-
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 -
Japanese Journal of Clinical Oncology Oct 2022Japan has the highest proportion of older adults globally, and the average life expectancy of the Japanese population has increased in recent decades. Given that the... (Review)
Review
Japan has the highest proportion of older adults globally, and the average life expectancy of the Japanese population has increased in recent decades. Given that the incidence of cancer increases with age, it is a major health concern for older adults. However, geriatric oncology is a relatively new field and collaboration between oncologists and geriatricians in Japan is limited. Hence, oncologists and other healthcare professionals engaged in cancer care have not been able to adequately understand geriatric care, and information and experience are insufficient for this specific population. Thus, they may struggle with the assessment and management of older adults with cancer. Recently, several Japanese academic societies for cancer have developed practical guidelines and research policy with regard to geriatric research in older adults with cancer, in addition to organizing symposia and workshops focusing especially on geriatric oncology. Furthermore, because the Japan Geriatrics Society established a discipline committee on cancer, close collaboration between oncologists and geriatricians has grown steadily. Geriatric oncology is currently recognized as an important field of cancer care in Japan. The integration of oncology and geriatric care is anticipated in the near future. However, understanding the aspects of geriatric care and meanings of technical jargons used in geriatric oncology is difficult. Accordingly, this article provides an overview of the current knowledge and recent advancements in geriatric oncology. In addition, it outlines the current status and problems of geriatric oncology in Japan.
Topics: Aged; Geriatrics; Humans; Japan; Medical Oncology; Neoplasms; Oncologists
PubMed: 35863011
DOI: 10.1093/jjco/hyac118 -
PloS One 2022The COVID-19 pandemic upended nearly all aspects of daily life and of medical care, placing a double burden of professional and personal concerns on those who provide...
PURPOSE
The COVID-19 pandemic upended nearly all aspects of daily life and of medical care, placing a double burden of professional and personal concerns on those who provide medical care. We set out to assess the burden of the pandemic on provider outlook and understand how cancer survivorship providers experienced rapid changes to practice.
METHODS
We distributed a survey through the American College of Surgeons Commission on Cancer (CoC) to its accredited organizations in mid-October 2020. We included questions on provider characteristics, changes in patient care practices resulting from the pandemic, worry about COVID-19, and concern about impact on cancer survivors.
RESULTS
Of the n = 607 participants, three-quarters were female and three-quarters were White. Only 2.1% of participants reported having had COVID-19, but 43% reported anxiety about getting COVID-19 and over a quarter experienced sadness or depression, anxiety about the future, changes to sleep, difficulty concentrating, or social isolation. Approximately half of providers also expressed significant concern about progression of cancer in patients who experienced care delays or were afraid of accessing in-person care. In terms of changes to survivorship care, respondents reported changes to visitor policies, delays or cancellations, and efforts to reduce in-person visits.
CONCLUSIONS
COVID-19 has taken a significant toll on front-line healthcare professionals, including oncologists and cancer care allied health professionals. Findings support proactive mental health support of healthcare professionals as well as emergency preparedness to manage delays to care for cancer patients in the event of future unexpected pandemics.
Topics: COVID-19; Female; Humans; Male; Medical Oncology; Neoplasms; Oncologists; Pandemics; SARS-CoV-2
PubMed: 35881586
DOI: 10.1371/journal.pone.0270651 -
International Journal of Radiation... Sep 2019
Review
Topics: Biology; Career Mobility; Diffusion of Innovation; Forecasting; Global Health; Health Policy; Humans; Industrial Development; Medical Informatics; Medical Informatics Applications; Palliative Care; Radiation Oncologists; Radioactive Hazard Release; Rural Health Services; United States
PubMed: 31128144
DOI: 10.1016/j.ijrobp.2019.05.025 -
Cancer Jul 2021Unsolicited patient complaints (UPCs) about physician practices are nonrandomly associated with malpractice claims and clinical quality. The authors evaluated the...
BACKGROUND
Unsolicited patient complaints (UPCs) about physician practices are nonrandomly associated with malpractice claims and clinical quality. The authors evaluated the distributions and types of UPCs associated with oncologists by specialty and assessed oncologist characteristics associated with UPCs.
METHODS
This retrospective study reviewed UPCs associated with US radiation oncologists (ROs), medical oncologists (MOs), and surgical oncologists (SOs) from 35 health care systems from 2015 to 2018. Average total UPCs were compared by specialty in addition to sex, medical school graduation year, degree, medical school location, residency location, practice setting, and practice region. For continuous variables, linear regression was used to test for an association with total complaints.
RESULTS
The study included 1576 physicians: 318 ROs, 1020 MOs, and 238 SOs. The average number of UPCs per physician was different and depended on the oncologic specialty: ROs had significantly fewer complaints (1.28; 95% confidence interval [CI], 1.02-1.54) than MOs (3.81; 95% CI, 3.52-4.10) and SOs (6.89; 95% CI, 5.99-7.79; P < .0001). In a multivariable analysis, oncologic specialty, recency of graduation, and academic practice were predictive of higher total UPCs (P < .05). UPCs described concerns with care and treatment (42.8%), communication (26.4%), accessibility (17.5%), concern for patient (10.3%), and billing (2.9%).
CONCLUSIONS
ROs had significantly fewer complaints than MOs and SOs and may have a lower risk of malpractice claims as a group. In addition to oncologic specialty, a more recent year of medical school graduation and working at an academic center were independent risk factors for UPCs. Further research is needed to clarify the reasons underlying these associations and to identify interventions that decrease UPCs and associated risks.
LAY SUMMARY
This study of 1576 oncologists found that radiation oncologists had significantly fewer complaints than medical oncologists, who in turn had significantly fewer complaints than surgical oncologists. Other characteristics associated with more patient complaints included recency of medical school graduation and practice in an academic setting. Oncologists' patient complaints provide information that may have practical applications for patient safety and risk management. Understanding and addressing the characteristics that increase the risk for complaints could improve patients' experiences and outcomes.
Topics: Communication; Humans; Malpractice; Oncologists; Radiation Oncologists; Retrospective Studies; Risk Factors
PubMed: 33724453
DOI: 10.1002/cncr.33513 -
Journal of Cancer Research and... 2016Superior vena cava syndrome is referred to as a constellation of symptoms and signs caused by obstruction of superior vena cava. It can occur due to both benign and... (Review)
Review
Superior vena cava syndrome is referred to as a constellation of symptoms and signs caused by obstruction of superior vena cava. It can occur due to both benign and malignant causes with the latter being the predominant. There is a paradigm shift in the approach to manage this condition. It is no longer considered a medical emergency and histological diagnosis is necessary before treatment. This article reviews the causes, symptoms, pathophysiology, and overall management policy which have changed over decades.
Topics: Humans; Neoplasm Grading; Neoplasms; Radiation Oncologists; Radiation Oncology; Superior Vena Cava Syndrome
PubMed: 27461602
DOI: 10.4103/0973-1482.177503 -
American Society of Clinical Oncology... Apr 2022Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and...
Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and unwelcoming atmospheres in the workplace. Specifically, women in oncology have lower promotion rates and less financial support and mentorship, and they are less likely to hold leadership positions. These experiences are exceedingly likely at the intersection of identities, leading to decreased satisfaction, increased burnout, and a higher probability of leaving the workforce. Microaggressions have also been associated with depression, suicidal thoughts, and other health and safety issues. Greater workplace diversity and equity are associated with improved financial performance; greater productivity, satisfaction, and retention; improved health care delivery; and higher-quality research. In this article, we provide tools and steps to promote equity in the oncology workplace and achieve cultural change. We propose the use of tailored approaches and tools, such as active listening, for individuals to become microaggression upstanders; we also propose the implementation of education, evaluation, and transparent policies to promote a culture of equity and diversity in the oncology workplace.
Topics: Ethnicity; Female; Humans; Microaggression; Minority Groups; Oncologists; Racial Groups
PubMed: 35649205
DOI: 10.1200/EDBK_350691 -
Polish Archives of Internal Medicine May 2020
Topics: Bone Marrow; Colorectal Neoplasms; Disease Progression; Humans; Oncologists
PubMed: 32469188
DOI: 10.20452/pamw.15395 -
Cancer Reports (Hoboken, N.J.) Apr 2021In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision-makers for the patient.... (Review)
Review
BACKGROUND
In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision-makers for the patient. Further, owing to acute resource constraints in the Indian healthcare system, it may be difficult for oncologists to assess and elicit questions from each patient/caregiver. Consequently, there is a need to address these unique aspects of oncology care in India to improve patient outcomes and understanding of their illness and treatment. This can be achieved through a Question Prompt List (QPL), a checklist used by care recipients during medical consultations.
RECENT FINDINGS
This narrative review will first introduce research on the development and effectiveness of the QPL, and then it will highlight current gaps in oncology care in India and explore how the QPL may aid in closing these gaps. A literature search of the empirical research focused on the development, feasibility and acceptability of the QPL in oncology settings was conducted. The final review included 40 articles pertaining to QPL research. Additionally, psycho-oncology research in India centered on information needs and experiences was reviewed. Current Indian psycho-oncology research reports patients' want to be actively involved in their cancer care and a need for more illness information. However, a high demand on physicians' resources and the family caregivers' interference can be barriers to meeting patients' information/communication needs. International research demonstrates that a QPL helps structure and decrease consultation time, improves patient satisfaction with care, and improves the quality of communication during medical encounters.
CONCLUSION
QPLs for Indian patients and caregivers may focus on the scope of medical consultations to address patient needs while influencing the course and content of the patient-caregiver-physician interactions. Further, it can address the resource constraints in Indian oncology care settings, thus reducing the physician's burden.
Topics: Caregivers; Checklist; Communication; Humans; India; Medical Oncology; Oncologists; Patient Participation; Patient Satisfaction; Physician-Patient Relations; Psychology; Referral and Consultation
PubMed: 33295152
DOI: 10.1002/cnr2.1316 -
JAMA Network Open Jun 2021Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month...
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.
Topics: Adult; Advance Care Planning; Aged; Aged, 80 and over; Communication; Female; Humans; Male; Middle Aged; Neoplasms; Oncologists; Patient Care Planning; Patients; Physician-Patient Relations; Qualitative Research; Terminal Care; United States
PubMed: 34110395
DOI: 10.1001/jamanetworkopen.2021.13193