statistical analysis included univariate inferential tests on SPSS and GraphPad software. RESULTS The national survey was completed by 166 students representing 22 UK medical schools. Students reported limited interest, knowledge and exposure to oncology, lack of confidence in skills, and teaching dissatisfaction. Oncology was perceived as a challenging specialty (mean 4.5/5 ± 0.7), yet most students estimate receiving only 1-2 weeks of dedicated oncology teaching. The national symposium generated a statically significant increase in students' interest, knowledge, and confidence in skills surrounding oncology, improving students' perceived ability to cope with the emotional challenges in this field. CONCLUSION Students' views towards oncology alongside their teaching dissatisfaction underpin the need to revisit and strive to improve current undergraduate oncology curricula. Increasing medical student oncology exposure by proposing outcome-based guidelines and adopting a standardised undergraduate oncology curriculum should be the foremost priority in inspiring future oncologists to ensure excellent cancer patient care.
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Affiliation(s)
- Kathrine S Rallis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna Maria Wozniak
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sara Hui
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marios Nicolaides
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Neha Shah
- Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Beena Subba
- North Middlesex University Hospital NHS Trust, London, UK
| | | | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
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27
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Selvy M, Pereira B, Kerckhove N, Busserolles J, Farsi F, Guastella V, Merle P, Pezet D, Balayssac D. Prevention, diagnosis and management of chemotherapy-induced peripheral neuropathy: a cross-sectional study of French oncologists' professional practices. Support Care Cancer 2021; 29:4033-4043. [PMID: 33403401 DOI: 10.1007/s00520-020-05928-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/24/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is challenging for oncologists. Many publications mention the high incidence of CIPN and the lack of effective preventive/management strategies and robust diagnostic tools. This cross-sectional study was aimed at assessing the practice of French oncologists for CIPN prevention, diagnosis and management. METHODS This web-based survey was sent to French oncologists by the regional cancer networks. Incidence and impact of CIPN were assessed using visual analogue scales (VAS) and diagnostic strategies were recorded. Also recorded were the drugs used to prevent or manage CIPN and their perceived efficacy and safety (VAS). RESULTS Among the 210 oncologists included, the perceived incidence of CIPN was about 36.2 ± 22.1% of patients. About 99.5% of oncologists declared that they assess CIPN during medical follow-up. The use of drugs to prevent CIPN was reported by 9.6% of oncologists (group B vitamins (35.0%) and calcium and magnesium infusion (25.0%)). In the case of CIPN, the therapeutic adjustment of neurotoxic anticancer drugs is performed by 99.0% of oncologists (chemotherapy change (49.8%), dose reduction (30.9%) or interruption (19.3%)). The pharmacological management of CIPN was declared by 72.9% of oncologists. The main drugs used are pregabalin (75.8%), amitriptyline (32.7%) and gabapentin (25.5%). Duloxetine (ASCO recommendation) is used by only 11.8% of oncologists. CONCLUSION Oncologists were clearly aware of CIPN risks, but its incidence tended to be underestimated and the ASCO recommendations for the management of CIPN were not followed. The prevention, diagnosis and management of CIPN remain problematic in clinical practice in France. TRIAL REGISTRATION ClinicalTrials.gov : NCT03854864.
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Affiliation(s)
- Marie Selvy
- CHU Clermont-Ferrand, INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation de la recherche clinique et de l'innovation, Biostatistics Unit, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France
| | - Nicolas Kerckhove
- CHU Clermont-Ferrand, INSERM U1107 NEURO-DOL, Institut ANALGESIA, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Jérôme Busserolles
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Fadila Farsi
- Réseau Régional de Cancérologie ONCO-AURA, CRLCC Léon Bérard, F-69373, Lyon Cedex 08, France
| | - Virginie Guastella
- Service de soins palliatifs, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France
| | - Patrick Merle
- Service de Pneumologie, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France
| | - Denis Pezet
- INSERM U1071, M2iSH, USC-INRA 2018, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - David Balayssac
- CHU Clermont-Ferrand, INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France.
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Salins N, Ghoshal A, Hughes S, Preston N. How views of oncologists and haematologists impacts palliative care referral: a systematic review. BMC Palliat Care 2020; 19:175. [PMID: 33228651 PMCID: PMC7686696 DOI: 10.1186/s12904-020-00671-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Worldwide, many patients with cancer, are infrequently referred to palliative care or are referred late. Oncologists and haematologists may act as gatekeepers, and their views may facilitate or hinder referrals to palliative care. This review aimed to identify, explore and synthesise their views on referrals systematically. METHODS Databases of MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science and Cochrane were searched for articles from 01/01/1990 to 31/12/2019. All studies were scored for their methodological rigour using Hawker's tool. Findings were synthesised using Popay's narrative synthesis method and interpreted using a critical realist lens and social exchange theory. RESULTS Out of 9336 initial database citations, 23 studies were included for synthesis. Five themes were developed during synthesis. 1. Presuppositions of oncologists and haematologists about palliative care referral: Role conflict, abandonment, rupture of therapeutic alliance and loss of hope were some of the presuppositions that hindered palliative care referral. Negative emotions and perception of self-efficacy to manage palliative care need also hindered referral. 2. Power relationships and trust issues: Oncologists and haematologists preferred to gatekeep the referral process and wished to control and coordinate the care process. They had diminished trust in the competency of palliative care providers. 3. Making a palliative care referral: A daunting task: The stigma associated with palliative care, navigating illness and treatment associated factors, addressing patient and family attitudes, and overcoming organisational challenges made referral a daunting task. Lack of referral criteria and limited palliative care resources made the referral process challenging. 4. Cost-benefit of palliative care referral: Pain and symptom management and psychosocial support were the perceived benefits, whereas inconsistencies in communication and curtailment of care were some of the costs associated with palliative care referral. 5. Strategies to facilitate palliative care referral: Developing an integrated model of care, renaming and augmenting palliative care resources were some of the strategies that could facilitate a referral. CONCLUSION Presuppositions, power relationships, trust issues and the challenges associated with the task of referrals hindered palliative care referral. Oncologists and haematologists appraised the cost-benefit of making a palliative care referral. They felt that an integrated model of care, changing the name of palliative care and augmenting palliative care resources might facilitate a referral.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, MB-G-75, DR E Borges Road, Parel, Mumbai, 400012, India
| | - Sean Hughes
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, C051, C - Floor, Bailrigg, LA1 4YW, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, C051, C - Floor, Bailrigg, LA1 4YW, UK.
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29
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Klassen PN, Goldenberg BA, Lambert P, Vagianos K, Kim CA. Ketogenic and low-sugar diets for patients with cancer: perceptions and practices of medical oncologists in Canada. Support Care Cancer 2020; 28:5243-5249. [PMID: 32090285 DOI: 10.1007/s00520-020-05361-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/20/2019] [Accepted: 02/13/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Many patients with cancer are interested in complementary therapies, including strategies such as reduced carbohydrate diets. Guidelines regarding the use of these diets during cancer treatment are lacking; therefore, we aimed to explore the perceptions and practices of medical oncologists in Canada regarding low-sugar and ketogenic diets. METHOD A cross-sectional, online multiple-choice survey was distributed to 206 Canadian medical oncologists. Questions explored frequency of patient interactions, oncologist perceptions of efficacy, advice given to patients, and concerns about side effects related to reduced carbohydrate diets. RESULTS Responses were received from 57 medical oncologists in seven of thirteen provinces and territories, with an overall response rate of 28%. Forty-nine percent of respondents were asked at least weekly about a low-sugar diet, and 9% about the ketogenic diet. Eighty-five percent supported the use of a low-added sugar diet in patients with diabetes or hyperglycemia, while conversely 87% did not support the use of a ketogenic diet for any of their patients undergoing active cancer treatment. Respondents felt either that a ketogenic diet was not effective (31%) or that the effect on cancer outcomes was unknown (69%). Ninety-six percent of respondents had concerns about a ketogenic diet for patients receiving active cancer treatment. CONCLUSION The role of reduced carbohydrate diets during cancer treatment is topical. Canadian oncologists are particularly reluctant to support a ketogenic diet for patients on active cancer treatment, with concerns about side effects and unknown efficacy. There may be a role for continuing medical education and institutional guidelines to inform these discussions with patients.
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Affiliation(s)
- Pamela N Klassen
- Department of Nutrition Services, CancerCare Manitoba, Winnipeg, MB, Canada.
- Division of Human Nutrition, Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-126A Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
| | - Benjamin A Goldenberg
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Pascal Lambert
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Kathy Vagianos
- Department of Nutrition and Food Services, Health Sciences Centre, Winnipeg, MB, Canada
- Manitoba Partnership Dietetics Education Program, Winnipeg, MB, Canada
| | - Christina A Kim
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
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30
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Okeke M, Oderinde O, Liu L, Kabula D. Oncology and COVID-19: Perspectives on cancer patients and oncologists in Africa. ACTA ACUST UNITED AC 2020; 14:100550. [PMID: 32835064 PMCID: PMC7298482 DOI: 10.1016/j.jemep.2020.100550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 06/02/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023]
Abstract
The global communities have been grappling with health pandemics for months since the outbreak of COVID-19, which has been flagged a global health emergency by World Health Organisation, WHO. While the entire health sector has been overburdened, cancer patients are also at a high risk of getting infected during this COVID-19 pandemic; hence, there is a great concern for these patients because there is little to no data to support their management with the current health care structure in Africa. This article outlines the challenges that frontline health workers face in the management of cancer patients, as the entire health sector calls for effective policy formulation and implementation by the government in their role in ensuring the sound health of their citizenry.
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Affiliation(s)
- M Okeke
- Department of Oncology, School of Medicine, Southeast University, Dingjiaqiao Campus, No. 87, Dingjiaoqiao, Gulou District, Nanjing, People's Republic of China
| | - O Oderinde
- School of Chemistry and Chemical Engineering, Southeast University, Jiulonghu Campus, Jiangning District, 211189 Nanjing, People's Republic of China
| | - L Liu
- Department of Oncology, School of Medicine, Southeast University, Dingjiaqiao Campus, No. 87, Dingjiaoqiao, Gulou District, Nanjing, People's Republic of China
| | - D Kabula
- Department of Pharmaceutics, China Pharmaceutical University, No. 24, Tongjia Lane, Zhongyang Road, Gulou District, Nanjing, People's Republic of China
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Abstract
In this commentary, the authors explore the short‐ and long‐term challenges of balancing education and oncologic care from the epicenter of the COVID‐19 pandemic. Once local conditions allow for resumption of outpatient care, the authors discuss how now is an especially important time to prioritize educating trainees.
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Affiliation(s)
- Noura Choudhury
- Department of Medicine, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Alexander Shoushtari
- Department of Medicine, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
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Watanabe SM, Faily V, Mawani A, Huot A, Tarumi Y, Potapov A, Fassbender K, Fairchild A, Joy AA, King KM, Roa W, Venner CP, Baracos VE. Frequency, Timing, and Predictors of Palliative Care Consultation in Patients with Advanced Cancer at a Tertiary Cancer Center: Secondary Analysis of Routinely Collected Health Data. Oncologist 2020; 25:722-728. [PMID: 32445194 DOI: 10.1634/theoncologist.2019-0384] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/13/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Early integration of palliative care (PC) with oncological care is associated with improved outcomes in patients with advanced cancer. Limited information exists on the frequency, timing, and predictors of PC consultation in patients receiving oncological care. The Cross Cancer Institute (CCI) is the sole tertiary cancer center serving the northern half of the Canadian province of Alberta, located in the city of Edmonton. The objectives of this study were to estimate the proportion of patients with advanced cancer at the CCI who received consultation by the CCI PC program and the comprehensive integrated PC program in Edmonton, and to determine the timing and predictors of consultation. MATERIALS AND METHODS In this secondary analysis of routinely collected health data, adult patients who died between April 2013 and March 2014, and had advanced disease while under the care of a CCI oncologist, were eligible. Data from the Alberta Cancer Registry, electronic medical records, and Edmonton PC program database were linked. RESULTS Of 2,253 eligible patients, 810 (36%) received CCI PC consultation. Median time between consultation and death was 2 months (range, 1.1-5.4). In multivariable logistic regression analysis, age, residence, income, cancer type, and interval from advanced cancer diagnosis to death influenced odds of receiving consultation. Among 1,439 patients residing in Edmonton, 1,121 (78%) were referred to the Edmonton PC program. CONCLUSION A minority of patients with advanced cancer received PC consultation at the tertiary cancer center, occurring late in the disease trajectory. Frequency and timing of PC consultation varied significantly, according to multiple factors. IMPLICATIONS FOR PRACTICE Clinical and demographic factors are associated with variations in frequency and timing of palliative care consultation at a cancer center and may, in some cases, reflect barriers to access that warrant attention.
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Affiliation(s)
- Sharon M Watanabe
- University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Viane Faily
- University of Alberta, Edmonton, Alberta, Canada
| | - Asifa Mawani
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Ann Huot
- University of Alberta, Edmonton, Alberta, Canada
| | - Yoko Tarumi
- University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | - Konrad Fassbender
- University of Alberta, Edmonton, Alberta, Canada
- Covenant Health Palliative Institute, Edmonton, Alberta, Canada
| | - Alysa Fairchild
- University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Anil A Joy
- University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Karen M King
- University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Wilson Roa
- University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Christopher P Venner
- University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Edmonton, Alberta, Canada
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Oktay E, Levent M, Gelincik H, Aktaş G, Yumuk F, Koral L, Arpacı E, Keser M, Alkan A, Karci E, Karadurmuş N, Degirmencioglu S, Turan M, Uyeturk U, Cabuk D, Avci N, Toprak O, Ergen A, Urvay S, Bayman E, Petekkaya E, Nayir E, Paydaş S, Yavuzsen T, Senler FC, Yaren A, Barutca S, Şahinler İ, Ozyilkan O, Tanriverdi O. Perspective of Turkish Medicine Students on Cancer, Cancer Treatments, Palliative Care, and Oncologists (ARES Study): a Study of the Palliative Care Working Committee of the Turkish Oncology Group (TOG). J Cancer Educ 2020; 35:69-75. [PMID: 30446981 DOI: 10.1007/s13187-018-1441-6] [Citation(s) in RCA: 4] [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: 06/09/2023]
Abstract
Cancer is one of the most common causes of death all over the World (Rahib et al. in Cancer Res 74(11):2913-2921, 2014; Silbermann et al. in Ann Oncol 23(Suppl 3):iii15-iii28, 2012). It is crucial to diagnose this disease early by effective screening methods and also it is very important to acknowledge the community on various aspects of this disease such as the treatment methods and palliative care. Not only the oncologists but every medical doctor should be educated well in dealing with cancer patients. Previous studies suggested various opinions on the level of oncology education in medical schools (Pavlidis et al. in Ann Oncol 16(5):840-841, 2005). In this study, the perspectives of medical students on cancer, its treatment, palliative care, and the oncologists were analyzed in relation to their educational status. A multicenter survey analysis was performed on a total of 4224 medical school students that accepted to enter this study in Turkey. After the questions about the demographical characteristics of the students, their perspectives on the definition, diagnosis, screening, and treatment methods of cancer and their way of understanding metastatic disease as well as palliative care were analyzed. The questionnaire includes questions with answers and a scoring system of Likert type 5 (absolutely disagree = 1, completely agree = 5). In the last part of the questionnaire, there were some words to detect what the words "cancer" and "oncologist" meant for the students. The participant students were analyzed in two study groups; "group 1" (n = 1.255) were phases I and II students that had never attended an oncology lesson, and "group 2" (n = 2.969) were phases III to VI students that had attended oncology lessons in the medical school. SPSS v17 was used for the database and statistical analyses. A value of p < 0.05 was noted as statistically significant. Group 1 defined cancer as a contagious disease (p = 0.00025), they believed that early diagnosis was never possible (p = 0.042), all people with a diagnosis of cancer would certainly die (p = 0.044), and chemotherapy was not successful in a metastatic disease (p = 0.003) as compared to group 2. The rate of the students that believed gastric cancer screening was a part of the national screening policy was significantly more in group 1 than in group 2 (p = 0.00014). Group 2 had a higher anxiety level for themselves or their family members to become a cancer patient. Most of the students in both groups defined medical oncologists as warriors (57% in group 1 and 40% in group 2; p = 0.097), and cancer was reminding them of "death" (54% in group 1 and 48% in group 2; p = 0.102). This study suggested that oncology education was useful for the students' understanding of cancer and related issues; however, the level of oncology education should be improved in medical schools in Turkey. This would be helpful for medical doctors to cope with many aspects of cancer as a major health care problem in this country.
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Affiliation(s)
- Esin Oktay
- Faculty of Medicine, Department of Medical Oncology, Adnan Menderes University, Aydın, Turkey.
| | - Mustafa Levent
- Faculty of Medicine, Department of Internal Medicine, Sıtkı Kocman University, Mugla, Turkey
| | - Hakan Gelincik
- Faculty of Medicine, Department of Medical Oncology, Cukurova University, Adana, Turkey
| | - Gizem Aktaş
- Faculty of Medicine, Department of Medical Oncology, Cukurova University, Adana, Turkey
| | - Fulden Yumuk
- Faculty of Medicine, Department of Medical Oncology, Marmara University, Istanbul, Turkey
| | - Lokman Koral
- Faculty of Medicine, Department of Medical Oncology, Onsekiz Mart University, Canakkale, Turkey
| | - Erkan Arpacı
- Faculty of Medicine, Department of Medical Oncology, Sakarya University, Sakarya, Turkey
| | - Murat Keser
- Faculty of Medicine, Department of Medical Oncolog, Dokuz Eylul University, Izmir, Turkey
| | - Ali Alkan
- Faculty of Medicine, Department of MedicalOncology, Ankara University, Ankara, Turkey
| | - Ebru Karci
- Department of Medical Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Nuri Karadurmuş
- Department of Medical Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Serkan Degirmencioglu
- Faculty of Medicine, Department of Medical Oncology, Pamukkale University, Denizli, Turkey
| | - Merve Turan
- Faculty of Medicine, Department of Medical Oncology, Adnan Menderes University, Aydın, Turkey
| | - Ummugul Uyeturk
- Faculty of Medicine, Department of Medical Oncology, Izzet Baysal University, Bolu, Turkey
| | - Devrim Cabuk
- Faculty of Medicine, Department of Medical Oncology, Kocaeli University, Izmit, Turkey
| | - Nilufer Avci
- Faculty of Medicine, Department of Medical Oncology, Balıkesir University, Balıkesir, Turkey
| | - Omer Toprak
- Faculty of Medicine, Department of Internal Medicine, Balıkesir University, Balıkesir, Turkey
| | - Arzu Ergen
- Cerrahpasa Faculty of Medicine, Department of Radiation Oncology, Istanbul University, Istanbul, Turkey
| | - Semiha Urvay
- Faculty of Medicine, Department of Medical Oncology, Cumhuriyet University, Sivas, Turkey
| | - Evrim Bayman
- Faculty of Medicine, Department of Radiation Oncology, Osmangazi University, Eskisehir, Turkey
| | - Emine Petekkaya
- Faculty of Medicine, Department of Anatomy, Beykent University, Istanbul, Turkey
| | - Erdinç Nayir
- Department of Medical Oncology, Mersin Medicalpark Hospital, Mersin, Turkey
| | - Semra Paydaş
- Faculty of Medicine, Department of Medical Oncology, Cukurova University, Adana, Turkey
| | - Tugba Yavuzsen
- Faculty of Medicine, Department of Medical Oncolog, Dokuz Eylul University, Izmir, Turkey
| | - Filiz Cay Senler
- Faculty of Medicine, Department of MedicalOncology, Ankara University, Ankara, Turkey
| | - Arzu Yaren
- Faculty of Medicine, Department of Medical Oncology, Pamukkale University, Denizli, Turkey
| | - Sabri Barutca
- Faculty of Medicine, Department of Medical Oncology, Adnan Menderes University, Aydın, Turkey
| | - İsmet Şahinler
- Cerrahpasa Faculty of Medicine, Department of Radiation Oncology, Istanbul University, Istanbul, Turkey
| | - Ozgur Ozyilkan
- Faculty of Medicine, Department of Medical Oncology, Başkent University, Ankara, Turkey
| | - Ozgur Tanriverdi
- Faculty of Medicine, Department of Medical Oncology, Mugla Sıtkı Kocman University, Mugla, Turkey
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Yeob KE, Kim SY, Park BR, Shin DW, Yang HK, Park K, Cho J, Park JH. Burnout Among oncologists in the Republic of Korea: A nationwide survey. Curr Probl Cancer 2019; 44:100535. [PMID: 31926648 DOI: 10.1016/j.currproblcancer.2019.100535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/24/2019] [Revised: 07/04/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Burnout in oncologists negatively impacts patient care and health care system, as it is associated with poor patient satisfaction, medical errors, leaving current practice, and/or early retirement. Because the quality of life of oncologists is influenced by various factors and ultimately affects the patient's treatment and medical system, we aimed to investigate burnout among oncologists and to identify factors affecting burnout. MATERIALS AND METHODS A total of 130 oncologists recruited from 13 cancer centers participated in a nationwide survey. Professional Quality of Life scale used to evaluate burnout and multiple regression analysis was performed to identify factors affecting burnout. RESULTS A total of 144 oncologists were invited, 134 (93.1%) responded, and 130 (90.2%) of those completed the survey. Burnout score of all participants was 49.9, and males was 48.8, females was 53.9, females score was higher than males. According to the hours worked per session, the average burnout score increased with the hours worked per session. Multiple regression analysis showed that influencing or predictive factors in burnout were sex and hours worked per session. CONCLUSION To reduce burnout in oncologists, organization-directed interventions should be implemented to prevent work overload.
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Affiliation(s)
- Kyoung Eun Yeob
- College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - So Young Kim
- College of Medicine, Chungbuk National University, Cheongju, Republic of Korea; Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Bo Ram Park
- College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyung-Kook Yang
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Keeho Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Juhee Cho
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Health Sciences and Technology, Samsung Advanced institute of health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jong Hyock Park
- College of Medicine, Chungbuk National University, Cheongju, Republic of Korea; Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea; Division of Cancer Policy and Management, National Cancer Control Research Institute, National Cancer Center, Goyang, Republic of Korea; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
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Schallock H, Bartmann B, Keinki C, Huebner J. Online information on oncologists' and non-medical practitioners' websites in Germany: A critical comparison. Patient Educ Couns 2019; 102:2038-2048. [PMID: 31147090 DOI: 10.1016/j.pec.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To survey websites of oncologists and non-medical practitioners (NMPs) in Germany regarding range of treated symptoms, diagnostic tools and therapies offered to cancer patients as well as the quality of websites. METHODS Analysis of 98 websites of oncologists and NMPs was conducted between April and July 2018 with a standardized tool. RESULTS Range of diagnostic and therapeutic methods was high and differed between both groups. Many NMPs (65.3%) intended to support conventional therapy rather than to treat cancer. Most oncologists (85.7%) did not mention the role of complementary and alternative medicine (CAM). Texts on oncologists' websites, showed high complexity according to readability analysis using LIX score as opposed to those on NMPs websites that showed medium complexity. Only small difference of quality of websites between both groups could be detected. CONCLUSION Methods not acknowledged by evidence-based medicine as well as methods at risk for interaction with conventional cancer therapy but also treatment offers with potential benefits for cancer patients were found on NMPs websites. PRACTICE IMPLICATIONS As evidence-based CAM methods can be a useful support of cancer treatment, risk of herb drug interactions can be minimized by oncologists offering reasonable CAM.
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Affiliation(s)
- Henriette Schallock
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Berit Bartmann
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Christian Keinki
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Jutta Huebner
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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Peng J, Rushton M, Johnson C, Brezden-Masley C, Sulpher J, Chiu MG, Graham ID, Dent S. An international survey of healthcare providers' knowledge of cardiac complications of cancer treatments. Cardiooncology 2019; 5:12. [PMID: 32154018 PMCID: PMC7048147 DOI: 10.1186/s40959-019-0049-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
Background Cardio-oncology is a young sub-specialty that addresses the needs of cancer patients at risk of, or who have experienced cancer therapy related cardiac dysfunction (CTRCD). This study assessed clinicians' understanding of cardio-oncology, opinions towards current practice, and approach to diagnosing and managing CTRCD. Methods A 45-question survey was administered online via Survey Monkey and WeChat to health care providers (HCPs) comprising of cardiologists, oncologists, and others from September 2017 to March 2018. Implementation of the survey followed a modified Dillman's Total Design Method. Results In total, 160 responses were collected from 22 countries; majority were from cardiologists (53.8%) and oncologists (32.5%). The remaining 13.7% identified themselves as "others," including general internists, cardio-oncologists, pediatric oncologists, radiation oncologists, cardiac rehabilitation therapists, nurse practitioners, research students, and pharmacists. In the setting of metastatic cancer, there was a difference in risk tolerance for cardiotoxicity between subspecialties. In this case, more cardiologists (36.7%) accepted a 5-10% risk of cardiotoxicity compared to oncologists (20.0%). Majority of cardiologists felt that cardiotoxicity should be monitored, even in asymptomatic cancer patients (55.8%). Only 12% of oncologists selected this response. In contrast, 50.0% of oncologists reported that cardiologists should be involved only when patients develop cardiotoxicity. In comparison, 6.5% of cardiologists selected this response. Majority of cardiologists stated that cardio-oncology clinics would significantly improve cancer patients' prognosis (88.3%); only 45.8% of oncologists shared this opinion. Of all respondents, 66.9% stated they were familiar with a variety of international guidelines for managing cardiotoxicity. Of all oncologists, 65.3% indicated that they referred to these guidelines for clinical decision making. Conclusions Despite the growth of cardio-oncology clinics, there are significant knowledge gaps regarding prevention and treatment strategies for CTRCD among health care providers. Knowledge translation from guidelines and collaboration between cardiologists and oncologists are needed to improve cardiovascular outcomes of cancer patients.
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Affiliation(s)
- J Peng
- 1Department of Medicine, University of Ottawa, Ottawa, ON Canada.,2Department of Internal Medicine, University of Calgary, Calgary, AB Canada
| | - M Rushton
- 3Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON Canada
| | - C Johnson
- 4Division of Cardiology, Department of Medicine, The Ottawa Hospital, Ottawa, ON Canada
| | - C Brezden-Masley
- 5Division of Medical Oncology, Department of Medicine, St. Michael's Hospital, Toronto, ON Canada
| | - J Sulpher
- 6Division of Medical Oncology, Department of Medicine, BC Cancer Agency, Victoria, BC Canada
| | - Miliyun G Chiu
- Director of Peony Solutions, Kwai Bo Industrial Building, 40 Wong Chuk Hang Road, Aberdeen, Hong Kong
| | - I D Graham
- 8School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - S Dent
- 3Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON Canada.,9Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina USA
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Neeman E, Gresham G, Ovasapians N, Hendifar A, Tuli R, Figlin R, Shinde A. Comparing Physician and Nurse Eastern Cooperative Oncology Group Performance Status (ECOG-PS) Ratings as Predictors of Clinical Outcomes in Patients with Cancer. Oncologist 2019; 24:e1460-e1466. [PMID: 31227648 DOI: 10.1634/theoncologist.2018-0882] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 12/14/2018] [Accepted: 05/23/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale is commonly used by physicians and nurses in oncology, as it correlates with cancer morbidity, mortality, and complications from chemotherapy and can help direct clinical decisions and prognostication. This retrospective cohort study aimed to identify whether ECOG-PS scores rated by oncologist versus nurses differ in their ability to predict clinical outcomes. MATERIALS AND METHODS Over 19 months, 32 oncologists and 41 chemotherapy nurses from a single academic comprehensive cancer center independently scored ECOG-PS (range: 0-5) for a random sample of 311 patients with cancer receiving chemotherapy. Logistic regression models were fit to evaluate the ability of nurse and physician ECOG-PS scores, as well as the nurse-physician ECOG-PS score difference (nurse minus physician), to predict the occurrence of chemotherapy toxicity (CTCAE v4, grade ≥3) and hospitalizations within 1 month from ECOG-PS ratings, as well as 6-month mortality or hospice referrals. RESULTS Physician/nurse ECOG-PS agreement was 71% (Cohen's κ = 0.486, p < .0001). Nurse ECOG-PS scores had stronger odds ratio for 6-month mortality or hospice (odds ratio [OR], 3.29, p < .0001) than physician ECOG-PS scores (OR, 2.71, p = .001). Furthermore, ECOG-PS ratings by nurses, but not physicians, correlated with 1-month chemotherapy toxicity (OR, 1.44, p = .021) and 1-month hospitalizations (OR, 1.57, p = .041). Nurse-physician disagreement, but only when physicians gave "healthier" (lower) ratings, was also associated with worse outcomes (chemotherapy toxicity OR = 1.51, p = .045; 1-month hospitalization OR, 1.86, p = .037; 6-month mortality or hospice OR, 2.99, p < .0001). CONCLUSION Nurse ECOG-PS ratings seem more predictive of important outcomes than those of physicians, and physician-nurse disagreement in ECOG-PS ratings predicts worse outcomes; scoring by nurses may result in additional clinical benefit. IMPLICATIONS FOR PRACTICE Nurse-rated Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores, compared with those rated by oncologists, better predicted hospitalizations and severe chemotherapy toxicity within 1 month from ECOG-PS assessment, as well as mortality or hospice referrals within 6 months. Physician-nurse disagreement in ECOG-PS scoring was associated with worse hospitalization, chemotherapy toxicity, and mortality and hospice referral rates. Rating performance statuses of patients with cancer by nurses instead or in addition to oncologists can result in additional clinical benefits, such as improved prognostication, as well as better informed clinical decision making regarding whether or not to administer chemotherapy, the need for additional supportive care, and goals of care discussions.
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Affiliation(s)
- Elad Neeman
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Gillian Gresham
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Navasard Ovasapians
- Department of Internal Medicine, Baylor College of Medicine, Huston, Texas, USA
| | - Andrew Hendifar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Richard Tuli
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Robert Figlin
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Arvind Shinde
- Department of Hematology and Oncology, Transplant and Hepatopancreatobiliary Institute, St. Vincent Medical Center, Los Angeles, California, USA
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Loh KP, Mohile SG, Lund JL, Epstein R, Lei L, Culakova E, McHugh C, Wells M, Gilmore N, Mohamed MR, Kamen C, Aarne V, Conlin A, Bearden J, Onitilo A, Wittink M, Dale W, Hurria A, Duberstein P. Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists. Oncologist 2019; 24:e292-e302. [PMID: 31015317 PMCID: PMC6656513 DOI: 10.1634/theoncologist.2018-0890] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/11/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ensuring older patients with advanced cancer and their oncologists have similar beliefs about curability is important. We investigated discordance in beliefs about curability in patient-oncologist and caregiver-oncologist dyads. MATERIALS AND METHODS We used baseline data from a cluster randomized trial assessing whether geriatric assessment improves communication and quality of life in older patients with advanced cancer and their caregivers. Patients were aged ≥70 years with incurable cancer from community oncology practices. Patients, caregivers, and oncologists were asked: "What do you believe are the chances the cancer will go away and never come back with treatment?" Options were 100%, >50%, 50/50, <50%, and 0% (5-point scale). Discordance in beliefs about curability was defined as any difference in scale scores (≥3 points were severe). We used multivariate logistic regressions to describe correlates of discordance. RESULTS Discordance was present in 60% (15% severe) of the 336 patient-oncologist dyads and 52% (16% severe) of the 245 caregiver-oncologist dyads. Discordance was less common in patient-oncologist dyads when oncologists practiced longer (adjusted odds ratio [AOR] 0.90, 95% confidence interval [CI] 0.84-0.97) and more common in non-Hispanic white patients (AOR 5.77, CI 1.90-17.50) and when patients had lung (AOR 1.95, CI 1.29-2.94) or gastrointestinal (AOR 1.55, CI 1.09-2.21) compared with breast cancer. Severe discordance was more common when patients were non-Hispanic white, had lower income, and had impaired social support. Caregiver-oncologist discordance was more common when caregivers were non-Hispanic white (AOR 3.32, CI 1.01-10.94) and reported lower physical health (AOR 0.88, CI 0.78-1.00). Severe discordance was more common when caregivers had lower income and lower anxiety level. CONCLUSION Discordance in beliefs about curability is common, occasionally severe, and correlated with patient, caregiver, and oncologist characteristics. IMPLICATIONS FOR PRACTICE Ensuring older patients with advanced cancer and their caregivers have similar beliefs about curability as the oncologist is important. This study investigated discordance in beliefs about curability in patient-oncologist (PO) and caregiver-oncologist (CO) dyads. It found that discordance was present in 60% (15% severe) of PO dyads and 52% (16% severe) of CO dyads, raising serious questions about the process by which patients consent to treatment. This study supports the need for interventions targeted at the oncologist, patient, caregiver, and societal levels to improve the delivery of prognostic information and patients'/caregivers' understanding and acceptance of prognosis.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer L Lund
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ronald Epstein
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
- Department of Family Medicine, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
- Department of Medicine, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
| | - Lianlian Lei
- Department of Public Health Services, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Eva Culakova
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Colin McHugh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Megan Wells
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Nikesha Gilmore
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Mostafa R Mohamed
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Charles Kamen
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Valerie Aarne
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Alison Conlin
- Pacific Cancer Research Consortium NCORP, Seattle, Washington, USA
| | - James Bearden
- Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, North Carolina, USA
| | | | - Marsha Wittink
- Department of Psychiatry, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
| | - William Dale
- City of Hope National Medical Center, Duarte, California, USA
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, California, USA
| | - Paul Duberstein
- Department of Psychiatry, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
- Rutgers School of Public Health, Piscataway, New Jersey, USA
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Stephens JM, Bensink M, Bowers C, Hollenbeak CS. Risks and consequences of travel burden on prophylactic granulocyte colony-stimulating factor administration and incidence of febrile neutropenia in an aged Medicare population. Curr Med Res Opin 2019; 35:229-240. [PMID: 29661043 DOI: 10.1080/03007995.2018.1465906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Granulocyte colony-stimulating factors (G-CSFs) decrease the incidence of febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy. This study examines the impact patient travel burden has on administration of prophylactic G-CSFs and the subsequent impact on FN incidence. METHODS Medicare claims data were used to identify a cohort of beneficiaries age 65+ with non-myeloid cancers at high risk for FN between January 2012 and December 2014. Driving distance and time were calculated from patient residence ZIP code to the location of G-CSF and/or chemotherapy administration. Regression models were used to estimate the odds of G-CSF prophylaxis relative to patient driving distance and time, and odds of FN incidence relative to timing of G-CSF administration (optimal [days 2-4 after chemotherapy], sub-optimal [same day], or none). RESULTS The 52,389 study patients had a mean age of 73.5 years, and were 82% female and 89% white race; 49% had female breast cancer, 12% lung cancer, 15% ovarian cancer, and 24% non-Hodgkin's lymphoma. Of these high FN risk patients, 69% had at least one prophylactic G-CSF administration within at least one chemotherapy cycle. The percentage of patients receiving prophylactic G-CSFs in the first cycle was 56%. Median travel time was slightly longer for patients who did not receive G-CSFs and patients receiving short-acting vs long-acting G-CSFs. The odds of receiving no G-CSFs were 26-52% higher (depending on cancer type) for patients with a >80-min one-way travel time, compared to patients traveling <20-min. Concurrently, the odds of FN (using a "narrow" definition) were 18-93% higher for patients who did not receive G-CSFs in the first cycle of chemotherapy. CONCLUSIONS Travel burden, linked to clinic visits for G-CSF administration following myelosuppressive chemotherapy, is associated with sub-optimal use of G-CSF prophylaxis, which may result in a higher incidence of FN.
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Samawi HH, Yin Y, Lim HJ, Cheung WY. Primary Care Versus Oncology-Based Surveillance Following Adjuvant Chemotherapy in Resected Pancreatic Cancer. J Gastrointest Cancer 2018; 49:429-436. [PMID: 28674913 DOI: 10.1007/s12029-017-9988-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 10/19/2022]
Abstract
INTRODUCTION High level evidence to guide surveillance following curative intent treatment for pancreatic cancer is lacking and this has likely resulted in wide variations in practice. We aim to describe patterns of surveillance and evaluate their impact on outcomes. METHODS A total of 147 adult patients who received at least one cycle of adjuvant gemcitabine or 5-fluorouracil-based chemotherapy at any one of five British Columbia Cancer Agency centers between 2001 and 2015 were included. Surveillance strategies were classified into two categories: discharged to primary care physicians (PCPs) or follow-up at cancer centers (CC) that included regular clinical assessments, laboratory testing, and/or diagnostic imaging. RESULTS Median age at diagnosis was 64 (range 38-85) years and 48% were men. More patients were followed by CC than by PCPs (66 vs. 44%). Among the measured prognostic factors, only patients with advanced tumor stage (T3/4) were more likely to be followed by cancer specialists (78 vs. 62%, P = 0.03), while other patient and disease characteristics were balanced between the two groups. In the entire cohort, 100 (68%) patients had a documented recurrence. Patients followed by CC were more likely to receive palliative chemotherapy at recurrence than those followed by PCPs (58 vs. 34%, respectively, P = 0.03). The median overall survival (OS) was 2.82 (95% CI 2.17-3.32) years in the CC group and 3.35 (95% CI 2.85-5.06) years in the PCP group while the median relapse-free survival (RFS) was 1.4 (95% CI 1.37-1.77) and 2.4 (95% CI 2.07-4.59) years, respectively. On multivariate analysis, there was no significant difference in OS between CC and PCP-based surveillance (HR 1.23; 95% CI 0.74-2.04, P = 0.40); however, RFS favored the PCP group (HR 1.62; 95% CI 1.01-2.56, P = 0.04, for the CC group). CONCLUSION In this population-based analysis, surveillance tests and imaging performed by CC detected recurrences earlier when compared to follow-up by PCPs, but this did not result in OS differences. Patients with more advanced tumors were more likely to be seen at CC. PCPs may play a larger role in the follow-up care of selected low risk patients with resected pancreatic cancer.
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Affiliation(s)
- Haider H Samawi
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Yaling Yin
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Howard J Lim
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Winson Y Cheung
- Section of Medical Oncology, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada.
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Price SN, Studts JL, Hamann HA. Tobacco Use Assessment and Treatment in Cancer Patients: A Scoping Review of Oncology Care Clinician Adherence to Clinical Practice Guidelines in the U.S. Oncologist 2018; 24:229-238. [PMID: 30446582 DOI: 10.1634/theoncologist.2018-0246] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 04/20/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Smoking after a cancer diagnosis negatively impacts health outcomes; smoking cessation improves symptoms, side effects, and overall prognosis. The Public Health Service and major oncology organizations have established guidelines for tobacco use treatment among cancer patients, including clinician assessment of tobacco use at each visit. Oncology care clinicians (OCCs) play important roles in this process (noted as the 5As: Asking about tobacco use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts, and Arranging follow-up contact). However, OCCs may not be using the "teachable moments" related to cancer diagnosis, treatment, and survivorship to provide cessation interventions. MATERIALS AND METHODS In this scoping literature review of articles from 2006 to 2017, we discuss (1) frequency and quality of OCCs' tobacco use assessments with cancer patients and survivors; (2) barriers to providing tobacco treatment for cancer patients; and (3) the efficacy and future of provider-level interventions to facilitate adherence to tobacco treatment guidelines. RESULTS OCCs are not adequately addressing smoking cessation with their patients. The reviewed studies indicate that although >75% assess tobacco use during an intake visit and >60% typically advise patients to quit, a substantially lower percentage recommend or arrange smoking cessation treatment or follow-up after a quit attempt. Less than 30% of OCCs report adequate training in cessation interventions. CONCLUSION Intervention trials focused on provider- and system-level change are needed to promote integration of evidence-based tobacco treatment into the oncology setting. Attention should be given to the barriers faced by OCCs when targeting interventions for the oncologic context. IMPLICATIONS FOR PRACTICE This article reviews the existing literature on the gap between best and current practices for tobacco use assessment and treatment in the oncologic context. It also identifies clinician- and system-level barriers that should be addressed in order to lessen this gap and provides suggestions that could be applied across different oncology practice settings to connect patients with tobacco use treatments that may improve overall survival and quality of life.
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Affiliation(s)
- Sarah N Price
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Jamie L Studts
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
- Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
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Wiant K, Geisen E, Creel D, Willis G, Freedman A, de Moor J, Klabunde C. Risks and rewards of using prepaid vs. postpaid incentive checks on a survey of physicians. BMC Med Res Methodol 2018; 18:104. [PMID: 30305049 PMCID: PMC6180605 DOI: 10.1186/s12874-018-0565-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survey researchers use monetary incentives as a strategy to motivate physicians' survey participation. Experiments from general population surveys demonstrate that prepaid incentives increase response rates and lower survey administration costs relative to postpaid incentives. Experiments comparing these two incentive strategies have rarely been attempted with physician samples. METHODS A nationally representative sample of oncologists was recruited to participate in the National Survey of Precision Medicine in Cancer Treatment. To determine the optimal strategy for survey incentives, sample members were randomly assigned to receive a $50 prepaid incentive check or a $50 promised (postpaid) incentive check. Outcome measures for this incentives experiment include cooperation rates, speed of response, check-cashing behavior, and comparison of hypothetical costs for different incentive strategies. RESULTS Cooperation rates were considerably higher for sample members in the prepaid condition (41%) than in the postpaid condition (29%). Similar differences in cooperation rates were seen for physicians when stratified by region, size of the physician's metropolitan statistical area, specialty, and gender by age. Survey responders in the prepaid condition responded earlier in the field period than those in the postpaid condition, thus requiring fewer contacts. In the prepaid group, 84% of sample members who responded with a completed survey cashed the incentive check and only 6% of nonresponders cashed the check. In the postpaid condition, 72% of survey responders cashed the check; nonresponders were not given a check. The relatively higher cooperation rates and earlier response of the responders in the prepaid condition was associated with a 30% cost savings for the prepaid condition compared to the postpaid incentive condition. CONCLUSIONS The results of this study suggest that the rewards of offering physicians a prepaid incentive check outweigh the possible risks of nonresponders cashing the check. The relative cost benefit of this strategy is likely to vary depending on the amount of the incentive relative to the costs of additional contact attempts to nonresponders.
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Affiliation(s)
- Kristine Wiant
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Emily Geisen
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Darryl Creel
- RTI International, 6110 Executive Boulevard, Suite 902, Rockville, MD, 20852, USA
| | - Gordon Willis
- National Cancer Institute, 9609 Medical Center Drive, Rm 3E228, MSC 9762, Bethesda, MD, 20892-9762, USA
| | - Andrew Freedman
- National Cancer Institute, 9609 Medical Center Drive, Room 4E226, Rockville, MD, 20850, USA
| | - Janet de Moor
- National Cancer Institute, 9609 Medical Center Drive, Room 3E438, Bethesda, MD, 20892-9764, USA
| | - Carrie Klabunde
- National Institutes of Health, 6100 Executive Boulevard, Suite 2B03, Rockville, MD, 20852, USA
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Cazap E, Jacobs I, McBride A, Popovian R, Sikora K. Global Acceptance of Biosimilars: Importance of Regulatory Consistency, Education, and Trust. Oncologist 2018; 23:1188-1198. [PMID: 29769386 PMCID: PMC6263136 DOI: 10.1634/theoncologist.2017-0671] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 12/21/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022] Open
Abstract
Globally, biosimilars are expected to have a key role in improving patient access to biological therapies and addressing concerns regarding the escalating cost of health care. Indeed, in Europe, increased use of biologics and reduced drug prices have been observed after the introduction of biosimilars. Recently, several monoclonal antibody biosimilars of anticancer therapies have been approved, and numerous others are in various stages of clinical development. Biosimilars are authorized via a regulatory pathway separate from that used for generic drugs; they are also regulated separately from novel biologics. Biosimilar approval pathways in many major regulatory regions worldwide are, to a broad degree, scientifically aligned. However, owing to regional differences in health care priorities, policies, and resources, some important regulatory inconsistencies are evident. Acceptance of biosimilars by health care systems, health care professionals, and patients will be a key factor in the uptake of these therapies, and such regulatory variations could contribute to confusion and diminished confidence regarding the quality, efficacy, and reliability of these agents. Furthermore, the need for manufacturers to account for regulatory inconsistencies introduces inefficiencies and delays into biosimilar development programs. These issues should be addressed if biosimilars are to attain their maximal global potential. This review summarizes the evolution of the global biosimilar landscape and provides examples of inconsistencies between regulatory requirements in different regions. In addition, we review ongoing efforts to improve regulatory alignment and highlight the importance of education as a crucial factor in generating trust in, and acceptance of, biosimilars on a worldwide scale. IMPLICATIONS FOR PRACTICE Biosimilars of monoclonal antibody anticancer therapies are beginning to emerge, and more are likely to become available for clinical use in the near future. The extent to which biosimilars can contribute to cancer care will depend on their level of acceptance by health care systems, health care professionals, and patients. A better understanding of the regulatory basis for the approval of biosimilars may enhance confidence and trust in these agents. In order to have informed discussions about treatment choices with their patients, oncologists should familiarize themselves with the biosimilar paradigm.
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Affiliation(s)
- Eduardo Cazap
- Latin American & Caribbean Society of Medical Oncology, Buenos Aires, Argentina
| | | | - Ali McBride
- The University of Arizona Cancer Center, Department of Pharmacy, University of Arizona, Tucson, Arizona, USA
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Hu SL, Weiss RH. Management of the Incidental Kidney Mass in the Nephrology Clinic. Clin J Am Soc Nephrol 2018; 13:1407-1409. [PMID: 29653957 PMCID: PMC6140565 DOI: 10.2215/cjn.00860118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Susie L. Hu
- Division of Kidney Disease and Hypertension, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Robert H. Weiss
- Division of Nephrology and Cancer Center, University of California, Davis, California; and
- Nephrology Division, Medical Service, Veterans Affairs Northern California Health Care System, Sacramento, California
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Manso L, Sanchez-Muñoz A, Calvo I, Izarzugaza Y, Plata J, Rodriguez C. Late Administration of Trastuzumab Emtansine Might Lead to Loss of Chance for Better Outcome in Patients with HER2-Positive Metastatic Breast Cancer. Breast Care (Basel) 2018; 13:277-283. [PMID: 30319330 DOI: 10.1159/000488794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The optimal sequence of anti-human epidermal growth factor receptor 2 (HER2) therapies in metastatic breast cancer (MBC) is still undetermined. Physicians must therefore make decisions based on clinical trials and their own experience for the best treatment sequence in these patients. The objective of this review is to summarize the efficacy and safety data for trastuzumab emtansine (T-DM1) in patients with MBC. Additionally, the concept of 'loss of chance for a better outcome' is investigated. It applies to patients who are not receiving the best possible treatment for their disease. Physicians should strive to offer the best possible care, although getting optimal results in each individual patient is not guaranteed. Lastly, the number of patients with MBC lost per treatment line is evaluated. We conclude that both concepts reinforce the importance of giving the most active treatments as soon as possible in the course of disease to secure the longest possible survival for HER2-positive MBC patients.
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Affiliation(s)
- Luis Manso
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Alfonso Sanchez-Muñoz
- Clinical and Translational Cancer Research, Biomedical Research Institute of Málaga (IBIMA), Regional and Virgen de la Victoria University Hospital, Málaga, Spain
| | - Isabel Calvo
- Medical Oncology Department, HM Sanchinarro University Hospital, Madrid, Spain
| | - Yann Izarzugaza
- Medical Oncology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Jessica Plata
- Medical Oncology Department, Jaen University Hospital Complex, Jaén, Spain
| | - Cesar Rodriguez
- Medical Oncology Department, Salamanca Clinic University Hospital, Salamanca, Spain
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Dalzell MD. Fred Hutchinson Report Plots The Nexus of Cost and Quality. Manag Care 2018; 27:8-9. [PMID: 29989891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A report from the Hutchinson Institute for Cancer Outcomes Research is remarkable. Committing to transparency as a catalyst for improvement, 27 hospital systems and cancer centers across Washington State bare all in the first public report to integrate clinic level quality and cost data in oncology.
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Sriratana P, Norton J. New Immunotherapies in Oncology Treatment and Their Side Effect Profiles. J Am Board Fam Med 2018; 31:620-7. [PMID: 29986988 DOI: 10.3122/jabfm.2018.04.170387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/20/2018] [Accepted: 03/25/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Immunotherapies in cancer treatment have a long history going all the way back to the very beginning of the field, and recent advances are extremely promising. These therapies are becoming a larger part in many patients' oncology treatment as the number of approaches, individual medicines, and indications increase. Furthermore, these novel therapies have different side effect profiles from those traditional chemotherapies which have, until recently, typified the oncologist's approach to treatment together with surgery and radiation. METHODS An electronic literature search was conducted in May and June 2017 and March 2018 with the PubMed and Ebscohost databases. Articles were chosen for their relevance to the drugs in question, cancer physiology, or historic significance. CONCLUSIONS Checkpoint inhibitors are becoming very common and possess autoimmune side effects such as pneumonitis, hypothyroidism, and colitis. These may present at any time the patient is on the medications but are more common several weeks to several months from beginning therapy. Chimeric antigen receptor T-cell therapies are powerful but have strong side effects such as cytokine release syndrome. Neoantigens are currently in the early stages of clinical trials and may become an exciting avenue for personalized cancer treatment but are not yet typical.
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Granek L, Barbera L, Nakash O, Cohen M, Krzyzanowska MK. Experiences of Canadian oncologists with difficult patient deaths and coping strategies used. ACTA ACUST UNITED AC 2017; 24:e277-e284. [PMID: 28874898 DOI: 10.3747/co.24.3527] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to explore and identify what makes patient death more emotionally difficult for oncologists and how oncologists cope with patient death. METHODS A convenience sample of 98 Canadian oncologists (50 men, 48 women) completed an online survey that included a demographics section and a section about patient death. RESULTS More than 80% of oncologists reported that patient age, long-term management of a patient, and unexpected disease outcomes contributed to difficult patient loss. Other factors included the doctor-patient relationship, identification with the patient, caregiver-related factors, oncologist-related factors, and "bad deaths." Oncologists reported varying strategies to cope with patient death. Most prevalent was peer support from colleagues, including nurses and other oncologists. Additional strategies included social support, exercise and meditation, faith, vacations, and use of alcohol and medications. CONCLUSIONS Oncologists listed a number of interpersonal and structural factors that make patient death challenging for them to cope with. Oncologists reported a number of coping strategies in responding to patient death, including peer support, particularly from nursing colleagues. No single intervention will be suitable for all oncologists, and institutions wishing to help their staff cope with the emotional difficulty of patient loss should offer a variety of interventions to maximize the likelihood of oncologist participation.
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Affiliation(s)
- L Granek
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - L Barbera
- Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - O Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - M Cohen
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - M K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
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Koh SJ, Kim S, Kim J, Keam B, Heo DS, Lee KH, Kim BS, Kim JH, Chang HJ, Baek SK. Experiences and Opinions Related to End-of-Life Discussion: From Oncologists' and Resident Physicians' Perspectives. Cancer Res Treat 2017; 50:614-623. [PMID: 28675025 PMCID: PMC5912142 DOI: 10.4143/crt.2016.446] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 06/14/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose The aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care. Materials and Methods A survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t test, and the chisquare test were performed for the analyses. Results A total of 147 oncologists and 229 residents participated in this study. The study respondents reported diverse definitions of “terminal state,” and mostrespondents tried to disclose the patient’s condition to the patient and/or family members. Both groups were involved in EOL care discussions, with a rather low satisfaction level (57.82/100). The best timing to initiate discussionwas consideredwhen metastasis or disease recurrence occurred orwhen withdrawal of chemotherapy was anticipated. Furthermore, the study respondents suggested that patients and their family members should be included in the EOL discussion. Medical, legal, and ethical knowledge and communication difficulties along with practical issues were revealed as barriers and facilitators for EOL discussion. Conclusion This study explored various perspectives of oncologists and resident physicians for EOL discussion. Since the Life-Sustaining-Treatment Decision-Making Act will be implemented shortly in Korea, now is the time for oncologists and residents to prepare themselves by acquiring legal knowledge and communication skills. To achieve this, education, training, and clinical tools for healthcare professionals are required.
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Affiliation(s)
- Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Shinmi Kim
- Department of Nursing, Changwon National University, Changwon, Korea
| | - JinShil Kim
- College of Nursing, Gachon University, Incheon, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hee Lee
- Department of Hemato-Oncology, Yeungnam University, Daegu, Korea
| | - Bong-Seog Kim
- Department of Hemato-Oncology, Veterans Health Service Medical Center, Seoul, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Jung Chang
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
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Nowakowski J, Borowiec G, Zwierz I, Jagodzinski W, Tarkowski R. Stress In An Oncologist's Life: Present But Not Insurmountable : (Students Should Not Be Discouraged Choosing Oncology as Their Future Specialisation). J Cancer Educ 2017; 32:198-205. [PMID: 26475498 PMCID: PMC5290067 DOI: 10.1007/s13187-015-0928-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 06/05/2023]
Abstract
Burnout is a serious problem facing the majority of oncologists. Many medical students may regard oncology as depressive part of medicine. This false picture may discourage them from choosing oncology as their future specialization. To learn problems experienced by oncologists and to answer the students' question: is it dangerous to choose oncology? We conducted an anonymous survey among 69 oncologists. Young doctors (up to 5 years of service) accounted for 31 %, specialists 69 %, with a median length of practice of 14 years. The most frequently reported symptoms included irritability (84 %) and tension (74 %). Forty-five percent reported headaches, 25 % sleep disorders, 51 % negative impact on their personal lives. Excessive bureaucratization, overwork, and haste, with the disparity between undertaken effort and compensation were the most common sources of stress. Stress reduction methods were as follows: their relationship with family and/or friends (69 %), reading books/watching movies (66 %), emotional distance from their problems (63 %), and contact with nature (62 %). Ninety-six percent of physicians were satisfied with their choice of pursuing work with cancer patients. However, as many as 49 % of oncologists experienced moments of doubt regarding their sense of vocation. Students and young doctors considering pursuing an oncological speciality should not be discouraged by the likely degree of sacrifice or burden, but rather aim to develop effective ways to reduce stress, along with remembering one's own health needs. This could be valuable part of both pregradual and postgradual medical education, worth to become part of medical curricula.
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Affiliation(s)
- Jonatan Nowakowski
- Wrocław Medical University, Wybrzeże L. Pasteura 1, 50-367, Wroclaw, Poland
| | - Grazyna Borowiec
- Wrocław Medical University, Wybrzeże L. Pasteura 1, 50-367, Wroclaw, Poland
| | - Izabela Zwierz
- Wrocław Medical University, Wybrzeże L. Pasteura 1, 50-367, Wroclaw, Poland
| | - Wojciech Jagodzinski
- Analiza Badania Rozwoj, Osiedle Stefana Batorego 11 lok 74, 60-687, Poznan, Poland
| | - Radoslaw Tarkowski
- Department of Oncology, Division of Surgical Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 53-413, Wrocław, Poland.
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