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Davidson BA, Turner TB, Kim KH, Cass I, Calat L, McGwin G, Kushner DM. SGO and the elephant that is still in the room: Wellness, burnout and gynecologic oncology. Gynecol Oncol 2022; 167:354-359. [PMID: 36064677 DOI: 10.1016/j.ygyno.2022.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure wellness and burnout among gynecologic oncology clinicians and identify trends and at-risk populations to inform future interventions. METHODS Gynecologic oncologist (GO) and advanced practice provider (APP) responses to the 2020 Society of Gynecologic Oncology State of the Society survey were analyzed. The Maslach Burnout Inventory criteria for burnout was used. Work-life balance was scored on a 5-point Likert scale. Chi-square tests were used to compare mental health factors and the prevalence of burnout. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for associations between burnout and gender. RESULTS 543 survey responses were included for analysis. Most GO (54%) and all APP respondents were female. Female GOs were disproportionately affected by burnout particularly in the Northeast (female(F): 40.9% vs male(M): 19.1%, p = 0.007) and South (F: 42.5% vs M:22.9%, p = 0.01). Burnout in female GOs over 40 was 1.79 (CI: 1.13-2.83; p-value 0.01) times higher than similarly aged males. Females in non-private practice experienced burnout 1.66 times that of males in similar positions (CI: 1.18-2.94; p < 0.0001). Female GOs reported the worst work-life balance across all 5 domains. APPs and female GOs experienced more stress and feeling overwhelmed compared to men. GOs were more reluctant to see a mental health professional (p = 0.0003) or take medication (p = 0.009) than APPs. CONCLUSIONS Burnout in gynecologic oncology persists in both genders and is felt most acutely by female GOs. APPs are not immune and would benefit from inclusion in future research to mitigate burnout in healthcare clinicians.
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Affiliation(s)
- B A Davidson
- Division of Gynecologic Oncology, Duke University, Durham, NC, United States of America.
| | - T B Turner
- St. Luke's Cancer Institute, Boise, ID, United States of America
| | - K H Kim
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - I Cass
- Division of Gynecologic Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - L Calat
- Department of Obstetrics and Gynecology, NYU Langone Health, New York, NY, United States of America
| | - G McGwin
- School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - D M Kushner
- Division of Gynecologic Oncology, University of Wisconsin, Madison, WI, United States of America
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Abstract
This cross-sectional study uses worldwide oncology trial data to examine the proportion of female investigators in each country and across all trials.
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Affiliation(s)
| | - Tri Pham
- University of Texas Southwestern Medical School, Dallas
| | - Magdalena Espinoza
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - David Hsiehchen
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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3
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Gobbini E, Toffart AC, Boisserie Lacroix L, Pinsolle J, Schoutteten L, Federspiel I, Pierret T, Pérol M, Feyeux A. Immune checkpoint inhibitors and hospitalization at home in France. Bull Cancer 2021; 109:89-97. [PMID: 34785029 DOI: 10.1016/j.bulcan.2021.09.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The administration of immune checkpoints inhibitors (ICIs) within hospitalization at home (HaH) organizations is an interesting alternative to conventional care. Three surveys were carried out to describe the different organizational models of French HaHs and criteria used by physicians in patient selection. METHODS Three surveys were conducted between April 1 and August 31, 2020. The first one was addressed to all French HaHs, and the two others to public HaHs and oncologists treating patients with solid cancer in the Auvergne-Rhone-Alpes region. RESULTS Overall, 54 French HaHs and 23 oncologists participated to the study. The health professionals involved in the patients' care were very heterogeneous, although in 92% of cases, the treatment prescription was made by the oncologist. HaH physicians were more involved in clinical assessment the day before treatment (19% vs. 0%), treatment validation (56% vs. 15%), and treatment prescription (19% vs. 0%), while nurses were better equipped (emergency kit available in 81% versus 50% of cases) when HaHs did carry out ICIs compared to when they did not. Most oncologists agreed that age, neuropsychiatric disorders, home environment, as well as treatment duration and good tolerance should be considered in patient selection. ECOG PS status and treatment response were less consensually considered. CONCLUSION These results highlight the variability in French HaH organizations and patient selection criteria for employing ICIs at home. This study resulted in recommendations for administrating ICIs in HaH settings, which will likely be instrumental in further promoting this activity across France.
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Affiliation(s)
- Elisa Gobbini
- CHU Grenoble-Alpes, Unité d'oncologie thoracique, 38700 La Tronche, France; Centre de recherche sur le cancer de Lyon, 69008 Lyon, France.
| | | | | | - Julian Pinsolle
- Centre Hospitalier Métropole Savoie, Unité de pneumologie, 73000 Chambéry, France
| | - Laure Schoutteten
- CHU Grenoble-Alpes, Unité d'oncologie médicale, 38700 La Tronche, France
| | - Isabelle Federspiel
- Centre Hospitalier Universitaire de Grenoble-Alpes, Unité centralisée des préparations médicamenteuses cytotoxiques, Pharmacie hospitalière, La Tronche, France
| | - Thomas Pierret
- CHU Grenoble-Alpes, Unité d'oncologie thoracique, 38700 La Tronche, France
| | - Maurice Pérol
- Centre Léon Bérard, Unité d'oncologie Thoracique, 69008, Lyon, France
| | - Amélie Feyeux
- Centre Hospitalier de Bourg-en-Bresse, Hospitalisation À Domicile, France
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4
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Guidon AC, Burton LB, Chwalisz BK, Hillis J, Schaller TH, Amato AA, Betof Warner A, Brastianos PK, Cho TA, Clardy SL, Cohen JV, Dietrich J, Dougan M, Doughty CT, Dubey D, Gelfand JM, Guptill JT, Johnson DB, Juel VC, Kadish R, Kolb N, LeBoeuf NR, Linnoila J, Mammen AL, Martinez-Lage M, Mooradian MJ, Naidoo J, Neilan TG, Reardon DA, Rubin KM, Santomasso BD, Sullivan RJ, Wang N, Woodman K, Zubiri L, Louv WC, Reynolds KL. Consensus disease definitions for neurologic immune-related adverse events of immune checkpoint inhibitors. J Immunother Cancer 2021; 9:e002890. [PMID: 34281989 PMCID: PMC8291304 DOI: 10.1136/jitc-2021-002890] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 12/12/2022] Open
Abstract
Expanding the US Food and Drug Administration-approved indications for immune checkpoint inhibitors in patients with cancer has resulted in therapeutic success and immune-related adverse events (irAEs). Neurologic irAEs (irAE-Ns) have an incidence of 1%-12% and a high fatality rate relative to other irAEs. Lack of standardized disease definitions and accurate phenotyping leads to syndrome misclassification and impedes development of evidence-based treatments and translational research. The objective of this study was to develop consensus guidance for an approach to irAE-Ns including disease definitions and severity grading. A working group of four neurologists drafted irAE-N consensus guidance and definitions, which were reviewed by the multidisciplinary Neuro irAE Disease Definition Panel including oncologists and irAE experts. A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness and accuracy on 9-point scales in electronic surveys and provided free text comments. Aggregated survey responses were incorporated into revised definitions. Consensus was based on numeric ratings using the RAND/University of California Los Angeles (UCLA) Appropriateness Method with prespecified definitions. 27 panelists from 15 academic medical centers voted on a total of 53 rating scales (6 general guidance, 24 central and 18 peripheral nervous system disease definition components, 3 severity criteria and 2 clinical trial adjudication statements); of these, 77% (41/53) received first round consensus. After revisions, all items received second round consensus. Consensus definitions were achieved for seven core disorders: irMeningitis, irEncephalitis, irDemyelinating disease, irVasculitis, irNeuropathy, irNeuromuscular junction disorders and irMyopathy. For each disorder, six descriptors of diagnostic components are used: disease subtype, diagnostic certainty, severity, autoantibody association, exacerbation of pre-existing disease or de novo presentation, and presence or absence of concurrent irAE(s). These disease definitions standardize irAE-N classification. Diagnostic certainty is not always directly linked to certainty to treat as an irAE-N (ie, one might treat events in the probable or possible category). Given consensus on accuracy and usability from a representative panel group, we anticipate that the definitions will be used broadly across clinical and research settings.
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Affiliation(s)
- Amanda C Guidon
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuromuscular Medicine, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Leeann B Burton
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuromuscular Medicine, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Bart K Chwalisz
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuroimmunology and Neuroinfectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - James Hillis
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuroimmunology and Neuroinfectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Anthony A Amato
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuromuscular Medicine, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Allison Betof Warner
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Priscilla K Brastianos
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tracey A Cho
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Stacey L Clardy
- Department of Neurology, University of Utah, Salt Lake CIty, UT, USA
| | - Justine V Cohen
- Division of Oncology, Department of Medicine, University of Pennsylvania, PA, USA
| | - Jorg Dietrich
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Dougan
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher T Doughty
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuromuscular Medicine, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Divyanshu Dubey
- Departments of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Jeffrey T Guptill
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Division of Neuromuscular Medicine, Duke University, Durham, NC, USA
| | - Douglas B Johnson
- Division of Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vern C Juel
- Division of Neuromuscular Medicine, Duke University, Durham, NC, USA
| | - Robert Kadish
- Department of Neurology, University of Utah, Salt Lake CIty, UT, USA
| | - Noah Kolb
- Division of Neuromuscular Medicine, Department of Neurology, University of Vermont, Burlington, VT, USA
| | - Nicole R LeBoeuf
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Center for Cutaneous Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Jenny Linnoila
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuroimmunology and Neuroinfectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Maria Martinez-Lage
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuropathology, Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Meghan J Mooradian
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jarushka Naidoo
- Medical Oncology, Department of Medicine, Beaumont Hospital Dublin and RCSI University of Health Sciences, Dublin, Ireland
- Upper Aerodigestive Division, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center/Johns Hopkins University, Baltimore, MD, USA
| | - Tomas G Neilan
- Harvard Medical School, Boston, Massachusetts, USA
- Cardio-oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David A Reardon
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Neuro-oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Krista M Rubin
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Bianca D Santomasso
- Department of Neurology, Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryan J Sullivan
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy Wang
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Karin Woodman
- Section of Cancer Neurology, Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Leyre Zubiri
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Kerry L Reynolds
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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5
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Knutzen KE, Sacks OA, Brody-Bizar OC, Murray GF, Jain RH, Holdcroft LA, Alam SS, Liu MA, Pollak KI, Tulsky JA, Barnato AE. Actual and Missed Opportunities for End-of-Life Care Discussions With Oncology Patients: A Qualitative Study. JAMA Netw Open 2021; 4:e2113193. [PMID: 34110395 PMCID: PMC8193430 DOI: 10.1001/jamanetworkopen.2021.13193] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month before death, despite most patients desiring information earlier. Objective To describe successful navigation and missed opportunities for EOL discussions (eg, advance care planning, palliative care, discontinuation of disease-directed treatment, hospice care, and after-death wishes) between oncologists and outpatients with advanced cancer. Design, Setting, and Participants This study is a secondary qualitative analysis of outpatient visits audio-recorded between November 2010 and September 2014 for the Studying Communication in Oncologist-Patient Encounters randomized clinical trial. The study was conducted at 2 US academic medical centers. Participants included medical, gynecological, and radiation oncologists and patients with stage IV malignant neoplasm, whom oncologists characterized as being ones whom they "…would not be surprised if they were admitted to an intensive care unit or died within one year." Data were analyzed between January 2018 and August 2020. Exposures The parent study randomized participants to oncologist- and patient-directed interventions to facilitate discussion of emotions. Encounters were sampled across preintervention and postintervention periods and all 4 treatment conditions. Main Outcomes and Measures Secondary qualitative analysis was done of patient-oncologist dyads with 3 consecutive visits for EOL discussions, and a random sample of 7 to 8 dyads from 4 trial groups was analyzed for missed opportunities. Results The full sample included 141 patients (54 women [38.3%]) and 39 oncologists (8 women [19.5%]) (mean [SD] age for both patients and oncologists, 56.3 [10.0] years). Of 423 encounters, only 21 (5%) included EOL discussions. Oncologists reevaluated treatment options in response to patients' concerns, honored patients as experts on their goals, or used anticipatory guidance to frame treatment reevaluation. In the random sample of 31 dyads and 93 encounters, 35 (38%) included at least 1 missed opportunity. Oncologists responded inadequately to patient concerns over disease progression or dying, used optimistic future talk to address patient concerns, or expressed concern over treatment discontinuation. Only 4 of 23 oncologists (17.4%) had both an EOL discussion and a missed opportunity. Conclusions and Relevance Opportunities for EOL discussions were rarely realized, whereas missed opportunities were more common, a trend that mirrored oncologists' treatment style. There remains a need to address oncologists' sensitivity to EOL discussions, to avoid unnecessary EOL treatment.
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Affiliation(s)
- Kristin E. Knutzen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Olivia A. Sacks
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | | | - Genevra F. Murray
- Department of General Medicine, Boston Medical Center, Boston, Massachusetts
| | - Raina H. Jain
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | | | - Shama S. Alam
- Pharmaceutical Product Development, Evidera, Bethesda, Maryland
| | - Matthew A. Liu
- School of Medicine, University of California, San Diego, La Jolla
| | | | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Palliative Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Amber E. Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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6
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Morgan G, de Azambuja E, Punie K, Ades F, Heinrich K, Personeni N, Rahme R, Ferrara R, Pels K, Garassino M, von Bergwelt-Baildon M, Lopes G, Barlesi F, Choueiri TK, Burris H, Peters S. OncoAlert Round Table Discussions: The Global COVID-19 Experience. JCO Glob Oncol 2021; 7:455-463. [PMID: 33822643 PMCID: PMC8221235 DOI: 10.1200/go.20.00603] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 01/06/2023] Open
Abstract
The speed and spread of the COVID-19 pandemic has been affecting the entire world for the past several months. OncoAlert is a social media network made up of more than 140 oncology stakeholders: oncologists (medical, radiation, and surgical), oncology nurses, and patient advocates who share the mission of fighting cancer by means of education and dissemination of information. As a response to the COVID-19 pandemic, OncoAlert hosted The Round Table Discussions. We have documented this effort along with further discussion about the COVID-19 pandemic and the consequences on patients living with cancer to disseminate this information to our colleagues worldwide.
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Affiliation(s)
- Gilberto Morgan
- Department of Medical Oncology, Skåne
University Hospital, Lund, Sweden
| | - Evandro de Azambuja
- Medical Oncology Clinic, Institute Jules
Bordet, l'Université Libre de Bruxelles (U.L.B), Brussels,
Belgium
| | - Kevin Punie
- Department of General Medical Oncology,
University Hospitals Leuven, Leuven, Belgium
| | | | - Kathrin Heinrich
- Department of Medicine III, University
Hospital, LMU Munich, München, Germany
| | - Nicola Personeni
- Department of Biomedical Sciences,
Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit,
Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Ramy Rahme
- Hôpital Saint Louis, Université
Paris Diderot, Paris, France
| | - Roberto Ferrara
- Department of Medical Oncology, Thoracic
Oncology Unit, Fondazione IRCSS, Istituto Nazionale dei Tumori Milano, Milan,
Italy
| | - Kevin Pels
- Dana-Farber Cancer Institute, Harvard
Medical School, Boston, MA
| | - Marina Garassino
- Department of Medical Oncology, Thoracic
Oncology Unit, Fondazione IRCSS, Istituto Nazionale dei Tumori Milano, Milan,
Italy
| | | | - Gilberto Lopes
- Division of Medical Oncology, Department
of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami,
Miami, FL
| | | | - Toni K. Choueiri
- Dana-Farber Cancer Institute, Harvard
Medical School, Boston, MA
| | - Howard Burris
- Sarah Cannon Research Institute,
Tennessee Oncology, Nashville, TN
| | - Solange Peters
- Service d'oncologie médicale,
CHUV, Lausanne, Switzerland
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7
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Hall WA, Paulson E, Davis BJ, Spratt DE, Morgan TM, Dearnaley D, Tree AC, Efstathiou JA, Harisinghani M, Jani AB, Buyyounouski MK, Pisansky TM, Tran PT, Karnes RJ, Chen RC, Cury FL, Michalski JM, Rosenthal SA, Koontz BF, Wong AC, Nguyen PL, Hope TA, Feng F, Sandler HM, Lawton CAF. NRG Oncology Updated International Consensus Atlas on Pelvic Lymph Node Volumes for Intact and Postoperative Prostate Cancer. Int J Radiat Oncol Biol Phys 2021; 109:174-185. [PMID: 32861817 PMCID: PMC7736505 DOI: 10.1016/j.ijrobp.2020.08.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE In 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes (CTVs). Data have emerged further informing nodal recurrence patterns. The objective of this study is to provide an updated prostate pelvic nodal consensus atlas. METHODS AND MATERIALS A literature review was performed abstracting data on nodal recurrence patterns. Data were presented to a panel of international experts, including radiation oncologists, radiologists, and urologists. After data review, participants contoured nodal CTVs on 3 cases: postoperative, intact node positive, and intact node negative. Radiation oncologist contours were analyzed qualitatively using count maps, which provided a visual assessment of controversial regions, and quantitatively analyzed using Sorensen-Dice similarity coefficients and Hausdorff distances compared with the 2009 RTOG atlas. Diagnostic radiologists generated a reference table outlining considerations for determining clinical node positivity. RESULTS Eighteen radiation oncologists' contours (54 CTVs) were included. Two urologists' volumes were examined in a separate analysis. The mean CTV for the postoperative case was 302 cm3, intact node positive case was 409 cm3, and intact node negative case was 342 cm3. Compared with the original RTOG consensus, the mean Sorensen-Dice similarity coefficient for the postoperative case was 0.63 (standard deviation [SD] 0.13), the intact node positive case was 0.68 (SD 0.13), and the intact node negative case was 0.66 (SD 0.18). The mean Hausdorff distance (in cm) for the postoperative case was 0.24 (SD 0.13), the intact node positive case was 0.23 (SD 0.09), and intact node negative case was 0.33 (SD 0.24). Four regions of CTV controversy were identified, and consensus for each of these areas was reached. CONCLUSIONS Discordance with the 2009 RTOG consensus atlas was seen in a group of experienced NRG Oncology and international genitourinary radiation oncologists. To address areas of variability and account for new data, an updated NRG Oncology consensus contour atlas was developed.
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Affiliation(s)
- William A Hall
- Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, Wisconsin.
| | - Eric Paulson
- Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, Wisconsin
| | - Brian J Davis
- Mayo Clinic, Department of Radiation Oncology, Rochester, Minnesota
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - David Dearnaley
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mukesh Harisinghani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashesh B Jani
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | | | | | - Phuoc T Tran
- Department of Radiation Oncology, Johns Hopkins, Baltimore, Maryland
| | | | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas
| | - Fabio L Cury
- Department of Radiation Oncology, McGill University, Montreal, Canada
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Seth A Rosenthal
- Department of Radiation Oncology, Sutter Medical Group, Roseville, California
| | - Bridget F Koontz
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina
| | - Anthony C Wong
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana Farber Harvard Cancer Center, Boston, Massachusetts
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Felix Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Colleen A F Lawton
- Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, Wisconsin
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8
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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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Hui JYC, Yuan J, Teoh D, Thomaier L, Jewett P, Beckwith H, Parsons H, Lou E, Blaes AH, Vogel RI. Cancer Management During the COVID-19 Pandemic in the United States: Results From a National Physician Cross-sectional Survey. Am J Clin Oncol 2020; 43:679-684. [PMID: 32852291 PMCID: PMC7513953 DOI: 10.1097/coc.0000000000000757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) has significantly impacted health care delivery across the United States, including treatment of cancer. We aim to describe the determinants of treatment plan changes from the perspective of oncology physicians across the United States during the COVID-19 pandemic. METHODS Participants were recruited to an anonymous cross-sectional online survey of oncology physicians (surgeons, medical oncologists, and radiation oncologists) using social media from March 27 to April 10, 2020. Physician demographics, practice characteristics, and cancer treatment decisions were collected. RESULTS The analytic cohort included 411 physicians: 241 (58.6%) surgeons, 106 (25.8%) medical oncologists, and 64 (15.6%) radiation oncologists. In all, 38.0% were practicing in states with 1001 to 5000 confirmed COVID-19 cases as of April 3, 2020, and 37.2% were in states with >5000 cases. Most physicians (N=285; 70.0% of surgeons, 64.4% of medical oncologists, and 73.4% of radiation oncologists) had altered cancer treatment plans. Most respondents were concerned about their patients' COVID-19 exposure risks, but this was the primary driver for treatment alterations only for medical oncologists. For surgeons, the primary driver for treatment alterations was conservation of personal protective equipment, institutional mandates, and external society recommendations. Radiation oncologists were primarily driven by operational changes such as visitor restrictions. CONCLUSIONS The COVID-19 pandemic has caused a majority of oncologists to alter their treatment plans, but the primary motivators for changes differed by oncologic specialty. This has implications for reinstitution of standard cancer treatment, which may occur at differing time points by treatment modality.
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Affiliation(s)
| | | | | | | | | | | | - Helen Parsons
- School of Public Health, University of Minnesota, Minneapolis, MN
| | - Emil Lou
- Division of Hematology, Oncology, and Transplantation
| | - Anne H. Blaes
- Division of Hematology, Oncology, and Transplantation
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Sinaiko AD, Barnett ML, Gaye M, Soriano M, Mulvey T, Hochberg E. Association of Peer Comparison Emails With Electronic Health Record Documentation of Cancer Stage by Oncologists. JAMA Netw Open 2020; 3:e2015935. [PMID: 33021649 PMCID: PMC7539129 DOI: 10.1001/jamanetworkopen.2020.15935] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Systematically capturing cancer stage is essential for any serious effort by health systems to monitor outcomes and quality of care in oncology. However, oncologists do not routinely record cancer stage in machine-readable structured fields in electronic health records (EHRs). OBJECTIVE To evaluate whether a peer comparison email intervention that communicates an oncologist's performance on documenting cancer stage relative to that of peer physicians was associated with increased likelihood that stage was documented in the EHR. DESIGN, SETTING, AND PARTICIPANTS This 12-month, randomized quality improvement pilot study aimed to increase oncologist staging documentation in the EHR. The pilot study was performed at Massachusetts General Hospital Cancer Center from October 1, 2018, to September 30, 2019. Participants included 56 oncologists across 3 practice sites who treated patients in the ambulatory setting and focused on diseases that use standardized staging systems. Data were analyzed from July 2, 2019, to March 5, 2020. INTERVENTIONS Peer comparison intervention with as many as 3 emails to oncologists during 6 months that displayed the oncologist's staging documentation rate relative to all oncologists in the study sample. MAIN OUTCOMES AND MEASURES The primary outcome was patient-level documentation of cancer stage, defined as the likelihood that a patient's stage of disease was documented in the EHR after the patient's first (eg, index) ambulatory visit during the pilot period. RESULTS Among the 56 oncologists participating (32 men [57%]), receipt of emails with peer comparison data was associated with increased likelihood of documentation of cancer stage using the structured field in the EHR (23.2% vs 13.0% of patient index visits). In adjusted analyses, this difference represented an increase of 9.0 (95% CI, 4.4-13.5) percentage points (P = .002) in the probability that a patient's cancer stage was documented, a relative increase of 69% compared with oncologists who did not receive peer comparison emails. The association increased with each email that was sent, ranging from a nonsignificant 4.0 (95% CI, -0.8 to 8.8) percentage points (P = .09) after the first email to a statistically significant 11.2 (95% CI, 4.9-17.4) percentage points (P = .003) after the third email . The association was concentrated among an oncologist's new patients (increase of 11.8 [95% CI, 6.2-17.4] percentage points; P = .001) compared with established patients (increase of 1.6 [95% CI, -2.9 to 6.1] percentage points; P = .44) and persisted for 7 months after the email communications stopped. CONCLUSIONS AND RELEVANCE In a quality improvement pilot trial, peer comparison emails were associated with a substantial increase in oncologist use of the structured field in the EHR to document stage of disease.
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Affiliation(s)
- Anna D. Sinaiko
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Marema Gaye
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Therese Mulvey
- Division of Hematology and Oncology, Department of Medicine, General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Ephraim Hochberg
- Division of Hematology and Oncology, Department of Medicine, General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
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12
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Micha AE, Sinnett V, Downey K, Allen S, Bishop B, Hector LR, Patrick EP, Edmonds R, Barry PA, Krupa KDC, Rusby JE. Patient and clinician satisfaction and clinical outcomes of Magseed compared with wire-guided localisation for impalpable breast lesions. Breast Cancer 2020; 28:196-205. [PMID: 32974810 PMCID: PMC7796883 DOI: 10.1007/s12282-020-01149-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023]
Abstract
Background Guide-wire localisation remains the most commonly used technique for localisation of impalpable breast lesions in the UK. One alternative is magnetic seed localisation. We aimed to investigate patient and clinician satisfaction in two consecutive cohorts, describe re-excision and positive margin rates, and explore reasons for positive margins and the implications for localisation techniques. Methods A single-institution prospective service evaluation of two cohorts of consecutive cases of wire and then Magseed localisation was carried out. Data were collected on patient and clinician satisfaction, clinico-pathological findings, and causes of involved margins. T tests were used to compare continuous variables and Chi-squared test for satisfaction outcomes. Results 168 consecutive cases used wire-guided localisation (WGL) and 128 subsequent cases used Magseeds. Patients reported less anxiety between localisation and surgery in the Magseed group, and clinicians reported greater ease of use of Magseeds. There were no differences in lesion size, surgical complexity, or re-excision rate between the groups. In a subset of patients receiving standard wide local excision (i.e., excluding mammoplasties), the impact on margin involvement was investigated. There was no significant difference in radiological under-sizing or accuracy of localisation. However, specimen weight and eccentricity of the lesion were statistically significantly lower in the Magseed group. Despite this, re-excision rates were not significantly different (p = 0.4). Conclusions This is the first large study of satisfaction with localisation and showed clinician preference for Magseed and a reduction in patient anxiety. It also demonstrated similar positive margin rates despite smaller specimen weights in the Magseed group. Magnetic seed localisation offers an acceptable clinical alternative to guide wire localisation. The impact on local service provision should also be considered.
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Affiliation(s)
- Aikaterini E Micha
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Victoria Sinnett
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Kate Downey
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Steve Allen
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Briony Bishop
- Royal Marsden NHS Foundation Trust, London, UK
- Bedfordshire Hospitals NHS Trust, South Wing, Kempston Rd, Bedford, MK42 9DJ, UK
| | - Lauren R Hector
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Elaine P Patrick
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | | | - Peter A Barry
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Institute for Cancer Research, Sutton, UK
| | - Katherine D C Krupa
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Jennifer E Rusby
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK.
- Institute for Cancer Research, Sutton, UK.
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Nappi L, Ottaviano M, Rescigno P, Tortora M, Banna GL, Baciarello G, Basso U, Canil C, Cavo A, Cossu Rocca M, Czaykowski P, De Giorgi U, Garcia Del Muro X, Di Napoli M, Fornarini G, Gietema JA, Heng DYC, Hotte SJ, Kollmannsberger C, Maruzzo M, Messina C, Morelli F, Mulder S, Nichols C, Nolè F, Oing C, Sava T, Secondino S, Simone G, Soulieres D, Vincenzi B, Zucali PA, De Placido S, Palmieri G. Management of Germ Cell Tumors During the Outbreak of the Novel Coronavirus Disease-19 Pandemic: A Survey of International Expertise Centers. Oncologist 2020; 25:e1509-e1515. [PMID: 32735386 DOI: 10.1634/theoncologist.2020-0420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/12/2020] [Accepted: 07/07/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has become a public health emergency affecting frail populations, including patients with cancer. This poses the question of whether cancer treatments can be postponed or modified without compromising their efficacy, especially for highly curable cancers such as germ cell tumors (GCTs). MATERIALS AND METHODS To depict the state-of-the-art management of GCTs during the COVID-19 pandemic, a survey including 26 questions was circulated by e-mail among the physicians belonging to three cooperative groups: (a) Italian Germ Cell Cancer Group; (b) European Reference Network-Rare Adult Solid Cancers, Domain G3 (rare male genitourinary cancers); and (c) Genitourinary Medical Oncologists of Canada. Percentages of agreement between Italian respondents (I) versus Canadian respondents (C), I versus European respondents (E), and E versus C were compared by using Fisher's exact tests for dichotomous answers and chi square test for trends for the questions with three or more options. RESULTS Fifty-three GCT experts responded to the survey: 20 Italian, 6 in other European countries, and 27 from Canada. Telemedicine was broadly used; there was high consensus to interrupt chemotherapy in COVID-19-positive patients (I = 75%, C = 55%, and E = 83.3%) and for use of granulocyte colony-stimulating factor primary prophylaxis for neutropenia (I = 65%, C = 62.9%, and E = 50%). The main differences emerged regarding the management of stage I and stage IIA disease, likely because of cultural and geographical differences. CONCLUSION Our study highlights the common efforts of GCT experts in Europe and Canada to maintain high standards of treatment for patients with GCT with few changes in their management during the COVID-19 pandemic. IMPLICATIONS FOR PRACTICE Despite the chaos, disruptions, and fears fomented by the COVID-19 illness, oncology care teams in Italy, other European countries, and Canada are delivering the enormous promise of curative management strategies for patients with testicular cancer and other germ cell tumors. At the same time, these teams are applying safe and innovative solutions and sharing best practices to minimize frequency and intensity of patient contacts with thinly stretched health care capacity.
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Affiliation(s)
- Lucia Nappi
- British Columbia Cancer, Vancouver Cancer Center, Vancouver, BC, Canada
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Margaret Ottaviano
- Ospedale del Mare, Naples, Italy
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
- Centro di riferimento Campania per i tumori rar (CRCTR) Regional Rare Tumors Reference Center, Naples, Italy
| | - Pasquale Rescigno
- The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Marianna Tortora
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
- Centro di riferimento Campania per i tumori rar (CRCTR) Regional Rare Tumors Reference Center, Naples, Italy
| | | | - Giulia Baciarello
- Oncology Medicine Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Umberto Basso
- Oncology Unit, Oncology Department, Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Christina Canil
- The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, Canada
| | | | | | | | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | | | | | - Daniel Y C Heng
- Tom Baker Cancer Center, University of Calgary, Calgary, Canada
| | | | | | - Marco Maruzzo
- Oncology Unit, Oncology Department, Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | | | - Franco Morelli
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sasja Mulder
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Craig Nichols
- Testicular Cancer Commons, Portland, Oregon, USA
- Southwest Oncology Group (SWOG) Group Chair's Office, Portland, Oregon, USA
| | - Franco Nolè
- European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | | | - Teodoro Sava
- Oncologia Azienda Unità Locale Socio Sanitaria 6 (AUSLSS6) EUGANEA, Padua, Italy
| | | | | | - Denis Soulieres
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Paolo A Zucali
- Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
- Centro di riferimento Campania per i tumori rar (CRCTR) Regional Rare Tumors Reference Center, Naples, Italy
| | - Giovannella Palmieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
- Centro di riferimento Campania per i tumori rar (CRCTR) Regional Rare Tumors Reference Center, Naples, Italy
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Ürün Y, Hussain SA, Bakouny Z, Castellano D, Kılıçkap S, Morgan G, Mckay RR, Pels K, Schmidt A, Doroshow DB, Schütz F, Albiges L, Lopes G, Catto JWF, Peters S, Choueiri TK. Survey of the Impact of COVID-19 on Oncologists' Decision Making in Cancer. JCO Glob Oncol 2020; 6:1248-1257. [PMID: 32755479 PMCID: PMC7456315 DOI: 10.1200/go.20.00300] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To understand readiness measures taken by oncologists to protect patients and health care workers from the novel coronavirus (COVID-19) and how their clinical decision making was influenced by the pandemic. METHODS An online survey was conducted between March 24 and April 29, 2020. RESULTS A total of 343 oncologists from 28 countries participated. The median age was 43 years (range, 29-68 years), and the majority were male (62%). At the time of the survey, nearly all participants self-reported an outbreak in their country (99.7%). Personal protective equipment was available to all participants, of which surgical mask was the most common (n = 308; 90%). Telemedicine, in the form of phone or video encounters, was common and implemented by 80% (n = 273). Testing patients with cancer for COVID-19 via reverse transcriptase polymerase chain reaction before systemic treatment was not routinely implemented: 58% reported no routine testing, 39% performed testing in selected patients, and 3% performed systematic testing in all patients. The most significant factors influencing an oncologist's decision making regarding choice of systemic therapy included patient age and comorbidities (81% and 92%, respectively). Although hormonal treatments and tyrosine kinase inhibitors were considered to be relatively safe, cytotoxic chemotherapy and immune therapies were perceived as being less safe or unsafe by participants. The vast majority of participants stated that during the pandemic they would use less chemotherapy, immune checkpoint inhibitors, and steroids. Although treatment in neoadjuvant, adjuvant, and first-line metastatic disease was less affected, most of the participants stated that they would be more hesitant to recommend second- or third-line therapies in metastatic disease. CONCLUSION Decision making by oncologists has been significantly influenced by the ongoing COVID-19 pandemic.
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Affiliation(s)
- Yüksel Ürün
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Cancer Research Institute, Ankara, Turkey
| | - Syed A. Hussain
- Academic Unit of Oncology, University of Sheffield, Sheffield, United Kingdom
| | - Ziad Bakouny
- Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Gilberto Morgan
- Department of Medical and Radiation Oncology, Skåne University Hospital, Lund, Sweden
| | - Rana R. Mckay
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Kevin Pels
- Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Andrew Schmidt
- Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Deborah B. Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Fábio Schütz
- Clinical Oncology Department, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Gilberto Lopes
- Division of Hematology and Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
| | - James W. F. Catto
- Academic Unit of Oncology, University of Sheffield, Sheffield, United Kingdom
| | - Solange Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Toni K. Choueiri
- Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Walker B, Frytak J, Hayes J, Neubauer M, Robert N, Wilfong L. Evaluation of Practice Patterns Among Oncologists Participating in the Oncology Care Model. JAMA Netw Open 2020; 3:e205165. [PMID: 32421185 PMCID: PMC7235689 DOI: 10.1001/jamanetworkopen.2020.5165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/14/2020] [Indexed: 02/04/2023] Open
Abstract
Importance Health insurers reimburse clinicians in many ways, including the ubiquitous fee-for-service model and the emergent shared-savings models. Evidence on the effects of these emergent models in oncological treatment remains limited. Objectives To analyze the early use and cost associations of a recent Medicare payment program, the Oncology Care Model (OCM), which included a shared savings-like component. Design, Setting, and Participants This nonrandomized controlled study used a difference-in-differences approach on 2 years of data, from July 1, 2015, to June 30, 2017-1 year before and 1 year after launch of the OCM-to compare the differences between participating and nonparticipating practices, controlling for patient, clinician, and practice factors. Participation in the OCM began on July 1, 2016. Associations of participation with care use and cost were estimated for care directly managed by clinicians from a large network within their Medicare populations for breast, lung, colon, and prostate cancers. Data were analyzed from September 2019 to March 2020. Exposures Participating practices were paid a monthly management fee of $160 per beneficiary and a potential risk-adjusted performance-based payment for eligible patients who received chemotherapy treatment, in addition to standard fee-for-service payments. Main Outcomes and Measures Office visits, drug administrations, patient hydrations, drug costs, and total costs. Results Monthly means data at the physician-level were evaluated for 11 869 physician-months for breast cancers, 11 135 physician-months for lung cancers, 8592 physician-months for colon cancers, and 9045 physician-months for prostate cancers. Patients at OCM practices had a mean (SD) age of 63.4 (3.1) years, and a mean (SD) of 59% (7 percentage points) of their patients were women. Participation in the OCM was associated with less physician-administered prostate cancer drug use (difference, 0.29 [95% CI, -0.47 to -0.11] percentage points, or 24.0%) translating to a mean of $706 (95% CI, -$1383 to -$29) less in drug costs per month. Monthly drug costs were also lower, at $558 (95% CI, -$1173 to $58) less for treatment for lung cancer. Total costs were lower by 9.7% or $233 (95% CI, -$495 to $30) for breast cancer, 9.9% or $337 (95% CI, -$618 to -$55) for lung cancer, 14.2% or $385 (95% CI, -$780 to $10) for colon cancer, and 29.2% or $610 (95% CI, -$1095 to -$125) for prostate cancer; however, these differences were largely offset by program costs. Clinician visits were also lower by 11.2% or 0.11 (95% CI, -0.20 to -0.01) percentage points among patients with breast cancer and by 14.4% or 0.19 (95% CI, -0.37 to -0.02) among patients with colon cancer. Conclusions and Relevance These findings suggest that payment models with shared-savings components can be associated with fewer visits and lower costs in certain cancer settings in the first year, but the savings can be modest given the costs of program administration.
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Affiliation(s)
- Brigham Walker
- Data, Evidence & Insights, McKesson Life Sciences, The Woodlands, Texas
- Department of Health Policy and Management, Tulane University, New Orleans, Louisiana
| | - Jennifer Frytak
- Data, Evidence & Insights, McKesson Life Sciences, The Woodlands, Texas
| | - Jad Hayes
- Program Outcomes, McKesson Specialty Health, The Woodlands, Texas
| | | | - Nicholas Robert
- Data, Evidence & Insights, McKesson Life Sciences, The Woodlands, Texas
| | - Lalan Wilfong
- Value Based Care and Quality Programs, Texas Oncology, Dallas
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16
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Yabroff KR, Zhao J, de Moor JS, Sineshaw HM, Freedman AN, Zheng Z, Han X, Rai A, Klabunde CN. Factors Associated With Oncologist Discussions of the Costs of Genomic Testing and Related Treatments. J Natl Cancer Inst 2020; 112:498-506. [PMID: 31675070 PMCID: PMC7225678 DOI: 10.1093/jnci/djz173] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/31/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Use of genomic testing is increasing in the United States. Testing can be expensive, and not all tests and related treatments are covered by health insurance. Little is known about how often oncologists discuss costs of testing and treatment or about the factors associated with those discussions. METHODS We identified 1220 oncologists who reported discussing genomic testing with their cancer patients from the 2017 National Survey of Precision Medicine in Cancer Treatment. Multivariable polytomous logistic regression analyses were used to assess associations between oncologist and practice characteristics and the frequency of cost discussions. All statistical tests were two-sided. RESULTS Among oncologists who discussed genomic testing with patients, 50.0% reported often discussing the likely costs of testing and related treatments, 26.3% reported sometimes discussing costs, and 23.7% reported never or rarely discussing costs. In adjusted analyses, oncologists with training in genomic testing or working in practices with electronic medical record alerts for genomic tests were more likely to have cost discussions sometimes (odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.19 to 3.69) or often (OR = 2.22, 95% CI = 1.30 to 3.79), respectively, compared to rarely or never. Other factors statistically significantly associated with more frequent cost discussions included treating solid tumors (rather than only hematological cancers), using next-generation sequencing gene panel tests, having higher patient volume, and working in practices with higher percentages of patients insured by Medicaid, or self-paid or uninsured. CONCLUSIONS Interventions targeting modifiable oncologist and practice factors, such as training in genomic testing and use of electronic medical record alerts, may help improve cost discussions about genomic testing and related treatments.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | | | - Helmneh M Sineshaw
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | | | - Zhiyuan Zheng
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ashish Rai
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Carrie N Klabunde
- National Cancer Institute, and Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
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Abstract
IMPORTANCE Understanding adoption of new cancer therapies may help identify opportunities to increase use for high-value indications. OBJECTIVE To determine whether use of bevacizumab in 2005 to 2006 by oncologists' peers was associated with greater bevacizumab use among oncologists in 2007 to 2010. DESIGN, SETTING, AND PARTICIPANTS This cohort study of physicians and their patients took place in 51 randomly selected hospital referral regions in the United States. Participants were 44 012 fee-for-service Medicare beneficiaries aged 65 years or older with cancers of the colorectum, lung, breast, kidney, brain, or ovary treated by 3261 oncologists in 2005 to 2010 and assigned to one of 252 communities. Data were analyzed in 2017 to 2018. EXPOSURES Among patients treated with chemotherapy during 2007 to 2010 by an oncologist who had not treated patients with bevacizumab in 2005 to 2006, models assessed the association of bevacizumab use with rates of bevacizumab use in their physician's community of connected physicians in 2005 to 2006. Models adjusted for patient and physician characteristics and physician, practice, and community random effects. MAIN OUTCOMES AND MEASURES Receipt of bevacizumab. RESULTS A total of 34 750 patients (14 126 [40.6%] aged ≥75 years; 21 321 [61.4%] female) with cancers of the colorectum, lung, breast, kidney, brain, and ovary were treated with chemotherapy in 2005 to 2006 in the 51 hospital referral regions. Among 9262 patients treated in 2007 to 2010 by 829 physicians whose patients did not use bevacizumab in 2005 to 2006, 3654 (39.5%) were aged 75 years or older and 6227 (67.2%) were female. The rate of bevacizumab use relative to other chemotherapy in 2007 to 2010 by tertile of use (bevacizumab for <4.4%, 4.4%-6.2%, and >6.2% of all patients receiving chemotherapy) among their physician's peers in 2005 to 2006 was 10.0%, 9.5%, and 13.6%, respectively. After adjustment, use of bevacizumab in 2007 to 2010 was greater among physicians in communities with the highest rates of bevacizumab use in 2005 to 2006 compared with those whose peers were in the lowest tertile of bevacizumab use in 2005 to 2006 (adjusted odds ratio, 1.64; 95% CI, 1.20-2.25). CONCLUSIONS AND RELEVANCE This study found that an increase in oncologists' adoption and use of bevacizumab in the years after its approval was associated with their peer physicians being earlier adopters. As organizations seek to provide better care at lower costs, interventions that leverage physician ties may help to promote adoption of high-value use of new cancer treatments and deimplementation of low-value therapies.
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Affiliation(s)
- Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - A. James O’Malley
- Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, New Hampshire
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stacy W. Gray
- Department of Population Sciences and Medical Oncology, City of Hope Medical Center, Duarte, California
| | - Bruce E. Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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18
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Abstract
OBJECTIVES Fractional (part-time) appointments are becoming more commonplace in many professions, including medicine. With respect to the contemporary oncological landscape, this highlights a critical moment in the optimisation of employment conditions to enable high-quality service provision given growing patient numbers and treatment volume intensification. Data are drawn from a broader study which aimed to better understand the workforce experiences of medical oncologists in Australia. This paper specifically aims to examine a group of clinicians' views on the consequences of fractional work in oncology. DESIGN Qualitative, one-on-one semistructured interviews. Interview transcripts were digitally audio recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory. SETTING New South Wales, Australia. PARTICIPANTS Medical oncologists (n=22), including 9 female and 13 male participants, at a range of career stages. RESULTS Four key themes were derived from the analysis: (1) increasing fractional employment relative to opportunities for full-time positions and uncertainty about future opportunities; (2) tightening in role diversity, including reducing time available for research, mentoring, professional development and administration; (3) emerging flexibility of medical oncology as a specialty and (4) impact of fractional-as-norm on workforce sustainability and quality of care. CONCLUSION Fractional appointments are viewed as increasing in oncology and the broader consequences of this major shift in medical labour remain unexamined. Such appointments offer potential for flexible work to better suit the needs of contemporary oncologists; however, fractional work also presents challenges for personal and professional identity and vocational engagement. Fractional appointments are viewed as having a range of consequences related to job satisfaction, burnout and service delivery. Further research is needed to provide a critical examination of the multiple impacts of workforce trends within and beyond oncology.
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Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, UNSW, Sydney, New South Wales, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Deme Karikios
- Medical Oncology, Nepean Cancer Care Centre, Nepean Hospital, Penrith, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rosemary Harrup
- Department of Medical Oncology/Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Hersberger KE, Mendiratta-Lala M, Fischer R, Kaza RK, Francis IR, Olszewski MS, Harju JF, Shi W, Manion FJ, Al-Hawary MM, Sahai V. Quantitative Imaging Assessment for Clinical Trials in Oncology. J Natl Compr Canc Netw 2019; 17:1505-1511. [PMID: 31805530 DOI: 10.6004/jnccn.2019.7331] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Objective radiographic assessment is crucial for accurately evaluating therapeutic efficacy and patient outcomes in oncology clinical trials. Imaging assessment workflow can be complex; can vary with institution; may burden medical oncologists, who are often inadequately trained in radiology and response criteria; and can lead to high interobserver variability and investigator bias. This article reviews the development of a tumor response assessment core (TRAC) at a comprehensive cancer center with the goal of providing standardized, objective, unbiased tumor imaging assessments, and highlights the web-based platform and overall workflow. In addition, quantitative response assessments by the medical oncologists, radiologist, and TRAC are compared in a retrospective cohort of patients to determine concordance. PATIENTS AND METHODS The TRAC workflow includes an image analyst who pre-reviews scans before review with a board-certified radiologist and then manually uploads annotated data on the proprietary TRAC web portal. Patients previously enrolled in 10 lung cancer clinical trials between January 2005 and December 2015 were identified, and the prospectively collected quantitative response assessments by the medical oncologists were compared with retrospective analysis of the same dataset by a radiologist and TRAC. RESULTS This study enlisted 49 consecutive patients (53% female) with a median age of 60 years (range, 29-78 years); 2 patients did not meet study criteria and were excluded. A linearly weighted kappa test for concordance for TRAC versus radiologist was substantial at 0.65 (95% CI, 0.46-0.85; standard error [SE], 0.10). The kappa value was moderate at 0.42 (95% CI, 0.20-0.64; SE, 0.11) for TRAC versus oncologists and only fair at 0.34 (95% CI, 0.12-0.55; SE, 0.11) for oncologists versus radiologist. CONCLUSIONS Medical oncologists burdened with the task of tumor measurements in patients on clinical trials may introduce significant variability and investigator bias, with the potential to affect therapeutic response and clinical trial outcomes. Institutional imaging cores may help bridge the gap by providing unbiased and reproducible measurements and enable a leaner workflow.
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Affiliation(s)
- Katherine E Hersberger
- aDepartment of Internal Medicine, University of Michigan Medical School
- bUniversity of Michigan Rogel Cancer Center; and
| | | | | | - Ravi K Kaza
- cDepartment of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Isaac R Francis
- bUniversity of Michigan Rogel Cancer Center; and
- cDepartment of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - John F Harju
- bUniversity of Michigan Rogel Cancer Center; and
| | - Wei Shi
- bUniversity of Michigan Rogel Cancer Center; and
| | | | - Mahmoud M Al-Hawary
- bUniversity of Michigan Rogel Cancer Center; and
- cDepartment of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Vaibhav Sahai
- aDepartment of Internal Medicine, University of Michigan Medical School
- aDepartment of Internal Medicine, University of Michigan Medical School
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20
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Kordes M, Gerling M. Variations in the management of diarrhoea induced by cancer therapy: results from an international, cross-sectional survey among European oncologists. ESMO Open 2019; 4:e000607. [PMID: 31803505 PMCID: PMC6890383 DOI: 10.1136/esmoopen-2019-000607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/02/2019] [Revised: 10/17/2019] [Accepted: 10/25/2019] [Indexed: 01/12/2023] Open
Abstract
Background Chemotherapy-induced diarrhoea (CID) is a common side effect of cancer treatment. While cytotoxic agents are the main cause of CID, targeted drugs, immunotherapy and radiotherapy can also cause diarrhoea. Patients with severe CID often require hospital admission for intravenous fluid resuscitation and supportive treatment. In other patient populations, such as children with infectious diarrhoea, therapy is based on evidence from randomised-controlled clinical trials. In contrast, few trials have investigated CID management, and hence, treatment guidelines are largely based on expert opinion. Methods We conducted an online survey on CID management and institutional routines across Europe to obtain a more detailed picture of current practice in CID treatment. We analysed the responses from a total of 156 clinicians from 83 different medical centres in 31 countries. Results CID (any grade) is recognised as a common clinical problem in patients undergoing antitumoral treatment and it can require hospital admission in a substantial subgroup of patients. There is a strong consensus among clinicians as to the choice of resuscitation strategies and drug treatment for severe CID; 85.9% (n=134) of all respondents prefer intravenous crystalloid fluids and 95.5% (n=149) routinely use loperamide. In sharp contrast, we have identified disparities in the use of bowel rest in CID; approximately half of all participants (57.7%; n=90) consider bowel rest in initial CID management, while the remainder (42.3%; n=66) does not. Conclusions As previous studies have shown that bowel rest is associated with adverse outcomes in diarrhoea due to causes other than chemotherapy, the results from this survey suggest that further research is needed as to its role in CID.
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Affiliation(s)
- Maximilian Kordes
- CLINTEC, Karolinska Institute, Stockholm, Sweden
- Tema Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Gerling
- Tema Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
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21
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Richtig G, Richtig E, Böhm A, Oing C, Bozorgmehr F, Kruger S, Kiesewetter B, Zielinski C, Berghoff AS. Awareness of predatory journals and open access among medical oncologists: results of an online survey. ESMO Open 2019; 4:e000580. [PMID: 31803502 PMCID: PMC6890386 DOI: 10.1136/esmoopen-2019-000580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/26/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Predatory journals harm the integrity of science as principles of 'good scientific practice' are bypassed by omitting a proper peer-review process. Therefore, we aimed to explore the awareness of predatory journals among oncologists. Methods An online survey among oncologists working in Germany or Austria of various professional surroundings was conducted between October 2018 and April 2019. Results One hundred and eighty-eight participants (55 women (29.2%), 128 men (68.1%)) completed the questionnaire. 41 (21.8%) participants indicated to work in a hospital, 24 (12.8%) in private practice and 112 (59.6%) in a university hospital. 98.9% of participants indicated to actively read scientific articles and consider them in clinical decision-making (96.3%). 90.4% of participants indicated to have scientific experience by publishing papers in journals with peer-review system. The open-access system was known by 170 (90.4%), predatory journals by 131 (69.7%) and Beall's list by 52 participants (27.7%). Predatory journals were more likely to be known by participants with a higher number of publications (p<0.001), with more high-impact publications (p=0.005) and with recent publications (p<0.001). Awareness of predatory journals did not correlate with gender (p=0.515) or translation of scientific literature into clinical practice (p=0.543). Conclusions The problematic topic of 'predatory journals' is still unknown by a considerable amount of oncologist, although the survey was taken in a cohort of oncologists with scientific experience. Dedicated educational initiatives are needed to raise awareness of this problem and to aid in the identification of predatory journals for the scientific oncology community.
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Affiliation(s)
- Georg Richtig
- Otto-Loewi Research Center, Pharmacology Section, Medical University of Graz, Graz, Austria
- Divison of Oncology, Medical University of Graz, Graz, Austria
| | - Erika Richtig
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Alexandra Böhm
- 3rd Medical Department, Division of Hematology and Oncology, Hanusch Hospital, Vienna, Austria
| | - Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Divison of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- The Manchester Cancer Research Centre, Division of Cancer Sciences, University of Manchester, School of Medical Sciences, Manchester, UK
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Stephan Kruger
- Department of Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Barbara Kiesewetter
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Vienna Cancer Center, Central European Cooperative Oncology Group (CECOG), Vienna, Austria
| | - Anna S Berghoff
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
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22
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O’Callaghan N, Hanan T, Mullen L, Laffoy M. Seasonal Inactivated Influenza Vaccination in Oncology Settings. Ir Med J 2019; 112:983. [PMID: 31647211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aims The aims of this study were to establish the uptake rate of seasonal influenza vaccine amongst oncology healthcare workers (HCWs) during the 2016/17 influenza season and to ascertain which factors were associated with or predicted vaccination, along with determining if national guidance regarding influenza vaccination for cancer patients is implemented. Methods A national cross-sectional study was carried out on clinical staff working in oncology day wards. Results Vaccine uptake during the 2016/17 season among oncology day ward staff was 48%. Fear of vaccine side-effects, believing that if one is healthy, there is no need for vaccination, and doubt about vaccine effectiveness negatively predicted vaccination. Most staff (87.6%) recommend vaccination to some or all patients. Conclusion Every effort should be made to ensure HCWs are given the opportunity to get vaccinated, provided with evidence of vaccine effectiveness and safety and empowered to recommend influenza vaccination to their patients.
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Affiliation(s)
| | - T Hanan
- National Cancer Control Programme
| | - L Mullen
- National Cancer Control Programme
| | - M Laffoy
- National Cancer Control Programme
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23
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Lim SL, Puechl AM, Broadwater G, Ehrisman JA, Lorenzo A, Foote J, Davidson BA, Chino J, Havrilesky LJ. Gender variation in Medicare utilization and payments in gynecologic oncology. Gynecol Oncol 2019; 154:602-607. [PMID: 31303256 DOI: 10.1016/j.ygyno.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/09/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) and Medicare Physician and Other Supplier National Provider Identifier (POS NPI) Aggregate Report are publicly available files from the Center for Medicare and Medicaid Services that include payments to providers who care for fee-for-service Medicare recipients. The aim of this study was to analyze variability in gynecologic oncologists' Medicare reimbursements, with attention to differences in provider gender and time in practice. METHODS The 2015 POSPUF and POS NPI were analyzed with respect to gynecologic oncologists. We searched external publicly available data sources to confirm subspecialty and to determine each provider's number of years in practice. Evaluation and management (E&M) and procedure/surgery codes were analyzed; drug delivery codes were excluded due to variability in billing by facility/hospital. RESULTS The POS NPI file included 733 gynecologic oncologist providers receiving $55,626,739 in total payments. Female providers comprised 39% of gynecologic oncologists and received 31% of reimbursements (30% of E&M reimbursements and 24% of surgical reimbursements). During the first ten years in practice, female providers comprised 58% of providers and accounted for 52% of reimbursed services, compared to 38% of providers/26% of reimbursed services (11-20 years), and 18% of providers/19% of reimbursed services (>20 years). CONCLUSION Male gynecologic oncologists perform more Medicare services than their female counterparts. There is a comparable number of services performed between genders among both the most senior and the most junior providers, with a gender gap in services and reimbursements among mid-career providers.
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Affiliation(s)
- Stephanie L Lim
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America
| | - Allison M Puechl
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America
| | - Gloria Broadwater
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States of America
| | - Jessie A Ehrisman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America
| | - Amelia Lorenzo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America
| | - Jonathan Foote
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America
| | - Junzo Chino
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States of America
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America.
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24
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Coleman K, Brady C, O’Reilly S, O’ Brien T. Exploring the Interface of Oncology and Palliative Care in Ireland. Ir Med J 2019; 112:969. [PMID: 31642643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aims To explore the integration and delivery of oncology led referrals to palliative care (PC) by examining physician attitudes and referral practices. Methods An online survey was circulated to oncologists and PC physicians in Ireland. Results The study (N = 100) comprised sixty-nine oncologists (69%) and thirty-one PC physicians (31%). Ninety-two(92%) believe patients with advanced cancer should receive concurrent treatment, however only 53% of oncologists(N = 37) routinely refer. Regarding end-of-life (EOL) care: 81% of oncologists (N = 55) are directly involved in its administration, despite 84% (N = 53) agreeing patients benefit when PC specialists coordinate EOL care. Conclusion The gulf between positive attitudes and limited implementation suggests the need for interdisciplinary changes to facilitate integration of PC in clinical practice in Ireland.
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Affiliation(s)
- K Coleman
- School of Medicine, University College Cork
| | - C Brady
- Department of Medical Oncology, Cork University Hospital
| | - S O’Reilly
- Department of Medical Oncology, Cork University Hospital
| | - T O’ Brien
- Marymount University Hospital and Hospice, Co Cork
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25
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Feaster A, DeCapua-Guarino A, Wolf M, Dove J, Fluck M, Oxenberg J. Thyroidectomy Remains a Safe Option for Graves' Disease. Am Surg 2019; 85:851-854. [PMID: 32051065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Total thyroidectomy (TT) or near-TT (NTT) is often recommended over medical management for the treatment of Graves' disease (GD). We assess the safety within surgical subspecialties at our institution for TT/NTT in GD patients. A retrospective review of patients undergoing TT/NTT for GD was performed from 2004 to 2016. Patient factors, thyroid size, surgeon subspecialty, and intraoperative/postoperative outcomes were all reviewed. Multivariate analyses were used to determine risk factors for complications. A total of 383 patients underwent TT/NTT. Two hundred thirty-three patients underwent TT/NTT by otolaryngology (n = 233, 60.8%), surgical oncology (n = 140, 36.6%), general surgery (n = 8, 2.1%), and unknown (n = 2, 0.5%). On multivariate analysis, surgical duration was longer for males (P = 0.001) and increased thyroid weights (P = 0.001). No association with hypocalcemia or recurrent laryngeal nerve paralysis was found with factors considered. No factors were found to be associated with the ability to identify the recurrent laryngeal nerve. Estimated blood loss (EBL) was increased in younger patients (0.010), males (P = 0.001), increased BMI (P = 0.012), and increased thyroid weight (P < 0.001). EBL was also associated with the physician performing the operation, where EBL was greatest for TT/NTT performed by general surgeons, followed by surgical oncologists and then by otolaryngology (P = 0.006). TT/NTT is safe and a reasonable option for the treatment of GD.
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Vasista A, Stockler M, Martin A, Pavlakis N, Sjoquist K, Goldstein D, Gill S, Jain V, Liu G, Kannourakis G, Kim YH, Nott L, Snow S, Burge M, Harris D, Jonker D, Chua YJ, Epstein R, Bonaventura A, Kiely B. Accuracy and Prognostic Significance of Oncologists' Estimates and Scenarios for Survival Time in Advanced Gastric Cancer. Oncologist 2019; 24:e1102-e1107. [PMID: 30936377 DOI: 10.1634/theoncologist.2018-0613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/01/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Worst-case, typical, and best-case scenarios for survival, based on simple multiples of an individual's expected survival time (EST), estimated by their oncologist, are a useful way of formulating and explaining prognosis. We aimed to determine the accuracy and prognostic significance of oncologists' estimates of EST, and the accuracy of the resulting scenarios for survival time, in advanced gastric cancer. MATERIALS AND METHODS Sixty-six oncologists estimated the EST at baseline for each of the 152 participants they enrolled in the INTEGRATE trial. We hypothesized that oncologists' estimates of EST would be unbiased (∼50% would be longer or shorter than the observed survival time [OST]); imprecise (<33% within 0.67-1.33 times the OST); independently predictive of overall survival (OS); and accurate at deriving scenarios for survival time with approximately 10% of patients dying within a quarter of their EST (worst-case scenario), 50% living within half to double their EST (typical scenario), and 10% living three or more times their EST (best-case scenario). RESULTS Oncologists' estimates of EST were unbiased (45% were shorter than the OST, 55% were longer); imprecise (29% were within 0.67-1.33 times observed); moderately discriminative (Harrell's C-statistic 0.62, p = .001); and an independently significant predictor of OS (hazard ratio, 0.89; 95% confidence interval, 0.83-0.95; p = .001) in a Cox model including performance status, number of metastatic sites, neutrophil-to-lymphocyte ratio ≥3, treatment group, age, and health-related quality of life (EORTC-QLQC30 physical function score). Scenarios for survival time derived from oncologists' estimates were remarkably accurate: 9% of patients died within a quarter of their EST, 57% lived within half to double their EST, and 12% lived three times their EST or longer. CONCLUSION Oncologists' estimates of EST were unbiased, imprecise, moderately discriminative, and independently significant predictors of OS. Simple multiples of the EST accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer. IMPLICATIONS FOR PRACTICE Results of this study demonstrate that oncologists' estimates of expected survival time for their patients with advanced gastric cancer were unbiased, imprecise, moderately discriminative, and independently significant predictors of overall survival. Simple multiples of the expected survival time accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer.
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Affiliation(s)
- Anuradha Vasista
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia
| | - Martin Stockler
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia
| | - Nick Pavlakis
- Royal North Shore Hospital, New South Wales, Australia
| | - Katrin Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia
- St George Hospital, New South Wales, Australia
| | | | | | - Vikram Jain
- ICON Cancer Foundation, Queensland, Australia
| | - Geoffrey Liu
- University Health Network, Princess Margaret Hospital, Toronto, Canada
| | - George Kannourakis
- Ballarat Oncology and Haematology Services, Ballarat, Victoria, Australia
| | | | | | - Stephanie Snow
- Queen Elizabeth II Health Sciences Centre, Nova Scotia, Canada
| | - Matthew Burge
- Royal Brisbane and Womens Hospital, Queensland, Australia
| | - Dean Harris
- Christchurch Hospital, Canterbury, New Zealand
| | - Derek Jonker
- Ottawa Health Research Institute, Ottawa, Canada
| | - Yu Jo Chua
- Canberra Hospital, Australian Capital Territory, Australia
| | - Richard Epstein
- The Kinghorn Cancer Centre, St Vincent's Hospital, New South Wales, Australia
| | | | - Belinda Kiely
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia
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Mitchell AP, Winn AN, Lund JL, Dusetzina SB. Evaluating the Strength of the Association Between Industry Payments and Prescribing Practices in Oncology. Oncologist 2019; 24:632-639. [PMID: 30728276 DOI: 10.1634/theoncologist.2018-0423] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/30/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown. MATERIALS AND METHODS We evaluated physician use of orally administered cancer drugs for four cancers: prostate (abiraterone, enzalutamide), renal cell (axitinib, everolimus, pazopanib, sorafenib, sunitinib), lung (afatinib, erlotinib), and chronic myeloid leukemia (CML; dasatinib, imatinib, nilotinib). Separate physician cohorts were defined for each cancer type by prescribing history. The primary exposure was the number of calendar years during 2013-2015 in which a physician received payments from the manufacturer of one of the studied drugs; the outcome was relative prescribing of that drug in 2015, compared with the other drugs for that cancer. We evaluated whether practice setting at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict-of-interest policies were associated with the strength of the payment-prescribing association. We used modified Poisson regression to control confounding by other physician characteristics. RESULTS Physicians who received payments for a drug in all 3 years had increased prescribing of that drug (compared with 0 years), for renal cell (relative risk [RR] 1.81, 95% confidence interval [CI] 1.58-2.07), CML (RR 1.22, 95% CI 1.08-1.39), and lung (RR 1.69, 95% CI 1.58-1.82), but not prostate (RR 0.97, 95% CI 0.93-1.02). Physicians who received compensation payments or >$100 annually had increased prescribing compared with those who did not, but NCI setting and institutional conflict-of-interest policies were not consistently associated with the direction of prescribing change. CONCLUSION The association between industry payments and cancer drug prescribing was greatest among physicians who received payments consistently (within each calendar year). Receipt of payments for compensation purposes, such as for consulting or travel, and higher dollar value of payments were also associated with increased prescribing. IMPLICATIONS FOR PRACTICE Financial payments from pharmaceutical companies are common among oncologists. It is known from prior work that oncologists tend to prescribe more of the drugs made by companies that have given them money. By combining records of industry gifts with prescribing records, this study identifies the consistency of payments over time, the dollar value of payments, and payments for compensation as factors that may strengthen the association between receiving payments and increased prescribing of that company's drug.
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Affiliation(s)
- Aaron P Mitchell
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York New York, USA
| | - Aaron N Winn
- School of Pharmacy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, Wisconsin, USA
| | - Jennifer L Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
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Clemons M, Mazzarello S, Pond G, Amir E, Asmis T, Berry S, Brackstone M, Brule S, Goodwin R, Hilton JF, Julião M, Nicholas G, Stewart DJ, Wheatley-Price P, Cholmsky L, Krentel A, Hutton B, Joy AA. A prospective intervention to improve happiness and reduce burnout in oncologists. Support Care Cancer 2018; 27:1563-1572. [PMID: 30506102 DOI: 10.1007/s00520-018-4567-5] [Citation(s) in RCA: 6] [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: 06/01/2018] [Accepted: 11/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of data about effective interventions to improve happiness and reduce burnout in oncologists. Benjamin Franklin developed a 13-week program of "necessary activities" or "virtues" (temperance, silence, order, resolution, frugality, industry, sincerity, justice, moderation, cleanliness, tranquility, chastity, and humility) to follow, in his attempt at self-improvement. In this pilot study, we explored whether using a modified version of this was associated with any discernable impact on physician happiness, burnout, or compliance with each of the virtues. METHODS Self-reported happiness (Oxford happiness scores) and burnout (Abbreviated Maslach Burnout Inventory) were completed at baseline (pre-study), week 13, and 1 month after completion of the program. Each day during the 13-week program, oncologists were emailed a list of virtues to focus on and scored how they felt they were complying with them. The oncologist's spouses also assessed how they felt the oncologist was complying with the virtues. RESULTS Thirteen physicians completed the baseline scores, 11 completed Maslach/Oxford scores at the end of the study, and 8 the 1-month post-study assessment. No significant improvements in happiness and burnout (emotional exhaustion, depersonalization, personal accomplishment) scores were observed. Statistically significant changes in self-rated virtue scores were observed for temperance (p = 0.046), order (p = 0.049), and resolution (p = 0.014). Additionally, although not reaching statistical significance, 11 of 13 virtues (excepting sincerity and chastity) assessed by spouses indicated a positive change over time. CONCLUSION In this hypothesis generating study, daily reflection on personal virtues was not associated with any statistically significant change in happiness or burnout scores. Alternative strategies should be considered.
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Affiliation(s)
- Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada.
| | - Sasha Mazzarello
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Gregory Pond
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Eitan Amir
- Princess Margaret Cancer Centre, Toronto, Canada
| | - Timothy Asmis
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Scott Berry
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | | | - Stephanie Brule
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - Rachel Goodwin
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - John F Hilton
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos ACES Sintra, Sintra, Portugal
| | - Garth Nicholas
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - David J Stewart
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Paul Wheatley-Price
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Laurel Cholmsky
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | | | - Brian Hutton
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Anil A Joy
- Division of Medical Oncology, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Canada
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Berkowitz C, Allen DH, Tenhover J, Zullig LL, Ragsdale J, Fischer JE, Pollak KI, Koontz BF. Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care. J Cancer Educ 2018; 33:1323-1327. [PMID: 28707205 DOI: 10.1007/s13187-017-1250-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Long-term care for head and neck cancer (HNC) survivors is complex and requires coordination among multiple providers. Clinical practice guidelines highlight the role of primary care providers (PCPs) in screening for secondary cancer/recurrence, assessment of late/long-term side effects, and referrals for appropriate specialty management of toxicity. However, these responsibilities may be difficult to meet within the scope of primary care practice. We conducted this study to explore preferences, comfort, and knowledge of PCPs in the care of HNC survivors. We piloted a 40-item web-based survey developed with oncologist and PCP input targeted for family medicine and internal medicine providers. Responses were collected within a single university health system over 2 months. PCPs (n = 28; RR = 11.3%) were interested in learning about health promotion after cancer treatment (89%) and generally agree that their current practice patterns address healthy lifestyle behaviors (82%). However, only 32% of PCPs felt confident they could manage late/long-term side effects of chemotherapy, radiation, or surgery. Only 29% felt confident they could provide appropriate cancer screening. Looking at shared care responsibilities with oncology providers, PCPs perceived being responsible for 30% of care in the first year after treatment and 81% of care after 5 years. Seventy-one percent of PCPs agreed that oncologists provided them necessary information, yet 32% of PCPs found it difficult to coordinate with cancer providers. While these PCPs perceive increased care responsibility for long-term survivors, most are uncomfortable screening for recurrence and managing late/long-term side effects. Education and mutual coordination between PCPs and oncology providers may improve survivor care.
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Affiliation(s)
| | - Deborah H Allen
- Duke Cancer Institute, Box 3085 DUMC, Durham, NC, 27710, USA
- Duke University Health System, Durham, NC, USA
| | | | - Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
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Hatfield J, McClelland S, Luo J, Degnin C, Chen Y, Maggiore RJ, Mitin T. Management of Localized Breast Angiosarcoma by North American Radiation and Medical Oncologists. Clin Breast Cancer 2018; 18:498-503. [PMID: 30482726 DOI: 10.1016/j.clbc.2018.09.009] [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] [Received: 06/08/2018] [Revised: 08/16/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Primary breast angiosarcoma is a rare malignancy with no clinical trials to guide management. The current use of surgery, chemotherapy, and radiotherapy among North American oncologists is unknown. PATIENTS AND METHODS An institutional review board-approved anonymous electronic survey was distributed to 9660 practicing North American radiation and medical oncologists. Questions pertained to treatment recommendations for localized nonmetastatic primary breast angiosarcoma, as well as knowledge/use of β-blockers in angiosarcoma. The Fisher exact test was used to compare responses of medical and radiation oncologists. RESULTS Surgery was recommended by 95% of all respondents. Chemotherapy was recommended by over half of medical and radiation oncologists. Radiotherapy was recommended by 92% of radiation and 56% of medical oncologists. The most common treatment recommendation was a trimodal treatment, with up-front surgery followed by adjuvant chemotherapy, then by adjuvant radiotherapy. Twenty-two percent of respondents were aware of clinical data pertaining to the use of β-blockers in management of angiosarcoma, and among these respondents 69% were comfortable incorporating this treatment into standard practice. CONCLUSION Trimodal management of primary localized breast angiosarcoma is supported by North American radiation and medical oncologists, with the majority recommending up-front surgery followed by adjuvant chemotherapy and radiation. The recently published reports of successful use of β-blockers are not yet known among North American clinicians, but there is a great enthusiasm to incorporate these commonly prescribed medications into standard practice. These findings may greatly influence the standard of care for breast angiosarcoma treatment, particularly given the absence of Level I-supported evidence.
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Affiliation(s)
- Jess Hatfield
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Shearwood McClelland
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Jia Luo
- Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Catherine Degnin
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR
| | - Yiyi Chen
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR
| | - Ronald J Maggiore
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR.
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Jagsi R, Ward KC, Abrahamse P, Wallner LP, Kurian AW, Hamilton AS, Katz SJ, Hawley ST. Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer. Cancer 2018; 124:3668-3676. [PMID: 30033631 PMCID: PMC6553459 DOI: 10.1002/cncr.31532] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [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: 02/19/2018] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Little is known regarding whether growing awareness of the financial toxicity of a cancer diagnosis and its treatment has increased clinician engagement or changed the needs of current patients. METHODS The authors surveyed patients with early-stage breast cancer who were identified through population-based sampling from 2 Surveillance, Epidemiology, and End Results (SEER) regions and their physicians. The authors described responses from approximately 73% of surgeons (370 surgeons), 61% of medical oncologists (306 medical oncologists), 67% of radiation oncologists (169 radiation oncologists), and 68% of patients (2502 patients). RESULTS Approximately one-half (50.9%) of responding medical oncologists reported that someone in their practice often or always discusses financial burden with patients, as did 15.6% of surgeons and 43.2% of radiation oncologists. Patients indicated that financial toxicity remains common: 21.5% of white patients and 22.5% of Asian patients had to cut down spending on food, as did 45.2% of black and 35.8% of Latina patients. Many patients desired to talk to providers about the financial impact of cancer (15.2% of whites, 31.1% of blacks, 30.3% of Latinas, and 25.4% of Asians). Unmet patient needs for engagement with physicians about financial concerns were common. Of 945 women who worried about finances, 679 (72.8%) indicated that physicians and their staff did not help. Of 523 women who desired to talk to providers regarding the impact of breast cancer on employment or finances, 283 (55.4%) reported no relevant discussion. CONCLUSIONS Many patients report inadequate clinician engagement in the management of financial toxicity, even though many providers believe that they make services available. Clinician assessment and communication regarding financial toxicity must improve; cure at the cost of financial ruin is unacceptable. Cancer 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Reshma Jagsi
- University of Michigan, Department of Radiation Oncology, Center for Bioethics and Social Science in Medicine
| | - Kevin C. Ward
- Emory University, Rollins School of Public Health, Department of Epidemiology
| | | | - Lauren P. Wallner
- University of Michigan, Department of Internal Medicine
- University of Michigan, Department of Epidemiology
| | | | - Ann S. Hamilton
- Keck School of Medicine, University of Southern California, Department of Preventive Medicine
| | - Steven J. Katz
- University of Michigan, Department of Internal Medicine
- University of Michigan, Department of Health Management and Policy
| | - Sarah T. Hawley
- University of Michigan, Department of Internal Medicine
- University of Michigan, Department of Health Management and Policy
- Ann Arbor VA Center of Excellence in Health Services Research & Development
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Granek L, Nakash O, Ben-David M, Shapira S, Ariad S. Oncologists' Treatment Responses to Mental Health Distress in Their Cancer Patients. Qual Health Res 2018; 28:1735-1745. [PMID: 29973126 DOI: 10.1177/1049732318786479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/08/2023]
Abstract
The objectives of this study were to identify how oncologists respond to mental health distress in their patients, what specific strategies they use in treating this distress, and what barriers they report responding to their patients' emotional distress. Twenty-three oncologists at two cancer centers were interviewed. The grounded theory method of data collection and analysis was used. Oncologists varied in their response to patients' emotional distress. Strategies used in responding to patients' distress included creating supportive relationships and prescribing medications, while barriers included patient reluctance, a lack of protocol on how to respond to patients, limited psychosocial resources, and a lack of time. Developing and adopting clear guidelines to addressing mental health distress among cancer patients is critical in assuring quality care for the whole patient and reduce the risk for poor quality of life and potential disease-related morbidity and mortality.
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Affiliation(s)
- Leeat Granek
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ora Nakash
- 2 Smith College, Northampton, Massachusetts, USA
- 3 Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Merav Ben-David
- 4 Tel Aviv University, Tel Aviv, Israel
- 5 Sheba Medical Center, Ramat-Gan, Israel
| | - Shahar Shapira
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Samuel Ariad
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
- 6 Soroka University Medical Center, Beer-Sheva, Israel
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Bieber C, Nicolai J, Gschwendtner K, Müller N, Reuter K, Buchholz A, Kallinowski B, Härter M, Eich W. How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer? J Cancer Educ 2018; 33:708-715. [PMID: 27966192 PMCID: PMC5949132 DOI: 10.1007/s13187-016-1146-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The aims of this study are to assess patients' preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients' preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients' 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p < 0.05) with more patients perceiving SDM or an active role, but their preference matching was not influenced. A SDM intervention for oncologists boosted patient autonomy but did not improve preference matching. This highlights the already well-known reluctance of physicians to engage in explicit role clarification. TRIAL REGISTRATION German Clinical Trials Register DRKS00000539; Funding Source: German Cancer Aid.
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Affiliation(s)
- Christiane Bieber
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany.
| | - Jennifer Nicolai
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
- Department of Psychology III - Cognition and Individual Differences, University of Mannheim, Mannheim, Germany
| | - Kathrin Gschwendtner
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Nicole Müller
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Katrin Reuter
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
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Furui T, Takai Y, Kimura F, Kitajima M, Nakatsuka M, Morishige K, Yamamoto K, Hashimoto H, Matsumoto K, Ozono S, Horibe K, Suzuki N. [Current Status of Oncofertility in Adolescent and Young Adult (AYA) Generation Cancer Patients in Japan - National Survey of Oncologists]. Gan To Kagaku Ryoho 2018; 45:841-846. [PMID: 30026448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A national survey conducted in 2016 aimed to evaluate the current status and needs of the field of oncofertility and to consider optimized medical delivery systems. A total of 739 oncologists, excluding gynecological and urological specialists, were surveyed. Of these, 99.2% thought that providing information on fertility preservation was important. Of the surveyed oncologists, 48% were affiliated with facilities providing assisted reproductive technology, and 79.3% practiced in university hospitals. Of 238 (32.2%) specialists who provided information on the risk of reproductive damage resulting from treatment in their facility, 163 (44.9%) and 75 (19.9%) practiced in university hospitals (n=363) and non-university hospitals (n= 376), respectively. In contrast, 14.3% and 32.7% of oncologists who practiced in university hospitals and non-university hospitals, respectively, collaborated with local obstetricians and gynecologists. Among oncologists who use a gradually expanding regional oncofertility network, 0.6% practice in university hospitals and 2.7% practice in non-university hospitals. Patients were advised that the risk of infertility was 92.3% and the likelihood of fertility preservation was 66.9%. Furthermore, as an ideal way of providing information on preservation of fertility, 22.9% of oncologists collaborate with local gynecologists, and 26.3% do so at a public cancer and reproductive medical counseling center. In addition, 34.7% and 55.1% of oncologists at university and non-university hospitals, respectively, thought that implementation of a fertility preservation program at a public facility would be desirable. Although most oncologists recognize the importance of providing information on reproductive medicine, the support system for reproductive function and fertility in adolescent and young adult (AYA) generation cancer patients is limited because of the lack of agreement on patient referral. The limited number of referrals in turn limits data collection in the field of oncofertility. Grant: A Health and Labour Sciences Research Grant: H27-Cancer Control-Ippan.
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Affiliation(s)
- Tatsuro Furui
- Dept. of Obstetrics and Gynecology, Gifu University Graduate School of Medicine
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Shaul E, Roth M, Lo Y, Geller DS, Hoang B, Yang R, Malkin D, Gorlick R, Gill J. Pediatric oncologist willingness to offer germline TP53 testing in osteosarcoma. Cancer 2018; 124:1242-1250. [PMID: 29313943 DOI: 10.1002/cncr.31212] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/08/2017] [Accepted: 12/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome caused by mutations in the tumor-suppressor gene TP53. Osteosarcoma is a sentinel cancer in LFS. Prior studies using Sanger sequencing platforms have demonstrated that 3% of individuals with osteosarcoma harbor a mutation in TP53. New data from next-generation sequencing have demonstrated that 3.8% of patients with osteosarcoma have a known pathogenic variant, and an additional 5.7% carry exonic variants of unknown significance in TP53. METHODS Pediatric oncologists were e-mailed an anonymous 18-question survey assessing their willingness to offer TP53 germline testing to a child with osteosarcoma with or without a family history, and they were evaluated for changes in their choices with the prior data and the new data. RESULTS One hundred seventy-seven pediatric oncologists (22%) responded to the survey. Respondents were more likely to offer TP53 testing to a patient with a positive family history (77.4% vs 12.4%; P < .0001). Significantly more providers responded that they would offer TP53 testing once they were provided with the new data (25.4% vs 12.4%; P = .0038). The proportion of providers who responded that they were unsure increased significantly when they were presented with the new data (25.4% vs 10.2%; P = .0002). Potential implications for other family members and the possibility that surveillance imaging would detect new malignancies at an earlier stage were important factors influencing a provider's decision to offer TP53 testing. CONCLUSIONS Recent data increase the proportion of providers willing to offer testing, and this suggests concern on the part of pediatric oncologists that variants of unknown significance may be disease-defining in rare cancers. Cancer 2018;124:1242-50. © 2018 American Cancer Society.
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Affiliation(s)
- Eliana Shaul
- Division of Pediatric Hematology/Oncology and Marrow and Blood Cell Transplantation, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Michael Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yungtai Lo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - David S Geller
- Department of Orthopaedic Surgery, Montefiore Medical Center and Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Bang Hoang
- Department of Orthopaedic Surgery, Montefiore Medical Center and Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Rui Yang
- Department of Orthopaedic Surgery, Montefiore Medical Center and Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - David Malkin
- Division of Hematology/Oncology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Richard Gorlick
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan Gill
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Niemier JY, Claudot F, Nguyen-Thi PL, Klein I, Rousselot H, Perret-Guillaume C. Decision making affecting care of older people with cancer: a comparison between general practitioners and oncologists in Lorraine. Geriatr Psychol Neuropsychiatr Vieil 2017; 15:369-376. [PMID: 29187326 DOI: 10.1684/pnv.2017.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The main objective of this study is to identify the decision criteria of general practitioners and oncologists in the management of older patients with cancer in Lorraine. The secondary objectives are to identify the difficulties encountered and to propose solutions to improve health path of these patients. 2,995 post mail questionnaires were sent to all general practitioners and oncologists in Lorraine. Some decision criteria differ between general practitioners and oncologists: civilian age and accessibility to a specialized advice for general practitioners; type of cancer, nutritional status, application of best practice recommendations, and multidisciplinary discussion for oncologists. The main difficulties reported are organizational and relate to time interval before specific care beginning, accessibility to a medical specialist, and post-diagnosis such link between primary care and hospital. General practitioners and oncologists mainly agree with the difficulties encountered and the solutions to find, even if some decision criteria differences are highlighted. The training of professionals remains the major lever for improvement of medical practices.
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Affiliation(s)
- Jean-Yves Niemier
- Service de gériatrie, Centre hospitalier régional universitaire de Nancy, Hôpitaux de Brabois, Vandœuvre-lès-Nancy, France
| | - Frédérique Claudot
- EI Ethos Axe 2, Faculté de médecine, Université de Lorraine, Nancy, France
| | - Phi Linh Nguyen-Thi
- Plateforme d'aide à la recherche clinique, Centre hospitalier régional universitaire de Nancy, Hôpitaux de Brabois, Vandœuvre-lès-Nancy, France
| | | | - Hubert Rousselot
- Service du SISSPO, Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Christine Perret-Guillaume
- Service de gériatrie, Centre hospitalier régional universitaire de Nancy, Hôpitaux de Brabois, Vandœuvre-lès-Nancy, France
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Vander Haegen M, Stassart C, Etienne AM. [Perception by the oncologist of the parental distress in childhood cancer survivor]. Rev Med Liege 2017; 72:488-493. [PMID: 29171947] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of the study was to assess the degree of similarity between the distress expressed by parents of a child cancer survivor and the distress perceived by the oncologist. Overall, 61 parents of a child cancer survivor (between 4 and 6 years of cancer remission) were recruited in Belgian hospitals (Province of Liège). Parents filled out questionnaires about the intolerance of uncertainty (IUS), positive beliefs about worry (WW-II), parental worries about the evolution of their child's health (QIPS-R15), problem orientation (NPOQ), cognitive avoidance (CAQ), ruminations (Mini-CERTS), and anxiety/depression (HADS). Eight oncologists who having taken care of the child filled out the «OncoMed» questionnaire that examines their perception of the parental distress (e.g. anxiety, worries). Parents suffered from anxiety,worries about their child's health and showed a low level of tolerance of uncertainty. Overall, oncologists demonstrated a low perceived distress compared to the level of parental distress. The study highlights the need to detect early parents who are intolerant of uncertainty in order to offer them an efficient psychological follow-up. This study underlines finally the necessity to develop medical perception tools about the distress in order to strengthen the medical communication and the follow-up of these families.
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Affiliation(s)
- M Vander Haegen
- Faculté de Psychologie, Logopédie et Sciences de l'Éducation, Université de Liège, 4000 Liège, Belgique
| | - C Stassart
- Faculté de Psychologie, Logopédie et Sciences de l'Éducation, Université de Liège, 4000 Liège, Belgique
| | - A-M Etienne
- Faculté de Psychologie, Logopédie et Sciences de l'Éducation, Université de Liège, 4000 Liège, Belgique
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Ernstmann N, Wirtz M, Nitzsche A, Gross SE, Ansmann L, Gloede TD, Jung J, Pfaff H, Baumann W, Schmitz S, Neumann M. Patients' Trust in Physician, Patient Enablement, and Health-Related Quality of Life During Colon Cancer Treatment. J Cancer Educ 2017; 32:571-579. [PMID: 28110419 DOI: 10.1007/s13187-017-1166-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In cancer care, where patients and their families experience significant emotional distress and patients have to deal with complex medical information, patient centeredness is an important aspect of quality of care. The aim of this study is to examine the impact of patients' trust in their oncologists and patients' enablement on changes in health-related quality of life of colon cancer patients during follow-up care. We conducted a prospective study in a representative sample of private practices of German oncologists (N = 44). Patients (N = 131) filled out a standardized questionnaire prior to their first consultation (T0), directly after the first consultation (T1) and after two months (T2). Data were analyzed by structural equation modeling. Significant associations were found between trust in physician and changes in physical functioning between T1 and T2, and between trust in physician and patient enablement. Patient enablement is significantly associated with changes in physical functioning between T1 and T2. The results underline the importance of building a close and trustful patient-physician relationship in the oncology encounter. A central mechanism of the association between the quality of the relationship and health outcomes seems to be patient enablement. To enable patients to cope with their situation by making them understand their diagnosis, treatments, and side effects can impact health-related quality of life in physical domains.
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Affiliation(s)
- Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Markus Wirtz
- Department for Research Methodology, University of Education, Kunzenweg 21, 79117, Freiburg, Germany
| | - Anika Nitzsche
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Sophie E Gross
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Lena Ansmann
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Tristan D Gloede
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Julia Jung
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Walter Baumann
- Scientific Institute of Office-Based Haematologists and Oncologists, WINHO , Vor den Siebenburgen 2, 50676, Cologne, Germany
| | - Stephan Schmitz
- Professional Organization of Office-Based Haematologists and Oncologists e.V. (BNHO), Sachsenring 69, 50677, Cologne, Germany
| | - Melanie Neumann
- Institute for Integrative Medicine, Department for Psychology/Psychotherapy, Department for Medicine, Faculty of Health, Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
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Weipert CM, Ryan KA, Everett JN, Yashar BM, Chinnaiyan AM, Scott Roberts J, De Vries R, Zikmund-Fisher BJ, Raymond VM. Physician Experiences and Understanding of Genomic Sequencing in Oncology. J Genet Couns 2017; 27:187-196. [PMID: 28840409 DOI: 10.1007/s10897-017-0134-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/12/2016] [Accepted: 07/18/2017] [Indexed: 01/14/2023]
Abstract
The amount of information produced by genomic sequencing is vast, technically complicated, and can be difficult to interpret. Appropriately tailoring genomic information for non-geneticists is an essential next step in the clinical use of genomic sequencing. To initiate development of a framework for genomic results communication, we conducted eighteen qualitative interviews with oncologists who had referred adult cancer patients to a matched tumor-normal tissue genomic sequencing study. In our qualitative analysis, we found varied levels of clinician knowledge relating to sequencing technology, the scope of the tumor genomic sequencing study, and incidental germline findings. Clinicians expressed a perceived need for more genetics education. Additionally, they had a variety of suggestions for improving results reports and possible resources to aid in results interpretation. Most clinicians felt genetic counselors were needed when incidental germline findings were identified. Our research suggests that more consistent genetics education is imperative in ensuring the proper utilization of genomic sequencing in cancer care. Clinician suggestions for results interpretation resources and results report modifications could be used to improve communication. Clinicians' perceived need to involve genetic counselors when incidental germline findings were found suggests genetic specialists could play a critical role in ensuring patients receive appropriate follow-up.
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Affiliation(s)
- Caroline M Weipert
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jessica N Everett
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109-5419, USA
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Scott Roberts
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Victoria M Raymond
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109-5419, USA.
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Mampuya WA, Matsuo Y, Nakamura A, Hiraoka M. Evaluation of the prevalence of burnout and psychological morbidity among radiation oncologist members of the Kyoto Radiation Oncology Study Group (KROSG). J Radiat Res 2017; 58:217-224. [PMID: 28399575 PMCID: PMC5571610 DOI: 10.1093/jrr/rrw094] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/11/2016] [Accepted: 08/30/2016] [Indexed: 06/07/2023]
Abstract
This study aimed to evaluate the self-reported prevalence of burnout and psychological morbidity among radiation oncologists members of the Kyoto Radiation Oncology Study Group (KROSG) and to identify factors contributing to burnout. We mailed an anonymous survey to 125 radiation oncologists members of the KROSG. The survey included; the demographic data, the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) and the 12-item General Health Questionnaire (GHQ-12). There were 87 responses out of 125 eligible respondents (69.6% response rate). In terms of burnout, three participants (3.4%) fulfilled the MBI-HSS criteria of having simultaneously high emotional exhaustion (EE), high depersonalization (DP) and low sense of personal accomplishment (PA). Eighteen (20.6%) reported a high score for either EE or DP meeting the alternative criteria for burnout with three of these simultaneously having high EE and high DP. The prevalence of psychological morbidity estimated using GHQ-12 was 32%. A high level of EE and low level of PA significantly correlated with high level of psychological morbidity with P < 0.001 and <0.01 respectively. Having palliative care activities other than radiotherapy and number of patients treated per year were the only factors associated with burnout. This is the first study investigating the prevalence of burnout and psychological morbidity among radiation oncologists in Japan. Compared with other studies involving radiation oncologists, the prevalence of low personal accomplishment was particularly high in the present study. The prevalence of psychological morbidity was almost the double that of the Japanese general population and was significantly associated with low PA and high EE.
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Affiliation(s)
- Wambaka Ange Mampuya
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akira Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Marshall DC, Moy B, Jackson ME, Mackey TK, Hattangadi-Gluth JA. Distribution and Patterns of Industry-Related Payments to Oncologists in 2014. J Natl Cancer Inst 2016; 108:djw163. [PMID: 27389914 PMCID: PMC5241893 DOI: 10.1093/jnci/djw163] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/29/2016] [Accepted: 05/25/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Industry-physician collaboration is critical for anticancer therapeutic development, but financial relationships introduce conflicts of interest. We examined the specialty variation and context of physician payments and ownership interest among oncologists. METHODS We performed a population-based multivariable analysis of 2014 Open Payments reports of industry payments to US physicians matched to physician and practice data, including sex, specialty, practice location, and sole proprietor status. Payment data were aggregated per physician and compared by specialty (medical, radiation, surgical, and nononcology), and practice location linked with spending level (low, average, and high). Primary outcomes included likelihood, mean annual amount, and number of general payments. Secondary outcomes included likelihood of holding ownership interests and receipt of royalty/license payments. Estimates for each outcome were determined using multivariable models, including logistic regression for likelihood and linear regression with gamma distribution and log-link for value, adjusted for physician specialty, sex, sole proprietor status, and practice spending. All statistical tests were two-sided. RESULTS In 2014, there were 883 438 physicians, including 22 712 oncologists, licensed to practice in the United States. Among oncology specialties, 52.4% to 63.0% of physicians received a general payment in 2014, totaling $76 million, $4 million, and $5 million to medical, radiation, and surgical oncology, respectively. The median annual per-physician payment to medical oncologists was $632 (IQR = 136-2500), compared with $124 (IQR = 39-323) in radiation oncology and $250 (IQR = 84-1369) in surgical oncology. After controlling for physician and practice characteristics, oncologists were 1.09 to 1.75 times as likely to receive a general payment compared with nononcologists (overall P < 001). There was a 67.6% difference (95% confidence interval [CI] = 63.6 to 71.5, P < .001) in the mean annual value of payments between medical oncology and nononcology specialties (vs -92.7%, 95%CI = -100.2 to -85.0, P < .001] for radiation oncology). Medical and radiation oncologists were more likely to hold ownership interest (adjusted OR = 3.72, 95% CI = 3.22 to 4.27, and 2.27, 95% CI = 1.65 to 3.03, respectively, P < .001 both comparisons). CONCLUSIONS In 2014, industry-oncologist financial relationships were common, and their impact on oncology practice should be further explored.
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Affiliation(s)
- Deborah C Marshall
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
| | - Beverly Moy
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
| | - Madeleine E Jackson
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
| | - Tim K Mackey
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
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Boero IJ, Gillespie EF, Hou J, Paravati AJ, Kim E, Einck JP, Yashar C, Mell LK, Murphy JD. The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2016; 97:571-580. [PMID: 28126306 DOI: 10.1016/j.ijrobp.2016.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE Despite multiple randomized trials showing the efficacy of hypofractionated radiation therapy in early-stage breast cancer, the United States has been slow to adopt this treatment. The goal of this study was to evaluate the impact of individual radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer. METHODS We identified 22,233 Medicare beneficiaries with localized breast cancer that was diagnosed from 2004 to 2011 who underwent breast-conserving surgery with adjuvant radiation. Multilevel, multivariable logistic models clustered by radiation oncologist and geographic practice area were used to determine the impact of the provider and geographic region on the likelihood of receiving hypofractionated compared with standard fractionated radiation therapy while controlling for a patient's clinical and demographic covariates. Odds ratios (OR) describe the impact of demographic or clinical covariates, and the median OR (MOR) describes the relative impact of the individual radiation oncologist and geographic region on the likelihood of undergoing hypofractionated radiation therapy. RESULTS Among the entire cohort, 2333 women (10.4%) were treated with hypofractionated radiation therapy, with unadjusted rates ranging from 0.0% in the bottom quintile of radiation oncologists to 30.4% in the top quintile. Multivariable analysis found that the individual radiation oncologist (MOR 3.08) had a greater impact on the use of hypofractionation than did geographic region (MOR 2.10) or clinical and demographic variables. The impact of the provider increased from the year 2004 to 2005 (MOR 2.82) to the year 2010 to 2011 (MOR 3.16) despite the publication of long-term randomized trial results in early 2010. Male physician and radiation oncologists treating the highest volume of breast cancer patients were less likely to perform hypofractionation (P<.05). CONCLUSIONS The individual radiation oncologist strongly influenced the likelihood of a patient's receiving hypofractionated radiation therapy, and this trend increased despite the publication of long-term data showing equivalence to standard fractionation. Future research should focus on physician-related factors that influence this decision.
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Affiliation(s)
- Isabel J Boero
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Erin F Gillespie
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Jiayi Hou
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Anthony J Paravati
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Ellen Kim
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California.
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Senturk MF, Cimen E, Tuzuner Oncul AM, Cambazoglu M. Oncologists awareness about bisphosphonate related osteonecrosis of the jaws. J PAK MED ASSOC 2016; 66:880-883. [PMID: 27427140] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the oncologists thoughts about the positive and adverse effects of bisphosphonates, drug holiday and the awareness about BRONJ. METHODS A written questionnaire was sent to 7 hospitals, which have oncology facilities in Ankara, Turkey. Results were evaluated as percentages. Chi Square and Kruskal Wallis H test was used to analyze the data. RESULTS A total of 53 oncologists replied to the questionnaire. BRONJ is the most seen complication (66%) due to bisphosphonates usage. Temporary suspension of the drug (52.8%) is the best treatment choice for this complication. Oncologists usually prefered dentist consultatation (39.6%). CONCLUSIONS A good cooperation of oncologists and dentists is very important to prevent BRONJ.
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Affiliation(s)
- Mehmet Fatih Senturk
- Dentistry Faculty, Oral and Maxillofacial Surgery Department, Suleyman Demirel University, Isparta, Turkey
| | - Emre Cimen
- Dentistry, Oral and Maxillofacial Surgery, Ugurel Dental Clinic, Istanbul, Turkey
| | | | - Mine Cambazoglu
- Dentistry Faculty, Oral and Maxillofacial Surgery Department, Ankara University, Ankara, Turkey
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