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The Oncologist Dec 2016An anecdote from a radiation-oncology setting is the underpinning of this recommendation that physicians consider introducing humor into the doctor-patient relationship.
An anecdote from a radiation-oncology setting is the underpinning of this recommendation that physicians consider introducing humor into the doctor-patient relationship.
Topics: Androgen Antagonists; Chemoradiotherapy; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Oncologists; Physician-Patient Relations; Prostatic Neoplasms; Wit and Humor as Topic
PubMed: 27864575
DOI: 10.1634/theoncologist.2016-0413 -
Chinese Clinical Oncology Jun 2016Breast surgical oncology is a defined sub-specialty of general surgery with focus on the surgical management of breast disease and malignancy within a multidisciplinary... (Review)
Review
Breast surgical oncology is a defined sub-specialty of general surgery with focus on the surgical management of breast disease and malignancy within a multidisciplinary context. Much of the training of breast surgical oncologists in the United States exists within a fellowship training structure with oversight and approval by the Society of Surgical Oncology (SSO). Rapid continuous changes in breast oncology practice have further substantiated dedicated expertise in breast surgical oncology. Training programs are structured to develop proficiency in fellows for advanced surgical techniques and clinical decision-making as well as exposure to the multidisciplinary aspects of breast cancer management. Components of a successful program include an intense multidisciplinary curriculum, engagement in clinical research and attention to strong mentorship. National curriculum and training requirements as well as supplemental resources assist in standardizing the fellowship experience. As surgical training and the field of breast oncology continues to evolve, so do fellowship training programs to ensure high quality breast surgical oncologists equipped to deliver high quality evidence based patient care while continuing to drive future research and trainee education.
Topics: Breast Neoplasms; Female; Humans; Male; Oncologists; Surgical Oncology; United States
PubMed: 27197510
DOI: 10.21037/cco.2016.03.14 -
ESMO Open Oct 2023
Topics: Humans; Medical Oncology; Oncologists
PubMed: 37659290
DOI: 10.1016/j.esmoop.2023.101625 -
Oncology (Williston Park, N.Y.) Apr 2018It is important for oncologists who provide comprehensive cancer care to be familiar with the principles of primary palliative care and interdisciplinary team-based... (Review)
Review
It is important for oncologists who provide comprehensive cancer care to be familiar with the principles of primary palliative care and interdisciplinary team-based approaches to palliative care. Palliative care is a medical subspecialty that provides specialized care to individuals with serious illnesses, with a primary focus on providing symptom relief, pain management, and relief from psychosocial distress, regardless of diagnosis or prognosis. Ideally, palliative care is provided by a team of physicians, nurses, social workers, psychologists, and chaplains. The core of palliative care is addressing, in depth, the physical, emotional, and spiritual suffering that a patient can experience. Palliative care is a key component of oncologic care, and we highly recommend that it be integrated into the plan of care for patients with advanced cancer. Early integration of palliative care has been shown to provide improved outcomes in patients with advanced cancer. This article reviews the ways in which palliative care and oncology teams can collaborate to provide high-quality care to patients and their families; it also provides practical tips for oncologists who wish to initiate primary palliative care for their patients. Prior to referral to a specialized interdisciplinary palliative care team, oncologists may start advance-care planning discussions, provide basic pain and non-pain symptom relief, and utilize assessment tools. If a specialized palliative care team is not available, the oncologist will often address additional aspects of palliative care, with assistance from social work departments and other resources in the community.
Topics: Hospice Care; Humans; Neoplasms; Oncologists; Palliative Care; Physician-Patient Relations
PubMed: 29684230
DOI: No ID Found -
JCO Oncology Practice Jun 2021Financial distress (FD) among older adults with cancer is not well studied. We sought to characterize prevalence and factors associated with FD among older adults with...
PURPOSE
Financial distress (FD) among older adults with cancer is not well studied. We sought to characterize prevalence and factors associated with FD among older adults with cancer and the association of FD with geriatric assessment (GA) -identified deficits.
PATIENTS AND METHODS
We included adults age ≥ 60 years with cancer in the University of Alabama at Birmingham Cancer and Aging Resilience Evaluation Registry who underwent GA during initial consultation with a medical oncologist before starting systemic therapy. We captured FD using a single-item question: "Do you have to pay for more medical care than you can afford?" We built multivariable models to study the impact of sociodemographic/clinical factors on FD as well as the association of FD with GA impairments.
RESULTS
We identified 447 older adults with a median age of 69 years; 60% were men, 75% were White, and colorectal (26%) and pancreatic (19%) cancers were the most common. Overall, 27% (n = 121) reported having FD. Factors associated with FD included being Black (v White; odds ratio [OR], 2.26; 95% CI, 1.35 to 3.81; .002), being disabled/unemployed (v employed; OR, 2.60; 95% CI, 1.17 to 5.76; = .019), and having an advanced degree ( less than high school; OR, 0.13; 95% CI, 0.03 to 0.65; = .012). Patients with FD were more likely to report several GA impairments, including depression (OR, 2.10; 95% CI, 1.06 to 4.18; = .034) and impaired health-related quality of life in physical (β = -2.82; = .014) and mental health domains (β = -3.31; = .002).
CONCLUSION
More than a quarter of older adults with cancer reported FD at the time of initial presentation to an oncologist. Several demographic factors and GA impairments were associated with FD.
Topics: Aged; Cross-Sectional Studies; Geriatric Assessment; Humans; Male; Middle Aged; Neoplasms; Oncologists; Quality of Life
PubMed: 33125296
DOI: 10.1200/OP.20.00601 -
Journal of Geriatric Oncology Jul 2022Caregiver-oncologist concordance regarding the patient's prognosis is associated with worse caregiver outcomes (e.g., depressive symptoms), but mechanisms underpinning...
INTRODUCTION
Caregiver-oncologist concordance regarding the patient's prognosis is associated with worse caregiver outcomes (e.g., depressive symptoms), but mechanisms underpinning these associations are unclear. We explored whether caregiving esteem mediates these associations.
METHODS
At enrollment, caregivers and oncologists used a 5-point ordinal scale to estimate patient survival; identical responses were considered concordant. At 4-6 weeks, caregivers completed an assessment of the extent to which caregiving imparts self-esteem (Caregiver Reaction Assessment self-esteem subscale; range 0-5; higher score indicates greater esteem). They also completed Patient Health Questionnaire-2 (PHQ-2) for depressive symptoms, Distress Thermometer, and 12-Item Short Form Survey for quality of life (QoL). Mediation analysis with bootstrapping (PROCESS macro by Hayes) was used to estimate the extent to which caregiving mediated the effects of prognostic concordance on caregiver outcomes through caregiving esteem.
RESULTS
Prognostic concordance occurred in 28% the caregiver-oncologist dyads; 85% of the discordance were due to caregivers estimating a longer patient's survival. At 4-6 weeks, mean caregiving esteem score was 4.4 (range 1.5-5.0). Lower caregiving esteem mediated the associations of concordance with higher PHQ-2 [indirect effect = 0.12; 95% Confidence Interval (CI) 0.03, 0.27], greater distress (indirect effect =0.25; 95% CI 0.08, 0.48), and poorer QoL (indirect effect = -1.50; 95% CI -3.06, -0.41). Caregiving esteem partially mediated 39%, 64%, and 48% of the associations between caregiver-oncologist concordance and PHQ-2, distress, and SF-12, respectively.
CONCLUSIONS
Caregiver-oncologist concordance was associated with lower caregiving esteem. Lower caregiving esteem mediated the negative relationship between caregiver-oncologist concordance and caregiver outcomes.
Topics: Caregivers; Humans; Oncologists; Prognosis; Quality of Life; Surveys and Questionnaires
PubMed: 35277372
DOI: 10.1016/j.jgo.2022.02.018 -
JCO Oncology Practice Dec 2020
Topics: Climate Change; Humans; Oncologists
PubMed: 32915709
DOI: 10.1200/OP.20.00609 -
The Oncologist Apr 2021Caregivers of adults with cancer often report a different understanding of the patient's prognosis than the oncologist. We examine the associations of...
BACKGROUND
Caregivers of adults with cancer often report a different understanding of the patient's prognosis than the oncologist. We examine the associations of caregiver-oncologist prognostic concordance with caregiver depressive symptoms, distress, and quality of life (QoL). We also explore whether these relationships differed by caregiver environment mastery, an individual's sense of control, and effectiveness in managing life situations.
MATERIALS AND METHODS
We used data from a national geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged 70 years and older with incurable cancer considering any line of cancer treatment at community oncology practices, their caregivers, and their oncologists. At enrollment, caregivers and oncologists estimated the patient's prognosis (0-6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; identical responses were concordant). Caregivers completed the Ryff's environmental mastery at enrollment. At 4-6 weeks, caregivers completed the Patient Health Questionnaire-2 (depressive symptoms), distress thermometer, and 12-Item Short-Form Health Survey (quality of life [QoL]). We used generalized estimating equations in models adjusted for covariates. We then assessed the moderation effect of caregiver mastery.
RESULTS
Of 411 caregiver-oncologist dyads (mean age = 66.5 years), 369 provided responses and 28% were concordant. Prognostic concordance was associated with greater caregiver depressive symptoms (β = 0.30; p = .04) but not distress or QoL. A significant moderation effect for caregiver depressive symptoms was found between concordance and mastery (p = .01). Specifically, among caregivers with low mastery (below median), concordance was associated with greater depressive symptoms (β = 0.68; p = .003).
CONCLUSIONS
Caregiver-oncologist prognostic concordance was associated with caregiver depressive symptoms. We found a novel moderating effect of caregiver mastery on the relationship between concordance and caregiver depressive symptoms.
IMPLICATIONS FOR PRACTICE
Caregiver-oncologist prognostic concordance is associated with greater caregiver depressive symptoms, particularly in those with low caregiver mastery. When discussing prognosis with caregivers, physicians should be aware that prognostic understanding may affect caregiver psychological health and should assess their depressive symptoms. In addition, while promoting accurate prognostic understanding, physicians should also identify strengths and build resilience among caregivers.
Topics: Adult; Aged; Aged, 80 and over; Caregivers; Depression; Geriatric Assessment; Humans; Oncologists; Prognosis; Quality of Life
PubMed: 33523583
DOI: 10.1002/onco.13699 -
International Journal of Environmental... Dec 2022(1) Background: Patients treated with radiotherapy require follow-up care to detect and treat acute and late side effects, and to monitor for recurrence. The increasing...
(1) Background: Patients treated with radiotherapy require follow-up care to detect and treat acute and late side effects, and to monitor for recurrence. The increasing demand for follow-up care poses a challenge for specialists and general practitioners. There is a perception that general practitioners do not have the specialised knowledge of treatment side effects and how to manage these. Knowing the concordance between general practitioner and oncologist clinical assessments can improve confidence in healthcare professionals. This study aimed to measure the level of agreement between general practitioners and radiation oncologists using a standardised clinical assessment; (2) Methods: a cross-sectional clinical practice study; sample aim of 20 breast, prostate or colorectal patients, three years post-radiotherapy treatment; their general practitioner and radiation oncologist; (3) Results: There was acceptable percent agreement (>75%) and a moderate to almost perfect agreement (Fleiss kappa) for all variables between the 15 general practitioner-radiation oncologist dyads; (4) Conclusions: The general practitioner and radiation oncologist concordance of a clinical follow-up assessment for radiation oncology patients is an important finding. These results can reassure both general practitioners and oncologists that general practitioners can provide cancer follow-up care. However, further studies are warranted to confirm the findings and improve reassurance for health professionals.
Topics: Male; Humans; General Practitioners; Radiation Oncologists; Aftercare; Cross-Sectional Studies; Neoplasms
PubMed: 36612430
DOI: 10.3390/ijerph20010108 -
The American Journal of Managed Care Jul 2022To assess provider and patient preferences for an oncologist selection tool, value-based care, involvement in cancer care, and end-of-life planning.
OBJECTIVES
To assess provider and patient preferences for an oncologist selection tool, value-based care, involvement in cancer care, and end-of-life planning.
STUDY DESIGN
We conducted a cross-sectional survey of primary care providers (PCPs) and insured patients with cancer.
METHODS
We asked PCPs about their method of oncologist referral; utilization of an oncologist selection tool that directs patients to high-quality, high-value oncologists; involvement in cancer care and value-based care; and when an advance directive should be established. We asked patients to reflect upon their personal experience when selecting their oncologist, utilization of an oncologist selection tool, and establishing an advance directive.
RESULTS
PCPs tend to refer patients to oncologists who are part of their health system (67.9%). Most PCPs (79.2%) were not currently utilizing an oncologist selection tool; most (77.3%) expressed a willingness to use such a tool. Most PCPs (69.8%) believe the best time to talk about an advance directive is at the time of cancer diagnosis. Patients ranked a PCP referral (52.7%) as "very important" when selecting an oncologist. One-third of patients used a web-based oncologist selection tool; 65.2% responded that an oncologist selection tool would be "somewhat" or "very" important. Most (54.5%) patients had an advance directive.
CONCLUSIONS
These results present a compelling rationale for developing a data-driven oncologist selection tool, optimizing patient and provider involvement in care, and expanding the portion of patients who have an advance directive at the start of their cancer care to optimize their cancer journey.
Topics: Cross-Sectional Studies; Humans; Medical Oncology; Neoplasms; Oncologists; Patient Preference
PubMed: 35852880
DOI: 10.37765/ajmc.2022.89178