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Current Oncology (Toronto, Ont.) Jan 2022As our global population ages, we will see more cancer diagnoses in older adults. Surgery is an important treatment modality for solid tumours, forming the majority of... (Review)
Review
As our global population ages, we will see more cancer diagnoses in older adults. Surgery is an important treatment modality for solid tumours, forming the majority of all cancers. However, the management of older adults with cancer can be more complex compared to their younger counterparts. This narrative review will outline the current challenges facing older adults with cancer and potential solutions. The challenges facing older adults with cancer are complex and include lack of high-level clinical trials targeting older adults and selection of the right patient for surgery. This may be standard surgical treatment, minimally invasive surgery or alternative therapies (no surgery) which can be local or systemic. The next challenge is to identify the individual patient's vulnerabilities to allow them to be maximally optimised for treatment. Prehabilitation has been shown to be of benefit in some cancer settings but uniform guidance across all surgical specialties is required. Greater awareness of geriatric conditions amongst surgical oncologists and integration of geriatric assessment into a surgical clinic are potential solutions. Enhanced recovery programmes tailored to older adults could reduce postoperative functional decline. Ultimately, the greatest challenge an older adult with cancer may face is the mindset of their treating clinicians-a shared care approach between surgical oncologists and geriatricians is required.
Topics: Aged; Geriatric Assessment; Humans; Medical Oncology; Neoplasms; Oncologists; Surgeons
PubMed: 35200558
DOI: 10.3390/curroncol29020058 -
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 -
The Oncologist Feb 2020Patients with cancer can go though many stages in their disease, including diagnosis, recurrence, metastasis, and treatment failure. Cancer stem cells (CSCs) are a... (Review)
Review
Patients with cancer can go though many stages in their disease, including diagnosis, recurrence, metastasis, and treatment failure. Cancer stem cells (CSCs) are a subgroup of cells within tumors that may explain the mechanism by which tumors recur and progress. CSCs can both self-renew and produce progenitor cells of more differentiated cancer cells as well as heterogeneously demonstrate resistance and the abilities to migrate and metastasize. These "stemness" characteristics are often the result of dysregulation of one or more pathways, which can be detected by various biomarkers. Although there has been considerable laboratory research conducted on CSCs, its relevance to the practicing oncologist may seem questionable. We sought to determine the clinical impact of CSCs on patients. A systematic literature search was conducted to identify analyses containing survival information based on the expression of known CSC biomarkers in any cancer. Overall, 234 survival analyses were identified, of which 82% reported that high expression of CSC biomarker(s) resulted in poor overall survival and/or disease-free survival compared with low or no expression of the biomarker. Elevated stemness biomarker levels were also associated with decreased tumor differentiation, altered TNM stage, and increased metastasis. This analysis would suggest that CSCs have a clinical impact on patients and that practicing oncologists need to start considering incorporating CSC-targeting therapies into their patients' treatment regimens. IMPLICATIONS FOR PRACTICE: Cancer stem cells (CSCs) may occur at any stage of cancer and are implicated in the occurrence of resistance, recurrence, and metastasis. A systematic literature analysis has shown that the presence of CSCs, identified via the upregulation of stemness pathway biomarkers, results in reduced survival across all cancers studied. Several CSC-targeting agents are currently approved, and several others are in clinical trials. Future treatment regimens will likely include CSC-targeting agents to enable the elimination of these holdouts to current therapies.
Topics: Cell Differentiation; Humans; Neoplasms; Neoplastic Stem Cells; Oncologists
PubMed: 32043793
DOI: 10.1634/theoncologist.2019-0517 -
Virchows Archiv : An International... Nov 2020The vast increase of technical, diagnostic, and treatment possibilities and deepened understanding of molecular biology has revolutionized diagnosis and treatment of...
The vast increase of technical, diagnostic, and treatment possibilities and deepened understanding of molecular biology has revolutionized diagnosis and treatment of cancer and thus has great impact on pathology. Different professionals are responsible for proper evaluation of the results and their translating into an accurate diagnosis and appropriate treatment. Next to expertise, a close interaction between clinical molecular biologists, pathologists, and oncologists is required; it is crucial that these professionals speak "the same language." Key to this is communication skills and creating possibilities for collaboration in a meaningful context. Here, we present an interprofessional, educational workshop model and we describe the parameters that contribute to effective learning by specialists.
Topics: Attitude of Health Personnel; Clinical Competence; Congresses as Topic; Cooperative Behavior; Education, Medical, Continuing; Humans; Inservice Training; Interprofessional Relations; Learning; Oncologists; Pathologists; Specialization; Staff Development
PubMed: 32270299
DOI: 10.1007/s00428-020-02803-x -
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 -
JCO Oncology Practice Aug 2022
Topics: Humans; Medical Oncology; Oncologists; Research Personnel
PubMed: 35157513
DOI: 10.1200/OP.21.00873 -
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 -
JCO Oncology Practice Dec 2020
Topics: Climate Change; Humans; Oncologists
PubMed: 32915709
DOI: 10.1200/OP.20.00609 -
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 -
ESMO Open Oct 2023
Topics: Humans; Medical Oncology; Oncologists
PubMed: 37659290
DOI: 10.1016/j.esmoop.2023.101625