"Someone to talk to": A qualitative study of oncology trainees' experience of mentorship around moral distress.

BACKGROUND: Moral distress is an intrinsic part of healthcare, particularly prevalent in oncology practitioners. Previous studies have suggested mentorship may play a role in combatting moral distress; however, there is a lack of good evidence aimed at understanding trainees' experience with either mentorship or moral distress, including the intersection between the two. METHODS: We conducted a single-centre study in the hermeneutic phenomenological approach at a Canadian academic cancer centre. Six semi-structured interviews with senior oncology trainees were conducted and analysed according to the interpretive profiles hermeneutic phenomenological approach. FINDINGS/RESULTS: Key findings include the idea that trainees do find mentorship valuable and helpful in navigating moral distress, which is described as common and inevitable, with a number of triggers and factors identified. However, a mentorship relationship must involve mutual respect, understanding, and honesty in order to be valuable. Additionally, engaging in open, honest discussions with mentors, particularly more senior individuals, is seen as a risk-benefit balance by trainees; vertical mentors bring more wisdom and experience, but may also have a greater impact on a trainee's future. CONCLUSION: This thought-provoking study highlights mentorship as a potential method to combat the troubling phenomenon of moral distress in oncology trainees.

Real-World Analysis of Durvalumab after Chemoradiation in Stage III Non-Small-Cell Lung Cancer.

The 2017 PACIFIC trial heralded the incorporation of routine adjuvant durvalumab following curative-intent chemoradiation for stage III non-small-cell lung cancer (NSCLC). However, carefully selected clinical trial populations can differ significantly from real-world populations, which can have implications on treatment toxicities and outcomes, making it difficult to accurately counsel patients. Consequently, we performed a real-world, retrospective analysis of outcomes and toxicities in 118 patients with stage III NSCLC treated with durvalumab after platinum-based chemoradiotherapy. The data were collected from patients who underwent treatment at a single, tertiary-level Canadian cancer centre from May 2018 to October 2020. The variables collected included patient demographics, treatment specifics, progression-free survival, overall survival, and immune-related adverse events (IRAE) from durvalumab. Descriptive statistics were used for toxicity analysis, and progression-free survival and overall survival estimates were calculated using the Kaplan-Meier method. The statistical analyses indicated a 64.4% (n = 76) toxicity rate, with a 21% (n = 25) toxicity rate of grade 3+ IRAEs. The most common documented IRAEs were pneumonitis (n = 44; 40%), followed by rash (n = 20; 18%) and thyroid dysfunction (n = 17; 15%). FEV1 and DLCO were not found to be associated predictors of pneumonitis toxicity. The median PFS and OS were estimated to be >1.7 years and >2.7 years, respectively.

Skin Deep: A Fascinating Case Report of Immunotherapy-Triggered, Treatment-Refractory Autoimmune Lichen Planus and Keratoacanthoma.

This case discusses a 62-year-old woman with de novo metastatic lung adenocarcinoma (PD-L1 >50% with a KRAS G12C mutation, ALK and EGFR negative) who was on pembrolizumab for 1 year without any significant toxicity, only low-grade dermatitis and hypothyroidism. She was transitioned to pembrolizumab every 6 weeks at 4 mg/kg and began to develop oral sores shortly thereafter. The sores proved refractory to nystatin and mouth rinses containing corticosteroids, and the patient was ultimately diagnosed with autoimmune-triggered lichen planus. Unfortunately, her symptoms also proved refractory to typical treatments for lichen planus and worsened to the point where she began to develop cutaneous lesions and difficulty swallowing. Unfortunately, she also developed a keratoacanthoma that required excision. The pembrolizumab was stopped, and the patient's symptoms improved with 5 days of systemic prednisone, metronidazole, and triamcinolone oral paste. Her NSCLC remains stable off active treatment for 6 months. This case study is on rare auto-immune toxicity as well as a keratoacanthoma from anti-PD-(L) 1 blockade, accompanied by sustained treatment response after cessation of the offending drug.