Cancer Center Staff Satisfaction: Descriptive Results of a Canadian Study.

Caring for cancer patients is generally considered very rewarding work, but it can also be stressful and demanding. Therefore, it is important for oncology healthcare professionals to feel satisfied with their work environment in order to provide the best care possible. An ethics-approved 61-item staff satisfaction survey was developed in-house to gain insights regarding workplace satisfaction among all staff at The Ottawa Hospital Cancer Center. Descriptive statistics were used to analyze the responses. A total of 478 individuals completed the online survey, with 75.1% women, 23.2% men, and 1.7% preferring not to say. This represented the vast majority (>75%) of cancer center staff. The approximate breakdown according to healthcare professional type was as follows: 21% nurses, 20% radiation therapists, 18% physicians, 13% clerical staff, and 28% other types of staff. Almost all (97.4%) generally enjoyed their work, with 60% stating "very much" and 37.4% stating "a little bit", and 93.3% found working with cancer patients rewarding. The overall satisfaction level at work was high, with 30.1% reporting "very satisfied" and 54.2% "somewhat satisfied". However, in terms of their work being stressful, 18.6% stated it was "very much" and 62.1% "a little bit". Also, in terms of their workload, 61.3% stated it was "very busy" and 10% stated it was "excessively busy". The most enjoyable aspects of work were listed as interactions with colleagues, interactions with patients, and learning new things. The least enjoyable aspects of work were excessive workload, a perceived unsupportive work environment, and technology problems. Levels of satisfaction and stress at work varied according to role at the cancer center. Most cancer center staff seem to enjoy their work and find it rewarding. However, the work environment can be challenging and stressful. Areas for improvement include managing workloads, ensuring staff feel supported, and improving the user-friendliness of technology.

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2023.

The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2023 was held in Quebec City, Quebec 2-4 February 2023. The purpose of the conference was to develop consensus statements on emerging and evolving treatment paradigms. Participants included Canadian medical oncologists, radiation oncologists, pathologists and surgical oncologists from across Ontario, Quebec, and the Atlantic provinces. Consensus statements were developed following rapid review presentations and discussion of available literature. The recommendations proposed here represent the consensus opinions of physicians involved in the care of patients with gastrointestinal malignancies who participated in this meeting.

Opioid consumption and pain in patients with gynecological cancer who underwent spinal anesthesia vs. general anesthesia for interstitial brachytherapy.

AIMS: Interstitial brachytherapy (ISBT) is an effective option for delivering conformal high dose radiation to the target volume with better organ-at risk sparing but is thought to be more invasive and painful than other methods. This study investigated pain levels and opioid consumption in patients who received spinal anesthesia (SA) or general anesthesia (GA) for their ISBT. MATERIALS AND METHODS: Patients that underwent ISBT from April 2014 to September 2018 were analyzed from a prospective institutional database. The most prevalent malignancies were cervical (45%), recurrent endometrial (27%) and vaginal (20%) cancers. Baseline patient characteristics, radiation treatment details, anesthesia records, and inpatient charts were obtained. Opioid consumption was quantified as oral morphine equivalent per day (OMEq/day) from implantation until removal. Pain score levels were collected by using an 11-point scoring system. RESULTS: Ninety nine patients received GA and 40 patients received SA as their anesthesia for ISBT. During their first admission, 76 patients (55%) required intravenous opioids. Patients receiving SA had significantly lower mean pain scores on the morning of their procedure 6 (Interquartile range [IQR] 2-8) vs. 0 (IQR: 0-1); p < 0.001]. Pain did not significantly differ between cohorts at any other time. During the first admission, SA patients had a lower median opioid usage of 23 (IQR: 9-47) mg/day compared to GA patients at 38 (IQR: 21-71) mg/day (p = 0.011). No difference in opioid consumption was seen during subsequent admissions. CONCLUSIONS: In patients undergoing ISBT, SA provides better immediate pain control post insertion compared to GA. Patients who received SA used lower amounts of opioids during their first ISBT insertion.

Abdominal Schwannoma Mimicking Lymph Node Metastasis in Rectal Cancer.

Schwannomas are rare benign tumors that are often asymptomatic and identified incidentally on imaging studies undertaken for another purpose. Schwannomas arising from the vestibular nerve are the most common site of identification; however, schwannomas can arise extracranially in any peripheral nerve tissue. Here, we present a case study of a patient with a localized rectal adenocarcinoma who was found to have a retroperitoneal schwannoma initially felt to be a lymph node metastasis of his rectal cancer. The diagnosis of schwannoma was confirmed via biopsy, which resulted in changes to the patient's overall management including radiotherapy volumes and recommendation against neoadjuvant or adjuvant systemic therapy.

Cost Minimization Analysis of Hypofractionated Radiotherapy.

Early-stage breast cancer patients comprise a large proportion of patients treated with radiotherapy in Canada. Proponents have suggested that five-fraction hypofractionated radiotherapy for these patients would result in significant cost savings. An assessment of this argument is thus warranted. The FAST-Forward and UK FAST clinical trials each demonstrated that their respective hypofractionated regimens provided equivalent outcomes compared with standard regimens. Thus, a cost-minimization analysis was performed to quantify the potential savings associated with these regimens, which were designated as FAST-Forward 1 (26 Gy/5 fractions/1 week) and FAST-Forward 2 (27 Gy/5 fractions/1 week), and UK FAST 1 (28.5 Gy/5 fractions/5 weeks) and UK FAST 2 (30 Gy/5 fractions/5 weeks). A standard regimen of 42.5 Gy/16 fractions/5 weeks was also included. A comprehensive model of radiotherapy costs for a Canadian cancer centre was created. Time, labour costs, and capital costs were calculated for each regimen and applied using established measures. The total costs per patient for the FAST-Forward trials were $851.77 for FAST-Forward 1 and $874.77 for FAST-Forward 2, providing a total savings of $487.99 and $464.99, respectively. Similarly, the total costs per patient for the FAST trials were $979.75 for UK FAST 1 and $1017.70 for UK FAST 2, providing savings of $360.01 and $322.06, respectively. Following the FAST-Forward 1 regimen results in the greatest reduction of infrastructure and human resources costs at 36.42% compared with the standard. Sensitivity analysis shows a maximum per-patient costs savings ranging from $474.60 to $508.53 for the FAST-Forward 1 trial, which translates to an annual savings of $174,700/year locally and $2.06 million/year province-wide, based on a moderate-to-large size department workload. Compared with a standard radiotherapy regimen, all FAST-Forward and UK FAST hypofractionated regimens provide cost savings for the treatment of early-stage breast cancer. The cost savings associated with each of these equivalent regimens can be directly calculated; activities in this model can easily be adjusted to account for cost variations, allowing other centres to calculate cost impacts specific to their own centres.