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Oral Oncology Sep 2016Transoral Robotic Surgery (TORS) is a fascinating new technology allowing for excellent functional outcomes after resection of head and neck tumors that previously... (Review)
Review
Transoral Robotic Surgery (TORS) is a fascinating new technology allowing for excellent functional outcomes after resection of head and neck tumors that previously required morbid surgical approaches for access. With a new technology, however, come new questions as to optimal patient selection and its impact on adjuvant therapy considerations. Here we review the issues most pertinent to a radiation oncologist adapting to the use of TORS. Patient selection, indications for adjuvant radiotherapy, radiation dose and target volumes are discussed. Finally, ongoing clinical trials and future directions are considered.
Topics: Chemotherapy, Adjuvant; Combined Modality Therapy; Head and Neck Neoplasms; Humans; Mouth; Radiation Oncologists; Radiotherapy, Adjuvant; Robotic Surgical Procedures
PubMed: 27531879
DOI: 10.1016/j.oraloncology.2016.07.008 -
Gynecologic Oncology May 2021This commentary is presenting opinions and advice on mentorship in the field of gynecologic oncology. Eleven academic gynecologic oncologists from across the country...
This commentary is presenting opinions and advice on mentorship in the field of gynecologic oncology. Eleven academic gynecologic oncologists from across the country were interviewed and their thoughts about mentorship were recorded with recurring themes and ideas described in this commentary. Trust, respect, and mutual agreement on expectations were all described as vital to a functioning mentor/mentee relationship. Mentorship is critical for fellows and junior faculty to expand and uphold the standards of the field.
Topics: Attitude of Health Personnel; Female; Gynecology; Humans; Interprofessional Relations; Interviews as Topic; Leadership; Male; Medical Oncology; Mentoring; Mentors; Oncologists; Physician's Role; United States
PubMed: 33516530
DOI: 10.1016/j.ygyno.2021.01.017 -
Palliative & Supportive Care Feb 2024In this study, we assessed the patient-oncologist relationship, conceptualized as the working alliance from a dyadic perspective, and its relation to locus of control.
OBJECTIVES
In this study, we assessed the patient-oncologist relationship, conceptualized as the working alliance from a dyadic perspective, and its relation to locus of control.
METHODS
One hundred and three oncologist-patient dyads were recruited. Measures included a sociodemographic and medical questionnaire; the "internal, powerful others, and chance" locus of control scale; and the working alliance inventory.
RESULTS
Application of the actor-partner interdependence model yielded 2 actor effects: a positive association between oncologist "internal" locus of control and oncologist working alliance, and a negative association between oncologist "chance" locus of control and oncologist working alliance. It also yielded one partner effect: a positive association between oncologist "internal" locus of control and patient working alliance.
SIGNIFICANCE OF RESULTS
The actor-partner effect suggests that oncologists' locus of control has a role in the establishment of the patient-oncologist working alliance; oncologists' internal locus of control is a dominant factor affecting not only their own perceived alliance but patients' perceived alliance as well.
Topics: Humans; Physician-Patient Relations; Neoplasms; Internal-External Control; Oncologists; Patients
PubMed: 36222068
DOI: 10.1017/S1478951522001377 -
Surgical Oncology Clinics of North... Jul 2020Wounds resulting from wide local excision of melanoma vary in size and complexity, and require individualized solutions to achieve satisfactory closure. Goals of... (Review)
Review
Wounds resulting from wide local excision of melanoma vary in size and complexity, and require individualized solutions to achieve satisfactory closure. Goals of reconstruction include restoration of form, function, and aesthetics while minimizing donor site morbidity without compromising the effectiveness and safety of oncologic melanoma treatment. Optimal reconstruction relies on an in-depth understanding of the defect, locoregional anatomy and vasculature, available donor tissues, and basic wound healing and surgical principles. This article provides a broad overview of preoperative patient, timing, and wound considerations; various surgical techniques for complex reconstruction throughout the body; and postoperative care and complication management.
Topics: Humans; Melanoma; Oncologists; Plastic Surgery Procedures; Skin Neoplasms
PubMed: 32482313
DOI: 10.1016/j.soc.2020.02.003 -
Journal of Medical Internet Research Aug 2023The COVID-19 pandemic exacerbated gender inequity in medicine, with women physicians reporting greater household responsibilities than their men counterparts and steeper...
The COVID-19 pandemic exacerbated gender inequity in medicine, with women physicians reporting greater household responsibilities than their men counterparts and steeper barriers to career advancement. The pandemic highlighted the systemic assumptions and challenges faced by women physicians, which we anticipate is also true in our field of oncology. Prior literature suggests that women physicians were tasked with increased personal and professional responsibilities without compensation for their additional work, as well as derailments in career progression and significant burnout. Our aims are to highlight areas of opportunity to optimize the workplace experience of the oncology workforce and to invest in the professional well-being and sustainability of women oncologists as a step toward global workplace equity and future pandemic preparedness.
Topics: Female; Humans; Male; Burnout, Psychological; COVID-19; Oncologists; Pandemics; Workplace; Physicians, Women
PubMed: 37603399
DOI: 10.2196/47784 -
Journal of Cancer Research and... 2022The diagnosis of malignancy, particularly brain tumors, in pregnancy is uncommon but poses a complex dilemma for the management of both the patient and her fetus, as the... (Review)
Review
The diagnosis of malignancy, particularly brain tumors, in pregnancy is uncommon but poses a complex dilemma for the management of both the patient and her fetus, as the interplay of disease with the physiological state of pregnancy affects both outcomes. The routine evaluations (symptomatology, imaging, and hormonal assessments) and treatments (surgery, radiation therapy, and chemotherapy) that are commonplace in brain tumor management may need to be omitted or modified keeping in mind the risk to offspring. Multidisciplinary care and extensive prenatal and perinatal counseling and monitoring are essential. In this review, we discuss the available data addressing these issues and factors which may affect considerations of therapeutic abortions, changes in surgical or medical practices, and outcomes thereof.
Topics: Brain Neoplasms; Counseling; Female; Humans; Oncologists; Pregnancy
PubMed: 35381756
DOI: 10.4103/jcrt.JCRT_1343_20 -
The Oncologist Aug 2021Tumor multigene next-generation sequencing (NGS) is increasingly being offered to cancer patients to guide clinical management and determine eligibility for clinical... (Review)
Review
BACKGROUND
Tumor multigene next-generation sequencing (NGS) is increasingly being offered to cancer patients to guide clinical management and determine eligibility for clinical trials. We undertook a review of studies examining the knowledge and attitudes of patients and oncologists regarding the primary results and potential secondary findings of such testing.
MATERIALS AND METHODS
A search was conducted through the MEDLINE database using the following keywords: "neoplasms" and "molecular sequencing / genome sequencing / tumor profiling / NGS / whole exome sequencing" and "patient / oncologist" and "knowledge / attitudes / satisfaction / experience / evaluation / perspective / practice / preference." Articles meeting the inclusion criteria and additional relevant articles from their references were selected.
RESULTS
From 1,142 publications identified by the search and 9 from references, 21 publications were included in the final review. Patients generally had positive attitudes toward tumor NGS despite relatively little knowledge of test-related genetics concepts, but their expectations often exceeded the reality of low clinical utility. Patients with higher education and greater genetics knowledge had more realistic expectations and a more altruistic view of the role of NGS. Attitudes toward disclosure of secondary findings were highly variable. Oncologists had poor to moderate genomic literacy; they communicated challenges with tempering patient expectations and deciding what information to disclose.
CONCLUSION
Patients considering undergoing tumor NGS should be provided with easily understandable resources explaining the procedure, goals, and probable outcomes, whenever possible based on evidence-based guidelines. Continuing medical education programs on this topic for oncology health care professionals should strive to improve their genomic literacy and instruct them on how to optimally present this information to their patients.
IMPLICATIONS FOR PRACTICE
Oncologists are increasingly offering tumor multigene testing to patients with advanced cancers to guide more "personalized" treatment and/or determine eligibility for clinical trials. However, patients often have inadequate understanding and unrealistic expectations. Oncologists must ensure that they themselves have sufficient knowledge of the benefits and limitations of testing and must provide their patients with appropriate educational resources. Prior to testing, patients should be told the likelihood of finding a mutation in their specific tumor type for which a targeted treatment or clinical trial is available. Patients also need clear information about the possibility and implications of secondary findings.
Topics: Genomics; High-Throughput Nucleotide Sequencing; Humans; Motivation; Neoplasms; Oncologists
PubMed: 33823080
DOI: 10.1002/onco.13783 -
International Journal of Radiation... Oct 2017Consideration of clinical research ethics in radiation oncology is underexplored relative to other areas of oncology. A number of ethical challenges related to informed... (Review)
Review
Consideration of clinical research ethics in radiation oncology is underexplored relative to other areas of oncology. A number of ethical challenges related to informed consent, randomization, conflicts of interest, and scientific validity and social value are shared with other areas of medicine, although their exact inflections are specific to radiation oncology. In addition, there are unique concerns in radiation oncology arising from the rapid evolution and uneven distribution of radiation technologies; the greater unfamiliarity of the general public and research oversight committees in regard to radiation oncology clinical practice; and the high complexity of managing most radiation oncology research, much of which is carried out in high-acuity multidisciplinary oncologic settings. To produce the best research, adherence to the highest ethical standards should be pursued as an integral component of all radiation oncology research.
Topics: Conflict of Interest; Ethics, Research; Humans; Informed Consent; Oncologists; Radiation Oncology; Reproducibility of Results; Social Values
PubMed: 28871967
DOI: 10.1016/j.ijrobp.2017.06.001 -
JCO Oncology Practice Mar 2023A validated risk model with inputs of pretreatment sodium and albumin can identify patients at risk for hospitalization during cancer treatment. We evaluated how the... (Comparative Study)
Comparative Study
PURPOSE
A validated risk model with inputs of pretreatment sodium and albumin can identify patients at risk for hospitalization during cancer treatment. We evaluated how the model compares with risk estimates from treating oncologists.
METHODS
We evaluated the 30-day risk of hospitalization or death in patients starting palliative-intent systemic therapy for solid tumor malignancy. For each patient, we prospectively recorded categorical estimates of 30-day hospitalization risk (bottom third, middle third, top third) generated by a treating oncologist and by the two-variable model; a third hybrid risk estimate represented a composite of the oncologist and model risk assessments. We analyzed the agreement of oncologist and model-based risk estimates and compared discrimination, sensitivity, and specificity of each risk assessment method.
RESULTS
We collected oncologist, model, and hybrid estimates of hospitalization risk for 120 patients. The 30-day rate of hospitalization or death was 20%. There was minimal agreement between oncologist and model risk estimates (weighted kappa = 0.27). The c-statistic (a measure of discrimination) was 0.69 (95% CI, 0.57 to 0.81) for the clinician assessment, 0.77 for the model assessment (CI, 0.67 to 0.86; = .24 compared with the oncologist assessment), and 0.79 for the hybrid assessment (CI, 0.69 to 0.90; = .007 compared with the oncologist assessment). Sensitivity and specificity of the high-risk categorization did not differ significantly between the oncologist and model assessments; the hybrid assessment was significantly more sensitive ( = .02) and less specific ( = .03) than the oncologist assessment.
CONCLUSION
A model with inputs of pretreatment sodium and albumin improves oncologists' predictions of hospitalization risk during cancer treatment.
Topics: Humans; Hospitalization; Neoplasms; Oncologists
PubMed: 36475736
DOI: 10.1200/OP.22.00422 -
Psycho-oncology Aug 2021Accumulating research suggests that the working alliance (WA) is a key component in the patient-oncologist relationship. Attachment theory provides a useful framework...
OBJECTIVE
Accumulating research suggests that the working alliance (WA) is a key component in the patient-oncologist relationship. Attachment theory provides a useful framework for understanding this alliance within the oncological setting, where patients' attachment systems are often activated. This study examined the association between attachment orientations of both dyad members (i.e., patient and oncologist) and patients' WA experience. It also probed whether this link was mediated by patients' attachment-related attitudes towards the oncologist, using a recently developed measure.
METHOD
Oncologists and their respective patients (N = 113: 103 patients, 10 oncologists) were sampled at oncological clinics. Eligible patients filled out online measures of the WA, attachment-related attitudes, and attachment orientations. The later was also completed by oncologists.
RESULTS
Structural equation modeling demonstrated that both patients' and oncologists' avoidant attachment orientation inversely predicted patients' WA experience, via patients' experience of feeling unsupported by their oncologists.
CONCLUSIONS
Findings suggest that attributes of both members of the patient-oncologist dyad are related to patients' WA experience, and that attachment-related attitudes towards oncologists occur within this relationship. Oncologists' understanding of patients' unique attachment behaviors, as well as their own such behaviors, could improve cancer patients' quality of care and illness outcomes. Results represent another step forward in fully exploring whether oncologists can serve as attachment figures for their patients.
Topics: Emotions; Humans; Medical Oncology; Neoplasms; Oncologists; Physician-Patient Relations
PubMed: 33834568
DOI: 10.1002/pon.5693