Mitigating Burnout in an Oncological Unit: A Scoping Review.

Objectives: The purpose of this study was to provide a scoping review on how to address and mitigate burnout in the profession of clinical oncology. Also, it examines how artificial intelligence (AI) can mitigate burnout in oncology. Methods: We searched Ovid Medline, PubMed, Scopus, and Web of Science, for articles that examine how to address burnout in oncology. Results: A total of 17 studies were found to examine how burnout in oncology can be mitigated. These interventions were either targeted at individuals (oncologists) or organizations where the oncologists work. The organizational interventions include educational (psychosocial and mindfulness-based course), art therapies and entertainment, team-based training, group meetings, motivational package and reward, effective leadership and policy change, and staff support. The individual interventions include equipping the oncologists with adequate training that include-communication skills, well-being and stress management, burnout education, financial independence, relaxation, self-efficacy, resilience, hobby adoption, and work-life balance for the oncologists. Similarly, AI is thought to be poised to offer the potential to mitigate burnout in oncology by enhancing the productivity and performance of the oncologists, reduce the workload and provide job satisfaction, and foster teamwork between the caregivers of patients with cancer. Discussion: Burnout is common among oncologists and can be elicited from different types of situations encountered in the process of caring for patients with cancer. Therefore, for these interventions to achieve the touted benefits, combinatorial strategies that combine other interventions may be viable for mitigating burnout in oncology. With the potential of AI to mitigate burnout, it is important for healthcare providers to facilitate its use in daily clinical practices. Conclusion: These combinatorial interventions can ensure job satisfaction, a supportive working environment, job retention for oncologists, and improved patient care. These interventions could be integrated systematically into routine cancer care for a positive impact on quality care, patient satisfaction, the overall success of the oncological ward, and the health organizations at large.

Anger expression, partner support, and quality of life in cancer patients.

OBJECTIVE: Family members are the most important source of social support for cancer patients. The determinants of family support, however, are not well understood. In this study, the associations of anger-expression styles of both patients and their partners with patient-perceived partner support and the impact of these variables on long-term health-related quality of life (HRQL) of the patient were examined. METHOD: The baseline data were collected at the time of diagnosis; a follow-up survey was conducted at 8 months. Questionnaires included the Spielberger AX scale, the Family Support scale, and the RAND-36 Health Survey. The sample comprised 153 patients and their partners. The theoretical model was tested with a path analysis using structural equation modeling, and gender differences were tested using multivariate analysis of covariance. RESULTS: Path analyses indicated that partner support was an important mediator, partly explaining the associations between anger-expression styles and HRQL. As hypothesized, anger control had a positive relationship with perceived partner support, while habitual inhibition of anger (anger-in) showed a negative correlation with partner support. Analyses by gender revealed some clear differences: for the male patients, the wife's high level of anger expression (anger-out) was significantly positively related to patient mental HRQL, whereas for the female patients, their husband's anger-out was negatively correlated with the patient's mental HRQL. In addition, patient's own anger-out had a more pronounced negative effect on HRQL for women as compared to men. CONCLUSION: The anger-expression styles of both patients and their partners seem to modify the family atmosphere, and together, they are important determinants of the long-term quality of life of the cancer patients. Interventions for couples facing cancer should include a focus on ways of dealing with anger and thereby support dyadic coping with cancer.

Comparative study of work ability between cancer survivors and their referents.

Even though cancer survivors are often able to continue working after they have been diagnosed, they may have health impairments resulting in reduced work ability. We studied the current work ability of 591 employed people with an early-stage of breast cancer, lymphoma, testicular or prostate cancer, and 757 referents. We also investigated whether the survivors perceived that cancer had impaired their work ability, and which disease-related, socio-demographic and social factors at work had an impact on their work ability. The work ability of the cancer survivors did not differ from that of their referents. Among the survivors, 26% reported that their physical work ability, and 19% that their mental work ability had deteriorated due to cancer. The survivors who had other diseases or had had chemotherapy, most often reported impaired work ability, whereas survivors with a strong commitment to their work organisation, or a good social climate at work, reported impairment less frequently.

Quality of life in women with breast cancer during the first year after random assignment to adjuvant treatment with marrow-supported high-dose chemotherapy with cyclophosphamide, thiotepa, and carboplatin or tailored therapy with Fluorouracil, epirubicin, and cyclophosphamide: Scandinavian Breast Group Study 9401.

PURPOSE: To compare, in high-risk breast cancer patients, the effects on health-related quality of life (HRQoL) of two adjuvant treatments. Treatments were compared at eight points during the first year after random assignment to treatment with tailored fluorouracil, epirubicin, and cyclophosphamide (FEC) therapy for nine courses versus induction FEC therapy for three courses followed by high-dose chemotherapy with cyclophosphamide, thiotepa, and carboplatin (CTCb) supported by peripheral-blood stem cells. PATIENTS AND METHODS: From March 1994 to March 1998, 525 breast cancer patients (estimated relapse risk > 70% within 5 years with standard therapy) were included in the Scandinavian Breast Group 9401 study. HRQoL evaluation, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 and EORTC Breast Cancer Module-23, included 408 of 446 eligible patients in Finland, Norway, and Sweden. RESULTS: Eighty-four percent to 95% of the patients completed questionnaires at eight points of assessment. Nostatistically significant overall differences were found between the tailored FEC group and the CTCb group for any of the HRQoL variables. Statistically significant differences over time were found for all HRQoL variables. HRQoL in the CTCb group demonstrated a steeper decrease, but a faster recovery than in the tailored FEC group. Emotional functioning improved with increased time from randomization. Higher levels of problems in body image and arm symptoms were reported in the tailored FEC group compared with the CTCb group. Sexual functioning and satisfaction were impaired during the study period. CONCLUSION: Both treatments had a negative influence on HRQoL during the treatment period. Despite the aggressive therapies, the patient's HRQoL returned to levels found at inclusion on most variables.

The impact of education and occupation on the employment status of cancer survivors.

We explored the effect of a diagnosis of cancer on employment according to cancer type, education, occupation, age, gender, mother tongue (Swedish or Finnish), calendar time and hospital district. All 12,542 new cancer cases diagnosed in 1987-1988 and 1992-1993, aged 15-60 years at the time of the diagnosis were identified from the Finnish Cancer Registry. The employment rate of the cancer survivors 2-3 years after the diagnosis was only 9% lower than their gender- and age-matched referents. However, we found that education and occupation modified the effect of cancer on the employment; the difference between cancer survivors and their referents in the probability of being employed was greater in the lower than in the higher educational groups. A modifying effect of education on the probability of employment was found among people with cancer of the lung, stomach, rectum and cervix uteri and those with cancers of the nervous system.

Patient Preference for Dissection of Sentinel Nodes Outside Level I-II of the Axilla.

In this study patients' and female doctors' opinions about harvesting sentinel nodes outside the axilla are evaluated and patients' ability to understand the concept of sentinel node biopsy is investigated. Information leaflets and questionnaires were mailed to 100 patients with breast cancer who had undergone sentinel node biopsy and to 300 female doctors. Seventy-three (73%) patients and 148 (49%) female doctors returned the questionnaire. Fifty-eight (79%) breast cancer patients and 71 (48%) female doctors wanted harvesting to be done in order to determine whether the nodes were involved. Sixty-six (90%) patients and 128 (86%) female doctors wanted the procedure if it changed the treatment. Sixty (82%) patients understood the outcome of the sentinel node procedure. Patients with breast cancer seem to value the information gained by harvesting sentinel nodes outside the axilla and want the procedure if there is even the slightest possibility that it might change the adjuvant treatment.

Changes in bone mineral density during and after 3 years' use of tamoxifen or toremifene.

OBJECTIVES: To study the effects of tamoxifen and toremifene on bone mineral density (BMD) in postmenopausal women with breast cancer. METHODS: Seventy patients with stage II-III breast cancer were randomized to start either tamoxifen (n = 36; 20 mg per day) or toremifene (n = 34; 40 mg per day) for 3 years. BMD in the lumbar spine and in the proximal femur was measured by dual-energy X-ray absorptiometry both before and during the treatment and 1 year after the discontinuation of the anti-estrogens. RESULTS: The baseline BMD measurements were comparable between the groups. In 3 years, lumbar BMD decreased by 1.7% in tamoxifen (P = 0.048) and 3.0% in toremifene (P = 0.001) users (ns between the groups), and femoral neck BMD by 0.9% (P = 0.040) and 1.3% (P = ns), respectively. The use of hormone replacement therapy (HRT) until the diagnosis of breast cancer was associated with decreases in lumbar BMD during anti-estrogen regimen (4% at 3 years) in contrast to unchanged lumbar BMD in women with no previous use of HRT. During the 1st year after the cessation of anti-estrogen, lumbar BMD did not change at all in either group whereas femoral BMD decreased in both the groups at the rate of 1.5-3.2%, as expected. CONCLUSIONS: We conclude that tamoxifen (20 mg) and toremifene (40 mg) have similar bone-sparing efficacy that in lumbar spine extends up to 1 year after the cessation of these regimens. This effect is not seen in lumbar spine BMD in those postmenopausal women who discontinue HRT at the time of breast cancer diagnosis.

Radiotherapy after segmental resection of breast cancer with favorable prognostic features: 12-year follow-up results of a randomized trial.

PURPOSE: Postoperative breast irradiation is considered standard after breast-preserving surgery for cancer. We evaluated the efficacy of radiation therapy in the prevention of local recurrence in a patient population that had small-size breast cancer with features that suggested low biologic aggressiveness. PATIENTS AND METHODS: Women (n = 264) older than 40 years who were treated by breast resection with > or = 1 cm of tumor-free margin and axillary nodal dissection were randomly assigned to receive or not to receive breast irradiation (cumulative dose, 50 Gy) after surgery. The tumor was required to be < or = 20 mm, node negative, progesterone receptor positive, well to moderately well differentiated and unifocal, and of low cell proliferation rate (ie, S phase fraction < or = 7% or nuclear Ki-67 expression < 10%) and had to lack an extensive intraductal component. The median follow-up time was 12.1 years after random assignment. RESULTS: Sixteen (11.6%) and 34 (27.2%) cancers recurred locally in the radiotherapy and the control arms, respectively (P = .0013). Time to local recurrence was longer in the radiotherapy arm (hazard ratio [HR], 0.36; 95% CI, 0.20 to 0.65; P = .00071). Twenty-one patients assigned to radiotherapy and 26 assigned to control died during the follow-up. There were no differences in overall survival time (HR, 0.63; 95% CI, 0.35 to 1.12; P = .11), distant disease-free survival (P = .94), or breast cancer-specific survival (P = .56) between the radiation therapy and control groups. CONCLUSION: Radiation therapy after breast resection reduces the frequency of ipsilateral breast recurrences, even among women with small-size breast cancers that have favorable histologic features and that are resected with at least a 1-cm margin. Postoperative radiotherapy did not significantly improve survival.

Quality of life in cancer patients: The role of optimism, hopelessness, and partner support.

The interaction of optimism, hopelessness and social support as predictors of Health-Related Quality of Life (HRQL) among seriously ill people is not well understood. Also, the impact of partner characteristics on patient quality of life has often been overlooked. In this study the relationships between optimism, hopelessness, partner support and HRQL were investigated in 155 cancer patients and their partners. Special attention was given to the effects of optimism and hopelessness as mediators and moderators in the partner support-HRQL relationship. The impact of partner optimism and hopelessness on perceived partner support and patient HRQL was also studied. The results indicated substantial gender differences in the relationships between the study variables. High levels of partner support were associated with female patients' optimistic appraisals, and together they predicted better HRQL at 8 months follow-up. Partial support was found for the effect of optimism as a mediator. For male patients, low hopelessness was the key variable predicting good HRQL. Clear evidence for the moderator effects of optimism/hopelessness was not found, and the expected impact of partner's characteristics on partner support or patient HRQL could not be confirmed. Although partner support, patient optimism and hopelessness all appeared to be important determinants of HRQL in cancer patients, the relationships between these variables differed by gender. The proposed mediation and moderation models needs to be confirmed in future studies.

Sense of coherence and distress in cancer patients and their partners.

Strong sense of coherence (SOC) is assumed to promote and protect health in stressful situations, such as a serious illness. There is, however, surprisingly little research-based discussion on the SOC-distress association in cancer patients and especially in their partners. The aim of this study was to clarify these issues. The associations between SOC, depression, and anxiety were studied in 123 cancer couples. Data were collected with self-report questionnaires at the time of diagnosis, 8 and 14 months later. The predictors of follow-up distress and possible mediators of the cross-lagged longitudinal data were analysed with SEM. No gender differences in the patients' study variables were found, but the female partners displayed more distress symptoms than their male counterparts. The results supported the SOC theory. Strong SOC alleviated the development of distress. In addition, patient SOC tended to strengthen during the follow-up. No direct crossover between baseline SOC and follow-up distress was found. However, all patient and partner variables at the 14-month follow-up were related to each other, but not at baseline. This could indicate a gradual crossover process of the shared experience. Special attention in clinical practice should be given to the psychological well-being of cancer patients' partners, especially female partners.

A short communication course for physicians improves the quality of patient information in a clinical trial.

We investigated whether a short course in communication skills for physicians would improve the quality of informed consent in a randomized clinical adjuvant trial on breast cancer. In this prospective, case-controlled intervention study, physicians and research nurses who introduced the cancer treatment trial to patients at three of the participating hospitals first attended a one-day communication skills course. The quality of informed consent was then evaluated by addressing a standardized questionnaire, QuIC, to trial patients at the three intervention hospitals and at control hospitals. Response rate was 90.0% (n = 288). Of the patients treated by the intervention group, 73% were very satisfied with the information received compared with 56% of those of the control group (p = 0.003). The patients of the intervention group considered the time given for making their decision sufficient more often than those of the controls (98% vs. 90%, p = 0.004). The patients of the intervention group recalled more often than those of the controls that the physician had also offered other therapeutic options than the trial treatment (91% vs. 97%, p = 0.032). They also understood the main aim of the study better than the patients of the controls (89% vs. 78%, p = 0.030). In conclusion, a short communication skills course for the trial physicians and nurses improved the quality of informed consent and patient satisfaction in the trial.

Cancer survivors' received and needed social support from their work place and the occupational health services.

GOALS OF WORK: Even though a lot of studies have been conducted concerning cancer patients' social support, the importance of social support from the work life is unclear. We examined the amount of emotional and practical support that cancer survivors needed and had actually received from their coworkers, supervisors, and the occupational health personnel. We also examined whether disease-related or sociodemographic background variables were associated with needed or received support. Finally, we investigated whether there were differences between various sources in received or needed support. PATIENTS AND METHODS: The data consisted of a total of 640 cancer survivors with breast cancer, lymphoma, testicular or prostate cancer, aged 25-57 years at the time of diagnosis. Information on social support was collected with a mailed questionnaire using an adapted version of the Structural-Functional Social Support Scale (SFSS). MAIN RESULTS: The cancer survivors had received most support from their coworkers and they hoped for more support especially from the occupational health care personnel (39% of women and 29% of men). The men who had lymphoma, had received chemotherapy, or had low education level needed more support. The need for practical support from the occupational health personnel was fivefold between the chemotherapy-treated and those not treated. The women both received and needed more support than the men did. CONCLUSIONS: There is a clear need for additional social support from work life among the cancer survivors especially from the occupational health personnel.

Employment status of Finnish cancer patients in 1997.

We explored the impact of cancer diagnosis on the employment status of 46 312 working-aged people with cancer, alive on 31 December 1997 in Finland, and an equal number of age- and gender-matched referents. In general, 50% of the cancer patients were employed, in comparison to 55% of their referents. People with cancer were slightly less often employed, mainly because of their higher retirement rate: 34% of the cancer patients and 27% of the referents had retired. People with lung cancer as well as those with cancer of the nervous system were less likely to be employed. Our results suggest that cancer diagnosis does not usually lead to unemployment or early retirement, even though the employment rate of the people with cancer varied greatly according to the cancer site. Early retirement is common among people with highly disabling cancer or poor prognosis, but in general, the employment of cancer survivors seems optimistic.

Patient preference for dissection of sentinel nodes outside level I-II of the axilla.

In this study patients' and female doctors' opinions about harvesting sentinel nodes outside the axilla are evaluated and patients' ability to understand the concept of sentinel node biopsy is investigated. Information leaflets and questionnaires were mailed to 100 patients with breast cancer who had undergone sentinel node biopsy and to 300 female doctors. Seventy-three (73%) patients and 148 (49%) female doctors returned the questionnaire. Fifty-eight (79%) breast cancer patients and 71 (48%) female doctors wanted harvesting to be done in order to determine whether the nodes were involved. Sixty-six (90%) patients and 128 (86%) female doctors wanted the procedure if it changed the treatment. Sixty (82%) patients understood the outcome of the sentinel node procedure. Patients with breast cancer seem to value the information gained by harvesting sentinel nodes outside the axilla and want the procedure if there is even the slightest possibility that it might change the adjuvant treatment.