Prevalence and factors associated with professional burnout in Polish oncologists-results of a nationwide survey.

BACKGROUND: High rates of burnout are observed among health care professionals worldwide, which could have negative consequences on personal and organizational levels. We aimed to evaluate the burnout prevalence and factors associated with burnout among oncologists in Poland. MATERIALS AND METHODS: An online survey was conducted using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and additional work/lifestyle questions. Descriptive statistics, parametric and nonparametric tests, and multivariate logistic regression were used to identify factors associated with burnout. RESULTS: A total of 228 physicians participated in the survey, including 168 medical oncologists, 43 radiation oncologists, and 17 from other specialties. Data collected from 211 medical and radiation oncologists were included in the final analyses. Most participants were female (71.6%) and ≤40 years of age (70.1%). A self-reported feeling of burnout was present in 65.9% of participants. Based on the MBI-HSS, 74.9% showed evidence of burnout with burnout subdomains as follows: depersonalization 37.0%; emotional exhaustion 64.5%; low accomplishment 43.1%. There were no differences in burnout rates based on specialization (oncology/haematology-75.6%, radiotherapy-72.1%), career stage, gender, or age groups. Lack of work-life balance was the only significant factor associated with the risk of burnout in the logistic regression (relative risk 2.6, 95% confidence interval 1.3-5.4). Only 20.9% of physicians had access to psychological support in their workplace; however, 70.1% desired such support. Three main factors impacting burnout in cancer care workers were: bureaucracy and administrative duties overload, admissions of many patients, and poor work culture. CONCLUSIONS: Burnout is common among medical and radiation oncologists in Poland. There is a high demand for psychological support and organizational changes in the workplace to reduce risk and mitigate the adverse effects of burnout among health care professionals.

On the holistic approach in cancer biology: tumor necrosis factor, colon cancer cells, chaos theory and complexity.

TNFalpha plays a role in the pathogenesis of septic shock, inflammatory diseases, autoimmune diseases, graft rejection reaction, acute, and chronic respiratory inefficiency among others. Its activity depends on the type of target cells and different regulating factors, but the effect of biological activity is conditioned by specific receptors such as p55 (type I, TNF R55) and p75 (type II, TNF R75). The aim of the study was to answer the following questions: 1) Is it possible to apply elements of non-linear dynamics to assess the level of expression of TNF, TNFRI, TNFRII genes in tumor cells, pathologically unchanged tissue and metastatically changed lymph nodes? 2) Is theoretically anticipated variability of cytokine and its receptors in colorectal carcinoma cells and the immediate vicinity justified in the developed mathematical model? The research material--specimens taken from tumor, unchanged tissue and metastatic lymph nodes--were histopathologically and molecularly analysed. Results of the molecular research were used to develop a mathematical model using the basic studies on the theory of chaos and biological system modelling.

[Evaluation of quality of life in patients with advanced colorectal cancer treated with topotecan]. / Ocena jakosci zycia chorych z zaawansowanym rakiem jelita grubego leczonych topotekanem.

UNLABELLED: During last years a few new directions appeared in therapy of advanced colorectal cancer. Topotecan, a camptothecin analog, seems to be one of the promising novel drug in these cases. Its unique mechanism of action is connected with inhibition of the nuclear enzyme topoizomerase I. Assessing therapeutic effects of new cytotoxic drugs we should consider their impact on survival time and quality of life as well. The aim of our study was the attempt to assess the quality of life of patients with advanced colorectal cancer (IV stage in TNM scale), treated by topotecan. Clinical trial was performed in the group of 10 patients. Topotecan was administered intravenously at 1.5 mg/m2/day for 5 days and repeated every 21 days. Quality of life assessment was performed at special time points using Rotterdam Symptom Checklist. We observed improvement in quality of life in six out ten patients having advanced colorectal cancer. Two patients did not show any change in quality of life and two patients with progression of disease demonstrated lower quality of life during topotecan treatment. CONCLUSION: Topotecan has a positive influence on quality of life of patients with advanced colorectal cancer. Further study are needed to confirm this observation.

Dynamics of circadian fluctuations in serum concentration of cortisol and TNF-alpha soluble receptors in gastrointestinal cancer patients.

The objective of the study was to investigate the dynamic changes of cortisol and soluble TNF-alpha p-55 and p-75 receptors in serum of advanced cancer patients during 24 h. The examined group consisted of 42 patients suffering from advanced gastrointestinal neoplasms (colorectal, gastric and pancreatic cancer). Serum levels of cortisol, TNF-alpha and both receptors in cancer patients were measured using ELISA type kits 6 times a day (8.00 a.m., 2.00 p.m., 6.00 p.m., 10.00 p.m., 2.00 a.m. and again 8.00 a.m.) as well as in healthy controls. The levels of cortisol, TNF-alpha and its soluble receptors were substantially increased in examined group and displayed statistically significant circadian fluctuations. Cortisol peak was found typically at 8.08 a.m., the minimum value appeared at 6 p.m. The presence of circadian rhythm of the cytokine was proved (acrophase -00.36 a.m.), however no diurnal rhythm of soluble TNF receptors was observed. The concentration of p-55 receptor was distinctly lower then p-75. The peak p-55 value appeared at 10.00 p. m. while the p-75 reached its minimum level at the same time. Although there was no statistical correlation between the receptor concentrations the shapes of both curves remained in inversely proportional manner to each other. The present results may suggest the presence of complex self-regulation mechanisms in advanced gastrointestinal cancer patients. There was no correlation observed between cortisol and TNF-alpha soluble receptor concentration.

Dynamics of diurnal changes in serum concentration of TNF-alpha soluble receptors in gastrointestinal cancer patients.

The objective of the study was to investigate the dynamic changes in soluble TNFalpha p-55 and p-75 receptors in serum of advanced cancer patients during 24 hours. The group examined consisted of 42 patients suffering from advanced gastrointestinal neoplasms (colorectal, gastric and pancreatic cancer). Serum levels of the cytokine and both receptors in cancer patients were measured using ELISA type kits 6 times a day (8.00 a.m., 2.00 p.m., 6.00 p.m., 10.00 p.m., 2.00 a.m. and again 8.00 a.m.) as well as in healthy controls. The levels of TNFalpha and its soluble receptors were substantially increased in the examined group and displayed statistically significant circadian fluctuations. The presence of circadian rhythm of the cytokine was proved (acrophase - 00.36 a.m.), however no diurnal rhythm of soluble TNF receptors was observed. The concentration of p-55 receptor was distinctly lower then p-75. The peak p-55 value appeared at 10.00 p.m. while the p-75 reached its minimum level at the same time. Although there was no statistical correlation between the receptor concentrations the shapes of both curves remained inversely proportional. The present results may suggest the presence of complex self-regulation mechanisms in advanced gastrointestinal cancer patients.

Central single and chronic administration of morphine stimulates corticosterone and interleukin (IL)-6 in adjuvant-induced arthritis.

Adjuvant-induced arthritis (AA) in the rat is a chronic inflammatory stress in which circulating corticosterone and interleukin (IL)-6 levels are elevated. In addition, there are profound neuroendocrine changes associated with the development of hind-paw inflammation which have major implications for the ability of the rat to respond to stress. Central injection of morphine is able to increase plasma corticosterone and circulating IL-6 concentration in control animals. In present study we have determined the effects of a single and repeated injection of morphine into the lateral ventricle of control and AA animals on plasma corticosterone, circulating IL-6 levels and course of hind-paw inflammation in AA rats. In the present study we found a sustained increase in plasma corticosterone both after single and repeated injection of morphine in control and AA rats and an increase of the level of circulating IL-6 in AA rats after repeated injection of morphine. These data suggest that alternative systems distinct from Athose activated in response to acute stress are activated by morphine in the AA animals. The similarity with the sustained increase in corticosterone following LPS injection suggest that central opiates may be involved in mediating HPA axis and cytokines response to inflammatory stress.

[Soluble tumor necrosis factor receptors--their properties and role in diagnosis and therapy of acute and chronic diseases]. / Rozpuszczalne receptory czynnika martwicy nowotworów--ich wlasciwosci i znaczenie w diagnostyce i terapii schorzen o przebiegu ostrym i przewleklym.

The review presents the properties and significance of soluble forms of tumor necrosis factor-alpha receptors in physiology and pathology of human organism. Special attention was turned to the possibility of practical application of those forms of the receptors in the therapy of diseases caused by excessive activity of TNF-alpha. The significance of the soluble receptors as prognostic factors of disease progression and outcome was stressed.

Breast self-examination: attitudes and practices among young women in Europe.

Breast self examination (BSE) is recommended for the early detection of breast cancer in the European Code against Cancer. Evidence from North America suggests that there is reasonable public awareness of its importance, but compliance with regular BSE is reported by only a minority of young women. Attitudes to and practice of BSE has rarely been studied outside North America. In the present study, attitudes to BSE were evaluated by questionnaire in a sample of 16,486 students aged 17-30 from 20 European countries. Frequency of BSE practice was reported by the 9,181 women in the sample. Information on public recommendations concerning BSE was obtained from cancer organizations in each country. The data were collected as part of the European Health Behaviour Survey, an international study on health beliefs and health behaviour. The results showed that BSE was recommended in 16 countries and 'breast awareness' in two, while two countries did not recommend self-examination. 54% of women reported as never having practiced BSE. Regular practice (monthly) was reported by only 8% of the sample, with another 36% reporting occasional BSE. Significant differences emerged between centres in different countries ranging from 6% to 15% reporting regular BSE. Attitude towards BSE was a significant predictor of BSE practice within each centre and across all centres combined. Attitudes towards BSE were significantly less positive in the two centres from countries without BSE recommendations than in the others, but levels of practice were similar.(ABSTRACT TRUNCATED AT 250 WORDS)