Twitterchats as a means to educate patients with CRC and caregivers and stimulate collaborations

Background: During the COVID-19 pandemic, Twitter has been instrumental in accelerating knowledge dissemination and forging collaborations within the medical community and amongst patient advocates. Tweetchats within Twitter are scheduled conversations on a specific topic. In oncology, Tweetchats have been used by cancer advocates to spread awareness and for patient and caregiver education. A colorectal cancer (CRC) specific tweetchat did not previously exist. This describes the creation, and experiences with a CRC specific tweetchat. Method(s): The #CRCTrialsChat tweetchat was created by a patient advocate for colorectal cancer patients, caregivers and clinicians to meet and exchange clinical trial-related information. Two gastrointestinal (GI) medical oncologists and two radiation oncologists were enlisted as moderators. The topic for each session is chosen by the patient advocate, who creates an outline and divides the content, which is designed to last a one hour session. The idea is to create engaging, technical, but easy to understand content. Each moderator then works on the answers to their assigned section, which is edited to fit tweet character limit. Sessions may also have guest moderators with expertise on a specific topic. Through tweeting, moderators answer specific questions that come up during the session and later. Result(s): To date, we have had four sessions covering the following topics: Clinical trial basics, CRC Updates from ASCO22, ClinicalTrialFinders and BRAF-mutated tumors. The content created has been simple and engaging, the format has functioned smoothly, and the reach of #CRCTrialsChat has been steadily increasing. After the most recent session on BRAF in September 2022, the @CRCTrialsChat has 281 followers, 17K impressions and 14.6K profile visits, a reflection of its excellent content. From a clinician perspective, this is a great format to interact with colleagues, discuss enrolling trials and also become familiar with using Twitter. Conclusion(s): A CRC clinical trial focused tweetchat is an engaging way to deliver trial-related content to an audience of clinicians, patients and caregivers. The current format appears to be an effective way to create and disseminate information. Future sessions will focus on ctDNA, molecular markers such as KRAS and HER2, and rectal cancer trials. Our hope is that #CRCTrialsChat will stimulate continued patient and clinician engagement, increase awareness of clinical trials, enhance trial participation and initiate patient-centric research and collaborations.

The Effect of COVID-19 on Radiation Oncology Practice in Turkiye

OBJECTIVE COVID-19 (Coronavirus Disease-19) was the name given to a novel pneumonia outbreak that occurred in Wuhan (Hubei province, China) in December 2019. For patients undergoing or scheduled for radiation therapy, radiation oncology (RO) departments were required to adjust their management protocols to maintain their ability to provide optimal care. The present survey study assesses the change in the daily practices of Turkish radiation oncologists. METHODS An online questionnaire was developed in Google Forms and sent out to oncologists registered with the Turkish society for RO. A total of 98 radiation oncologists completed the online questionnaire after three reminders were sent to the recipients over the course of 1 week. RESULTS After the pandemic has started, 65% of radiation oncologists moved their wards and outpatient clinics to different hospital units, resulting in an approximate 70% decline in the delivery of patient services in RO. Since the beginning of the pandemic in Turkiye, 52% of radiation oncologists have not been assigned to services related to COVID-19. Around half of the radiation oncologists surveyed stated that they were shunned by the society due to fear of transmitting the COVID-19 infection. CONCLUSION Further studies are needed to steer the creation of new regulations related to radiation oncologists, to be applied in the event of such emergencies as the COVID-19 pandemic. Copyright © 2022, Turkish Society for Radiation Oncology.

Usage of Regular Safety Surveys to Evaluate and Strengthen Safety Culture in the Radiation Treatment Department

Purpose: The Radiation Treatment Quality Assurance Committee (RTQAC) is a multidisciplinary committee within the Radiation Treatment department. As a newly established committee in 2013, the RTQAC had a desire to obtain feedback from staff and to evaluate the existing safety culture. This practice has continued in subsequent years, with six surveys conducted over an 8-year period. The purpose of the safety culture surveys is to measure staff comfort with reporting incidents and the informationgathering process which follow an incident, to gather staff feedback on ways to improve the quality of treatment delivery, to measure and assess the current state of the safety culture in the department, and to identify themes from the results to drive quality improvement initiatives. Material(s) and Method(s): The safety culture surveys are developed in an electronic format and have been sent to all staff across various disciplines in the Radiation Treatment department, including radiation oncologists, medical physicists, physics associates, electronics engineers, radiation therapists, nurses, and clerical staff. The most recent survey was conducted in 2021. The surveys have ranged from nine to fifteen questions in length. Many of the questions have remained the same across the years, while some have been modified with each survey as seen fit by the committee. Responses are collected in both a multiple-choice format as well as written responses. Responses collected from each survey are analyzed, and when possible, compared against similar questions asked in previous years. The results are compiled into a report which is shared with the department. Result(s): Safety culture is something that is dynamic, as it can change with the implementation of new procedures, updates to incident reporting systems, changes in staffing, and external challenges such as COVID-19. Regular collection of safety culture survey results have highlighted both successes and areas of improvement within the department and the RTQAC. While in many areas, trends are positive, those areas which illustrate progressively negative responses have identified common issues which can be addressed. Feedback that has been collected has subsequently helped guide quality improvement initiatives. Conclusion(s): The implementation of safety culture surveys in our department has proven invaluable. It has provided staff an opportunity to talk openly and anonymously about safety concerns. Through assessment of responses, quality improvement strategies can be undertaken, which in turn can advance the culture of safety in the program. Copyright © 2022 Elsevier Ireland Ltd. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Physician Perspectives on Telemedicine Implementation in Radiation Oncology

Background: The use of telemedicine in radiation oncology increased dramatically during the COVID-19 pandemic. While prior surveys suggest high levels of satisfaction with telemedicine among radiation oncologists, the published literature is limited regarding provider-specific factors impacting satisfaction and provider preferences regarding how telemedicine is implemented. Objective(s): To assess provider characteristics associated with satisfaction and perceived adoption of telemedicine in radiation oncology, and to characterize implementation preferences of providers at our institution. Method(s): We distributed a survey to all attending radiation oncologists at our large academic institution in October 2021 to assess several measures of satisfaction with telemedicine. We also asked providers to estimate metrics suggestive of successful telemedicine use. Univariate logistic regressions were performed to assess the role of physician characteristics (including age, gender, years in practice, main vs satellite location, disease site treated, annual new patient volume, and selfreported comfort with technology) on satisfaction and on whether physicians reported telemedicine was easy to use. We also performed descriptive statistics to characterize provider-estimated time-savings and training preferences. Kruskal-Wallis tests were used to assess whether provider characteristics or scheduling strategy (telemedicine scheduled separately from in-person visits) were associated with the rate of missed video visits. Result(s): A total of 60 of 82 eligible radiation oncologists (73%) responded to the survey. 78% of respondents were satisfied with telemedicine in the radiation oncology department and 78% felt telemedicine was easy to use. None of the tested factors on univariate analysis were statistically significant predictors for these outcomes. 38% of providers believed telemedicine encounters resulted in time savings of at least 10% compared to in-person visits, while 20% of providers reported virtual encounters took at least 10% more time. A median (IQR) of 10% (5%-20%) of video visits were estimated to be missed, and none of the tested provider characteristics or scheduling preferences were associated with a significantly greater proportion of missed visits. 78% of respondents reported having adequate training and support to perform telemedicine. Text, video, and private instruction were nearly equally preferred training modalities (31%, 31%, 34% respectively). Conclusion(s): Nearly 80% of surveyed radiation oncologists were satisfied with telemedicine, felt it was easy to use, and reported adequate training and support to perform telemedicine. In this highly technologically advanced field, age and years in practice were not significantly associated with satisfaction or self-reported success rates with telemedicine. Future directions include addressing actionable concerns and correlating these findings with patient impressions.

Northern Perspectives: Commissioning and Clinical Operation of the Northernmost Linear Accelerators in Canada

Purpose: Offering radiation therapy services closer to northern communities is an exciting step forward in improving patient quality of care in Canada. Thanks to close collaboration between Alberta cancer centers, expert and high quality treatment is now possible closer to home for more Canadians. Methods: The development of an excellent program in a short time frame was possible thanks to strong collaborations within Alberta as well as with the wider Medical Physics community. Virtualization of training and day-to-day communication allows a center, 500 km away from the next nearest radiation therapy program, to still draw on expertise of dozens of medical physicists, radiation therapists, and radiation oncologists. Results: A collaborative and competent local team has come together around a patient centric program that treats patients close to home. The team is treating 14 patients daily. With staffing to fully utilizing one unit at a time, the team has treated over 60 patients since opening. The response from the community is overwhelmingly positive and there is high demand for treatments. Conclusion: A new radiation therapy treatment center was opened in a northern community during a global pandemic. Lessons learned have application to the opening of radiation therapy centers across Canada especially as Covid continues to be an ebbing and flowing global threat. The response from the community and the benefits to patient quality of life is also motivation for other jurisdictions to bring radiation therapy closer to all Canadians.

Characterization of remote second-opinion oncology patients and associated changes in management

Background: The utilization of virtual second opinions in oncology has increased considerably in the last decade, driven by the increased complexity of care and desire for expert opinion, improved technologies in telemedicine, and the acceleration of virtual services due to the Covid-19 pandemic. Therefore, it is important to further understand the patient populations that currently use virtual second opinion programs and to measure their effectiveness. Virtual second opinion programs provide a platform for patients to submit their medical history and questions regarding their condition to remote specialists who then render their opinions on diagnosis and management. Currently there is a paucity of research on the types of patient populations that seek second opinions and the outcomes of these rendered opinions. Here we describe the patient characteristics and changes in management associated with utilization of a virtual second opinion service at an academic medical center. Methods: In this IRB-approved retrospective review, we identified 657 cancer patients that utilized a virtual digital health platform to engage in second opinions at Stanford Healthcare. Patient demographics, cancer staging, site of origin, and prior therapeutic and surgical history were collected. Physician opinions rendered were self-classified into “major change in treatment”, “minor change in treatment”, or “no change in treatment.”. Results: The majority of patients who utilized the virtual second-opinion platform had a diagnosis late-stage cancer (with 77.2% at Stage III or IV). Breast cancer was the most common primary tumor site (24.7% of patients) followed by GI (21.9%) and GU malignancies (14.0%). Patients diagnosed with dermatological (4.4%), head and neck (3.3%), and neurological (3.2%) malignancies were least common. Physicians providing the virtual second-opinion were primarily medical oncologists (67.6%), followed by gynecologists (6.8%), urologists (5.2%), radiation oncologists (5.0%), and surgical oncologists (4.4%). Physicians self-reported that in more than half of cases reviewed (53.8%) a minor or major treatment change was recommended. Conclusions: This study showed that patients access second opinion platforms at late stage of cancer disease progression. With treatment changes recommended for more than half of the cases, virtual second opinion programs can potentially have a significant impact on cancer care. Patient satisfaction and clinical outcomes from virtual second opinion programs is an area of on-going research.

Predictive toxicity markers in elderly patients underwent RT and managed by an oncogeriatric model

Purpose or Objective A growing number of elderly patients every year is treated with radiation therapy (RT), but little is known about side effects and outcome of irradiation in this potentially frail population. The identification of predictive factors of toxicity and frailty could offer a personalized treatment approach, thanks also to a multidisciplinary management of patients with increased risk of adverse outcomes. In this study we investigated the correlation of patient parameters with acute toxicities in elderly aged > 75 years treated with curative RT. Materials and Methods A prospective observational study was designed in our Center for patients with > 75years, candidate for curative RT. To these patients the radiation oncologist submitted the Geriatric 8 questionnaire (G8q) before and at the end of RT. Patients with G8 score < 14 were then evaluated by a multidimensional geriatric assessment, investigating cognitive (MMSE, GDS), functional (ADL, IADL, Tinetti) and nutritional (MNA short) domains, to define the frailty phenotype. In this setting, we retrospectively analyzed parameters like body mass index (BMI), number of comorbidities, total blood count, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and basal G8 score, and correlated these parameters to acute toxicity. Results G8q was administered to 150 patients from December 2019 to April 2021. In this study we included 98 patients who started and completed RT in our Unit in this period. Of them, 38 (38.8%) had a baseline G8 score < 14 (range 4-14) and 23 agreed to underwent a multidimensional assessment, while 15 could not be evaluated due to COVID-19 dispositions or their refusal. Eleven patients resulted fit, while 12 patients were classified as vulnerable. Acute toxicity grade was < grade 2 in 67 patients (68.4%) (Table 1). We evaluated associations between BMI, number of comorbidities, total blood count, NLR, PLR, G8 score and acute toxicity (Table 2). Total blood count, NLR, PLR and G8 score resulted not significantly correlated to toxicity. Instead, a higher BMI was associated with worse acute toxicity (p=0.031): considering the 31 patients reporting toxicity > grade 2, 17 patients were over-weighted (54.8%), 1 patient was under-weighted (3.2%). Overall, the 63.3% of population (62 patients) was over-weighted, with a median BMI of 26.3. (Table Presented) (Table Presented) Conclusion Although G8q considers under-weight as a possible responsible of frailty, our study suggested that attention should be paid to over-weight too, due to its prevalence in elderly patients. Furthermore our results suggested that in elderly patients > 75years the BMI correlates with worse acute toxicity, according to literature data. The 38.8% of patients needed a multidimensional evaluation;this approach resulted useful in order to obtain compliance to the treatment without increased toxicity. The study is still ongoing and further analysis will be done.

A national program for the implementation of lung Stereotactic Ablative Body Radiotherapy (SABR)

Purpose or Objective Following completion of an evaluation program of SABR for primary lung cancer and metachronous extracranial oligometastatic disease, NHS England & NHS Improvement funded a SABR expansion program to increase SABR provision to 50 radiotherapy centres. With reduced access to surgery due to the impact of the COVID-19 pandemic, efforts were focussed on implementing SABR for lung primary and oligometastatic disease in the first instance. Materials and Methods The program consisted of 3 elements, delivered by multi-disciplinary SABR experts from the SABR Consortium and the National Radiotherapy Trials Quality Assurance (RTTQA) Group: Education;Mentorship of RT centres new to SABR by those with extensive experience;QA to ensure the safe and consistent implementation of the technique. A contouring workshop for radiation oncologists was developed by the SABR Consortium Steering Committee. In addition, educational sessions were provided within the SABR Consortium Online Conference, offered free of charge to enable wide access to education and professional development. The Committee produced a Guide for SABR Mentorship, setting out a consistent framework under which mentorship would proceed (Table 1). Mentoring and local protocols followed implementation guidance from the UK SABR Consortium Guidelines. In parallel, RTTQA developed a comprehensive RT QA program (Table 2). Two radiation oncologists and one treatment platform were assessed per hospital. Credentialed clinicians then provided cascade training and education within their departments, formally documenting peer reviews through standard templates provided by RTTQA. (Table Presented) (Table Presented) Results 54 radiation oncologists participated in the contouring workshop. The conference had 1335 registrants, 65% of whom were UK multi-professionals. 15 experienced centres were invited to mentor 24 new SABR sites. Mentors were assigned by equipment for planning and delivery. The mentoring framework was adjusted to accommodate visiting restrictions due to the pandemic and performed remotely through email and video-conferencing instead. The RT QA program commenced in June 2020 with circulation of the facility questionnaire, collecting data on equipment, technique, intention to treat and expected level of mentoring. Responses were used to tailor mentoring and inform what components of the QA program were required for each centre. Contouring submissions were received from 46 radiation oncologists and planning benchmarks were completed by all 24 centres, 22 of which underwent the dosimetry audit. All assessments were reported through standard templates to ensure consistent feedback. Conclusion The implementation of lung SABR was completed in June 2021. Collaboration amongst all stakeholders ensured centres were trained and supported to safely deliver high-quality SABR for lung primary and oligometastatic disease. The education, mentoring and QA program proved effective and has now been rolled out to other oligometastatic sites.

Canadian Radiation Oncology 2020 Work Engagement and Burnout Survey

Purpose or Objective The Canadian Medical Association recently acknowledged that physician health remains a significant threat to the viability of Canada’s health care system. A 2014 survey reported a 44% prevalence of burnout among American oncologists. The purpose of this survey was to determine the national prevalence of burnout and document work engagement among Canadian radiation oncologists. Materials and Methods Between November 2019 and March 2020 (pre COVID pandemic), online questionnaire was distributed electronically to 333 Canadian radiation oncologists, across 49 centers, through the National Canadian Association of Radiation Oncology office mailing list. The survey included 62 questions determining job engagement, and validated burnout scale The Maslach Burnout Inventory (MBI) (22 questions). Results 241 of the 333 surveyed Canadian radiation oncologists (72%) completed the questionnaire and were included in this analysis. Responses to the MBI showed that 15% of radiation oncologist met the strict criteria for burnout (i.e. negative scores in all 3 domains: exhaustion, depersonalization, and low accomplishment). Another 60% scored negative in at least one of the three burnout domains. Using the more commonly reported definition of burnout (negative scores in either exhaustion and/or depersonalization), 44% of Canadian radiation oncologist were burnt out. Only 25% had positive scores in all 3 domains and were fully engaged in their work. The full burnout syndrome varies with the provinces and was the highest in British Columbia (22% ) and lowest in Quebec (3%). The responses to work engagement questions revealed a significant concerns regarding inefficiency in work flow (50%), heavy workloads (>50%), a poor work life balance (68%), lack of control over the work environment (47%) and lack of recognition from administrators (45%). 48% perceive the atmosphere at their primary work area as “chaotic and hectic”. Within the last 3 years, 41% had considered leaving their institution to work elsewhere and 51% were considering reducing their full-time equivalent (FTE). Reassuringly, 80% reported a sense of overall ability to provide high quality care and a 59% feel they have a supportive network of colleagues, 80% are willing to try something new. The top 4 strategies identified by respondants aimed to improve worklife quality were (1) more support staff at work, (2) more efficient care models, (3) more resources for patients, and (4) lighter workloads for physicians. Conclusion The survey shows that only 25% of the Canadian radiation oncologist is fully engaged in their work, 15 % meet the strict criteria for burnout and 44% meet the more commonly used burnout criteria. With the rising incidence of cancer and complexity of care, there is an urgent need for change, leverage the enthusiasm to “try something new”, and develop appropriate strategies to improve the wellbeing of the oncology work force.

SUSTAINING MULTIDISCIPLINARY CARE OF CHILDREN WITH CENTRAL NERVOUS SYSTEM TUMORS DURING THE COVID-19 PANDEMIC

INTRODUCTION: A multidisciplinary team (MDT) approach is essential for quality cancer care. Since 2019, we have conducted regular MDT meetings to discuss pediatric patients with central nervous system (CNS) tumors at the Philippine General Hospital. Because of COVID-19, an abrupt transition from in-person to virtual meetings became necessary. METHODS: We reviewed the proceedings of MDT meetings for pediatric CNS tumors from March 2020-December 2021. We identified the strategies and adaptations of our pediatric neuro-oncology group, and outlined recommendations for other institutions in low- and middle-income countries. RESULTS: Our pediatric neuro-oncology group conducted 18 virtual MDT meetings during the study period. Meetings were scheduled every last Tuesday of the month, with pediatric oncologists, neurologists, neurosurgeons, radiation oncologists, radiologists, and neuropathologists regularly attending. We invited other specialists as needed. In total, we had 135 case discussions for 79 unique patients, or about 8 patients per meeting. These included both inpatients (74%) and outpatients (26%). Ten patients received prior treatment elsewhere. At the time of the meeting, 86% were postoperative, 8% were preoperative, and 6% did not require surgery. Most (60%) had malignant CNS tumors and 15% had disseminated/leptomeningeal disease. Histopathologic diagnosis was obtained for 62 patients (79%). Concerns addressed were: formulating a treatment plan (88%), surveillance strategy (10%), and diagnostic workup (5%). DISCUSSION: Several factors contributed to the ease of online transition: (1) motivated care providers including a patient navigator, (2) fixed schedule, (3) institutional Zoom account for securing data privacy, and (4) availability of picture archiving and communication system (PACS) for neuroimaging. Challenges included: (1) delays due to internet connectivity, (2) Zoom fatigue and online distractions, and (3) risk for miscommunication or misunderstanding. Commitment of the entire neuro-oncology team is essential to ensure the delivery of best possible care for pediatric patients with CNS tumors.

Learn & Unite - a staff-driven in-service program

The COVID-19 pandemic affected everyone globally and at different levels, including staff education and training. Learning and sharing knowledge is key to successful development of the profession and patient service.1 Various workplace restrictions were in place during COVID-19 lockdowns, especially in medical settings.2 Any traditional education forums using face-to-face formats - including seminars, lectures or inservices - were halted. To help alleviate this disruption to education and training, our staff were consulted via an internal survey for input into an in-service program. A new initiative using technology to run the in-service program for the past 18 months was established. Zoom was readily used across the Victoria practice and interstate. Various topics were suggested by the team;therefore the program was a multi-disciplinary approach involving radiation therapists, radiation oncologists, physicists, allied health and management. A feedback survey was conducted after the 18 months in-service and had a huge staff satisfaction score (over 4.5 out of 5) for the content and program design. A staff-driven directive was one of the key factors of the program's success. Staff felt there was continuation of education as well as full engagement and collaboration with the wider teams. On average, each session had 60 staff attend. The in-service program will continue to run in a similar way in the near future. It is critical to give staff the flexibility and opportunity to collaborate broadly.

Impact of the COVID-19 pandemic on work routine, practice and mental state of radiation oncologists in India: an online survey.

BACKGROUND AND PURPOSE: COVID-19 has affected the lives of every medical professional including oncologists. The goal of this survey was to evaluate the impact of COVID-19 on the work routine, psychological state and radiotherapy practice of radiation oncologists. MATERIALS AND METHODS: An anonymous survey consisting of 23 questions regarding the lives of radiation oncologists during the COVID-19 pandemic was distributed online via social media from July 14 to July 21, 2020. Statistical analysis was performed with Statistical Package for the Social Sciences 18.0 software and basic descriptive statistics were applied. RESULTS: A total of 82 radiation oncologists responded to the survey. The majority were professors (28/82; 34.1%) and residents (28/82; 34.1%) and <50 years old (70/82; 85.4%). Cancer screening programs (57/62; 91.9%) and number of new cases reduced (44/82; 53.7%) in many institutes. Follow-up was still done in-person by 73.2% respondents. 35/82 (42.7%) respondents were satisfied about their safety during COVID-19, at the same time 36/82 (43.9%) were worried about the patient's safety. The fear of contracting COVID-19 (57/82; 69.5%) and infecting their families (64/82; 78%) was high. Physical presence during case implementation (59/82; 72%) and daily setup verification (60/82; 73.2%) remained the same during COVID-19. Half of the respondents adopted new fractionation schedules, commonly in breast and palliative cases. Time spent on research had reduced by 62.2%. Only 41.4% respondents were satisfied with the patient care provided by them during the COVID-19 pandemic. CONCLUSION: COVID-19 has significantly altered the work routine, radiotherapy practice and mental state of radiation oncologists.