ABSTRACT
The combination of the ongoing violence perpetuated against Black, Brown, and Asian people, and the increased incidence of death of Black, Indigenous, people of color (BIPOC) and Asian Americans and Pacific Islanders (AAPI) at the start of the COVID-19 pandemic, elicited an important response from the field of social work across the nation. This article describes the efforts undertaken by a Social Work Department at a comprehensive cancer center in response to a call to develop antiracist practice. This article recounts the process of creating educational opportunities for oncology social workers to help them identify bias and racism in themselves and throughout the healthcare system, to embrace intentional antiracist practice, and to better advocate for BIPOC/AAPI patients and colleagues. The strategies included the development of an antiracism committee, the use of a social location exercise to influence and disrupt white supremacy, the creation of community guidelines for engaging in conversations about race, and the formulation of a new departmental policy ensuring a commitment to antiracist social work practice. In addition, a forum using multimedia was created to explore racial dynamics and to highlight the narratives of BIPOC and AAPI people. Further, a monthly Antiracist Clinical Case Conference was implemented to explore their role in the context of working with the interdisciplinary team in an oncology setting. This article concludes with recommendations for ongoing antiracist social work practice development that may be applied in various healthcare settings.
Subject(s)
Antiracism , Neoplasms , Oncology Service, Hospital , Humans , Pandemics , Racism , Social Work , Social Workers , Oncology Service, Hospital/organization & administrationABSTRACT
INTRODUCTION: Clinical pharmacy is considered an integral discipline in the health care system for optimizing therapy and reducing drug-related problems. The objective of this study was to evaluate the impact of clinical pharmacists in optimizing management in a medical oncology service. METHODS: A prospective study was conducted at King Hussein Cancer Center between July 2019 and September 2019 of patients admitted to the medical oncology service. The impact of clinical pharmacists was measured by evaluating their interventions, defined as actions that were expected to result in a change in patient management. Data were collected daily by routine review of patients' profiles and by recording clinical pharmacists' interventions. The data collected were baseline characteristics of patients, numbers and types of clinical pharmacists' interventions, their significance, medications involved, and rate of acceptance of clinical pharmacists' interventions by physicians. The significance of each intervention was assessed by two clinical pharmacists on a Hatoum scale. Physicians' acceptance was assessed by whether the recommendations were implemented. RESULTS: During the study period, 748 patients were included, of whom 605 required a total of 1683 clinical interventions. The mean age was 56.3 years (±15.5 SD). Of the interventions, 39% resulted in initiation of a drug and 25% in drug discontinuations. The drug group most commonly associated with clinical pharmacists' interventions was antibiotics (26.5%). Physicians accepted 98% of the clinical pharmacists' interventions, and 92.4% of the interventions brought care to a more appropriate level and were considered significant. CONCLUSION: Most patients in the medical oncology service required clinical pharmacists' interventions, as demonstrated by the high number of significant clinical pharmacists' interventions. Studies should be conducted to follow up these findings with respect to patient outcomes and cost savings.
Subject(s)
Oncology Service, Hospital/organization & administration , Pharmacists , Adult , Aged , Anti-Bacterial Agents/adverse effects , Cost Savings , Female , Humans , Inpatients , Interprofessional Relations , Jordan , Male , Medication Errors , Middle Aged , Pharmacy Service, Hospital , Physicians , Prospective StudiesABSTRACT
BACKGROUND: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient's profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. METHODS: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). RESULTS: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07-0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. CONCLUSIONS: The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.
Subject(s)
Decision Making, Shared , Oncology Service, Hospital/standards , Referral and Consultation/standards , Time Factors , Aged , Delivery of Health Care, Integrated/methods , Delivery of Health Care, Integrated/standards , Delivery of Health Care, Integrated/trends , Female , Humans , Male , Middle Aged , Neoplasms/classification , Neoplasms/therapy , Oncology Service, Hospital/organization & administration , Oncology Service, Hospital/trends , Palliative Care/methods , Palliative Care/standards , Palliative Care/trends , Referral and Consultation/trends , Retrospective Studies , Terminal Care/organization & administration , Terminal Care/standards , Terminal Care/trendsABSTRACT
To improve understanding of the triage process following distress and problem identification and the factors associated with offer and acceptance of supportive care referrals. Review of patient records/charts at a metropolitan hospital in Melbourne, Australia. Data were collected on problem identifications from 1/1/13 to 30/6/14, including patient demographics, disease and treatment information, responses to the NCCN Distress Thermometer (DT) and Problem Checklist (PC), whether referrals to supportive care services were offered and accepted/declined. Logistic regressions examined factors associated with referral offer and acceptance. Of patients completing the DT/PC, 50.1% reported a high level of distress. Overall, 61% of patients were offered referral(s), with the majority (71%) being accepted. Referrals were more likely to be offered to patients with a greater number of problems (Odds Ratio[OR] = 1.18, 95%CI = 1.12-1.25) and higher distress (OR = 1.68, 95%CI = 1.07-2.64). Referrals were more likely to be accepted by patients with a greater number of problems (OR = 1.12, 95%CI = 1.06-1.19) and lower distress (OR = 0.58, 95%CI = 0.34-1.00). The type of problem experienced by the patient was strongly related to the type of referral they were offered. At a large metropolitan hospital with in-house supportive care services, simple problem identification with the DT/PC enabled triage to services that reflected patients' needs. The findings suggest that clear referral pathways and an organisational emphasis on supportive care may facilitate service use.
Subject(s)
Neoplasms , Oncology Service, Hospital/statistics & numerical data , Referral and Consultation/statistics & numerical data , Social Support , Adolescent , Adult , Aged , Aged, 80 and over , Disabled Persons/rehabilitation , Female , Humans , Logistic Models , Male , Mass Screening , Middle Aged , Needs Assessment/organization & administration , Neoplasms/complications , Neoplasms/psychology , Neoplasms/therapy , Oncology Service, Hospital/organization & administration , Palliative Care/statistics & numerical data , Psychotherapy , Stress, Psychological/diagnosis , Stress, Psychological/therapy , Triage/organization & administration , Young AdultABSTRACT
OBJECTIVE: To determine the differences between recommendations by the National Comprehensive Cancer Network (NCNN) guidelines and Food and Drug Administration approvals of anticancer drugs, and the evidence cited by the NCCN to justify recommendations where differences exist. DESIGN: Retrospective observational study. SETTING: National Comprehensive Cancer Network and FDA. PARTICIPANTS: 47 new molecular entities approved by the FDA between 2011 and 2015. MAIN OUTCOME MEASURES: Comparison of all FDA approved indications (new and supplemental) with all NCCN recommendations as of 25 March 2016. When the NCCN made recommendations beyond the FDA's approvals, the recommendation was classified and the cited evidence noted. RESULTS: 47 drugs initially approved by the FDA between 2011 and 2015 for adult hematologic or solid cancers were examined. These 47 drugs were authorized for 69 FDA approved indications, whereas the NCCN recommended these drugs for 113 indications, of which 69 (62%) overlapped with the 69 FDA approved indications and 44 (39%) were additional recommendations. The average number of recommendations beyond the FDA approved indications was 0.92. 23% (n=10) of the additional recommendations were based on evidence from randomized controlled trials, and 16% (n=7) were based on evidence from phase III studies. During 21 months of follow-up, the FDA granted approval to 14% (n=6) of the additional recommendations. CONCLUSION: The NCCN frequently recommends beyond the FDA approved indications even for newer, branded drugs. The strength of the evidence cited by the NCCN supporting such recommendations is weak. Our findings raise concern that the NCCN justifies the coverage of costly, toxic cancer drugs based on weak evidence.
Subject(s)
Antineoplastic Agents/pharmacology , Drug Approval/methods , Oncology Service, Hospital/organization & administration , Patient Care Management/standards , Evidence-Based Medicine/methods , Humans , Organizations, Nonprofit/statistics & numerical data , Retrospective Studies , United States , United States Food and Drug AdministrationABSTRACT
Introducción. Vivir la experiencia de tener un hijoa con cáncer es una situación que genera una crisis en la familia que afecta no solo a nivel estructural, sino también emocional. Las enfermeras son las profesionales miembros del equipo multidisciplinar que se relacionan más tiempo con estas familias, por lo que es interesante saber cómo evidencian esta experiencia para poder mejorar la práctica asistencial, que debe contemplar una orientación holística dentro de los cuidados de alta complejidad que precisa un niño oncológico. Objetivos. Analizar el impacto en las familias producido por el debut de una enfermedad oncológica infantil; describir la percepción de las enfermeras sobre el impacto y la vivencia de las familias en el inicio de una enfermedad oncológica infantil y comparar la percepción que tienen las familias con la percepción de las enfermeras con respecto al debut de la enfermedad oncológica infantil. Ámbito de estudio. Unidad de Oncología y Hospital de Día del Hospital Sant Joan de Déu de Barcelona. Metodología. Estudio cualitativo siguiendo un enfoque basado en la fenomenología hermenéutica de Heidegger. Los participantes serán las familias de niños con cáncer y las enfermeras dedicadas a su cuidado. Para la recogida de datos se utilizará la entrevista en profundidad y, si se considerara pertinente, el grupo de discusión. El tipo de análisis utilizado será el de la temática bajo el método de análisis del contenido, siguiendo el método de análisis Guía QUAGOL (Qualitative Analysis Guide of Leuven) (AU)
Introduction. Going through the experience of having a child with cancer often results in a structural and emotional crisis for the family. Nurses, as professional members of a multidisciplinary team, interrelate the most with the families of oncologic pediatric patients. It is of great interest to provide evidence of nurses experience, in order to improve the care practice for children with cancer. Due to these patients highly complex needs in terms of care, a holistic approach is required. Objectives. To design a study which will determine the impact that the debut of an oncologic disease on a child has on families, by comparing nurses perception on the impact and experience of families going through this process to those of the actual family. Field of study. Oncology Unit and Day Hospital Sant Joan de Déu, Barcelona. Methodology. A qualitative study based on Heideggers hermeneutic phenomenology. The subjects of study will be parents of children with cancer and nurses involved in their care. For data collection, interviews and group discussions (if considered relevant) will be collected. The type of analysis used will be content analysis, following the QUAGOL Guide (Qualitative Analysis Guide of Leuven) (AU)
Subject(s)
Humans , Child , Oncology Nursing/trends , Oncology Service, Hospital/organization & administration , Medical Oncology/trends , Sickness Impact Profile , Child, Hospitalized/psychology , Psychosocial Support Systems , Social Support , Uncertainty , Caregivers/psychology , Nursing Care/organization & administrationABSTRACT
BACKGROUND: In general, patients with a cancer suspicion visit the hospital multiple times before diagnosis is completed. Using various "operations management" techniques a few fast track diagnostic services were implemented in the Netherlands Cancer Institute (NKI) in 2006. Growing patient numbers and increasing process complexity, led to diminished service levels. To decrease the amount of patient visits and to extend these services beyond the (obvious) breast cancer services, fast track diagnostics is now implemented for all 18 cancer types that present with a frequency of minimally one per week. METHODS: The throughput time (first visit to diagnosis conversation) was measured before, and after implementation of fast track diagnostics. The process was redesigned closely involving the multidisciplinary teams. In an eclectic approach elements from lean management, theory of constraints and mathematical analysis were used to organize slots per tumor type for MRI, CT, PET and echography. A post measurement was performed after 3 and 6 months. RESULTS: In pre measurement access time was calculated to be 10 to 15 workdays, mean throughput time was 6.0 workdays. It proved possible to design the process of 18 tumors as a fast track, of which 7 as "one stop shop" (diagnosis completed in one visit). Involvement of clinical- and board leadership, massive communication efforts and commitment of physicians to reschedule their work proved decisive. After 3 and 6 months of implementation, the mean access time was 8.2 and 8.7 workdays respectively and mean throughput time was 3.4 and 3.3 workdays respectively. CONCLUSIONS: Throughput- and access time were considerably shortened after implementation of fast track diagnostics for 18 cancer types. The involvement of physicians in reorganizing their work and rapid responding to their needs during the implementation phase were a crucial success factor.
Subject(s)
Critical Pathways/organization & administration , Early Detection of Cancer , Health Services Research , Neoplasms/diagnosis , Oncology Service, Hospital/organization & administration , Communication , Female , Humans , Interdisciplinary Communication , Male , NetherlandsSubject(s)
Delivery of Health Care, Integrated/organization & administration , Emergency Service, Hospital/organization & administration , Medical Oncology/organization & administration , Neoplasms/therapy , Oncology Service, Hospital/organization & administration , Delivery of Health Care, Integrated/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Humans , Neoplasms/complications , Neoplasms/diagnosis , Oncology Service, Hospital/statistics & numerical data , Patient Admission , Risk FactorsABSTRACT
OBJECTIVE: Analyze the impact of embedding genetic counseling services in gynecologic oncology on clinician referral and patient uptake of cancer genetics services. METHODS: Data were reviewed for a total of 737 newly diagnosed epithelial ovarian cancer patients seen in gynecologic oncology at a large academic medical center including 401 from 11/2011-7/2014 (a time when cancer genetics services were provided as an off-site consultation). These data were compared to data from 8/2014-9/2016 (n=336), when the model changed to the genetics embedded model (GEM), incorporating a cancer genetic counselor on-site in the gynecologic oncology clinic. RESULTS: A statistically significant difference in proportion of patients referred pre- and post-GEM was observed (21% vs. 44%, p<0.0001). Pre-GEM, only 38% of referred patients were actually scheduled for genetics consultation and post-GEM 82% were scheduled (p<0.00001). The difference in the time from referral to scheduling in genetics was also statistically significant (3.92months pre-GEM vs. 0.79months post-GEM, p<0.00001) as was the time from referral to completion of genetics consultation (2.52months pre-GEM vs. 1.67months post-GEM, p<0.01). Twenty-five percent of patients referred post GEM were seen by the genetic counselor on the same day as the referral. CONCLUSIONS: Providing cancer genetics services on-site in gynecologic oncology and modifying the process by which patients are referred and scheduled significantly increases referral to cancer genetics and timely completion of genetics consultation, improving compliance with guideline-based care. Practice changes are critical given the impact of genetic test results on treatment and familial cancer risks.
Subject(s)
Genetic Counseling/organization & administration , Genital Neoplasms, Female/genetics , Guideline Adherence/standards , Oncology Service, Hospital/organization & administration , Referral and Consultation/organization & administration , Adult , Aged , Delivery of Health Care, Integrated/organization & administration , Female , Genetic Predisposition to Disease , Genital Neoplasms, Female/therapy , Health Services Accessibility/organization & administration , Humans , Middle Aged , Models, OrganizationalABSTRACT
Palliative care services provided alongside traditional oncology care have been shown to be beneficial to patients and families. This article provides a brief history of palliative care, a pathway to implementing these services into currently established oncology programs, and a brief discussion of common barriers.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , Neoplasms/therapy , Oncology Service, Hospital/organization & administration , Palliative Care/organization & administration , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , United StatesABSTRACT
The authors propose one possible vision for the transformative role that cancer imaging in an academic setting can play in the current era of personalized and precision medicine by sharing a conceptual model that is based on experience and lessons learned designing a multidisciplinary, integrated clinical and research practice at their institution. The authors' practice and focus are disease-centric rather than imaging-centric. A "wall-less" infrastructure has been developed, with bidirectional integration of preclinical and clinical cancer imaging research platforms, enabling rapid translation of novel cancer drugs from discovery to clinical trial evaluation. The talents and expertise of medical professionals, scientists, and staff members have been coordinated in a horizontal and vertical fashion through the creation of Cancer Imaging Consultation Services and the "Adopt-a-Radiologist" campaign. Subspecialized imaging consultation services at the hub of an outpatient cancer center facilitate patient decision support and management at the point of care. The Adopt-a-Radiologist campaign has led to the creation of a novel generation of imaging clinician-scientists, fostered new collaborations, increased clinical and academic productivity, and improved employee satisfaction. Translational cancer research is supported, with a focus on early in vivo testing of novel cancer drugs, co-clinical trials, and longitudinal tumor imaging metrics through the imaging research core laboratory. Finally, a dedicated cancer imaging fellowship has been developed, promoting the future generation of cancer imaging specialists as multidisciplinary, multitalented professionals who are trained to effectively communicate with clinical colleagues and positively influence patient care.
Subject(s)
Academic Medical Centers/organization & administration , Delivery of Health Care, Integrated/organization & administration , Neoplasms/diagnostic imaging , Oncology Service, Hospital/organization & administration , Precision Medicine/methods , Radiology Department, Hospital/organization & administration , Biomedical Research/organization & administration , Boston , Comprehensive Health Care/organization & administration , Diagnostic Imaging/trends , Humans , Models, OrganizationalABSTRACT
Animal-assisted activities (AAA) are increasingly common, yet little is known about practices in pediatric oncology. To address this gap, we surveyed the top 20 pediatric oncology hospitals in the United States in May and June of 2014. Questionnaires were sent via e-mail and generally returned by e-mail or postal mail. Among the 19 responding hospitals, the 18 that offered AAA to pediatric patients formed the basis of our analysis. All sites had written AAA policies. Most programs were restricted to dogs. At 11 hospitals, children with cancer could participate in AAA activities. Outpatient waiting rooms and individual inpatient rooms were the most common locations for AAA with pediatric oncology patients. Safety precautions varied by hospital, but all required hand sanitation after visits and that animals receive an annual health examination, be on a leash or in a carrier, be ≥1 year old, and not be directly from a shelter. Our findings reveal consistencies and variations in practice that may help other hospitals develop their own programs and researchers identify areas of future study.
Subject(s)
Animal Assisted Therapy/methods , Child, Hospitalized/psychology , Human-Animal Bond , Neoplasms/psychology , Neoplasms/therapy , Oncology Service, Hospital/organization & administration , Adaptation, Psychological , Animals , Child , Dogs , Female , Hospitals, Pediatric/organization & administration , Humans , Inpatients , Male , Outpatients , United StatesABSTRACT
OBJECTIVE: The National Comprehensive Cancer Network (NCCN) is comprised of 25 National Cancer Institute-designated cancer centers and arguably could thus set the standard for optimal psychosocial staffing for cancer centers; therefore, information was sought from NCCN Member Institutions about their current staffing for psychosocial services. These findings are put into perspective given the limited existing literature and consensus reports. METHODS: The NCCN Best Practices Committee surveyed member institutions about their staffing for psychosocial services. The survey was administered electronically in the winter of 2012. RESULTS: The survey was completed by 20 cancer centers. Across institutions, case managers and mental health therapists, typically social workers, were utilized most frequently to provide psychosocial services (67% of full-time-equivalents (FTEs)), with other psychosocial professionals also represented but less consistently. Most psychosocial services are institutionally funded (ranging from 64 to 100%), although additional sources of support include fee for service and grant funding. Training of psychosocial providers is unevenly distributed across responding sites, ranging from 92% of institutions having training programs for psychiatrists to 36% having training programs for mental health therapists. CONCLUSIONS: There was variability among the institutions in terms of patient volume, psychosocial services provided, and psychosocial staff employed. As accreditation standards are implemented that provide impetus for psychosocial services in oncology, it is hoped that greater clarity will develop concerning staffing for psychosocial services and uptake of these services by patients with cancer.
Subject(s)
Cancer Care Facilities/organization & administration , Health Personnel/statistics & numerical data , Neoplasms/therapy , Oncology Service, Hospital/organization & administration , Personnel Staffing and Scheduling/statistics & numerical data , Social Work, Psychiatric/statistics & numerical data , Health Personnel/psychology , Humans , Male , Medical Oncology/organization & administration , Neoplasms/psychology , Surveys and QuestionnairesABSTRACT
Cancer patients constitute one of the most complex, diverse and growing patient populations in Canada. Like other high-needs patient groups, cancer patients desire a more integrated approach to care delivery that spans organizational and professional boundaries. This article provides an overview of Cancer Care Ontario's experience in fostering a more integrated cancer system, and describes the organization's emerging focus on patient-centred models of integrated care through the whole cancer pathway, from prevention to end-of-life care and survivorship.
Subject(s)
Medical Oncology/methods , Patient-Centered Care/methods , Delivery of Health Care, Integrated/methods , Delivery of Health Care, Integrated/organization & administration , Humans , Medical Oncology/organization & administration , Models, Organizational , Neoplasms/prevention & control , Neoplasms/therapy , Oncology Service, Hospital/organization & administration , Ontario , Palliative Care/methods , Palliative Care/organization & administration , Patient-Centered Care/organization & administrationABSTRACT
CONTEXT: The palliative care program in King Hussein Cancer Center (KHCC) is growing rapidly to serve the needs of patients with cancer and their families. OBJECTIVE: To describe the KHCC palliative care program and its integration into the oncology care. METHODS: Narrative review of our palliative care program. RESULTS: Patients with cancer at KHCC have access to an interprofessional palliative care at different settings. In 2012, the inpatient team saw 400 consultations and 979 referrals and admissions. The outpatient clinic had a total of 1133 patient visits. The home care program provided a total of 1501 visits. Our program is a regional center for education and training and actively conducts research. CONCLUSION: Our palliative care program may be a model for successful delivery of comprehensive cancer care in the Middle East.
Subject(s)
Oncology Service, Hospital/organization & administration , Palliative Care/organization & administration , Tertiary Care Centers/organization & administration , Home Care Services/organization & administration , Humans , Jordan , Medical Oncology/education , Models, Organizational , Oncology Service, Hospital/statistics & numerical data , Outpatient Clinics, Hospital/organization & administration , Palliative Care/statistics & numerical data , Patient Care Team , Referral and Consultation , Tertiary Care Centers/statistics & numerical dataABSTRACT
The management of TYA with cancer is characterized by biological features in comparison to children. Therefore specialized treatment units have been established within professional structures of care for this group, and a European multidisciplinary framework for the treatment of TYA with cancer was founded.Objectives are to promote interdisciplinary collaboration and provide strategic concepts to improve patient care centered to the special needs of this age group. Access to clinical trials for all TYA in the EU will be improved and research initiated, examining biology, epidemiology and health services.Special goals of the interprofessional cooperation are:Different measurements are discussed improving outcomes for TYA is proceeding at different speeds in different parts of the world. In some there are established teams, bringing together paediatric and adult specialists from many healthcare professions, reviewing and contributing to the optimal care of all TYA with cancer as part of national health policy.
Subject(s)
Interdisciplinary Communication , Neoplasms/mortality , Neoplasms/therapy , Oncology Service, Hospital , Adolescent , Clinical Trials as Topic , Cooperative Behavior , Europe , Female , Germany , Health Policy , Health Services Accessibility/organization & administration , Humans , Male , National Health Programs/organization & administration , Oncology Service, Hospital/organization & administration , Patient Satisfaction , Patient-Centered Care/organization & administration , Quality Assurance, Health Care/organization & administration , Quality of Life , Survival Rate , Young AdultABSTRACT
BACKGROUND: Urologic cancers comprise one quarter of all newly diagnosed cancers per year in Germany. In addition to the increasing incidence treatment of solid and hematological tumors has become more differentiated, complex and potentially more effective as well as more expensive. Following the example of the USA multidisciplinary translational comprehensive cancer centers (CCCs) have been established in Germany. The financial support from the government and nonprofit organizations, such as the German Cancer Aid aims to ensure and to optimize treatment of tumor patients now and in the future. Coupled with this development new funding opportunities for translational research are opening up for the participating clinical and scientific partners. DISCUSSION: Just as attractive and coherent integration of urology into the structures of a CCC where available appears to be, just as controversial is the professional modus operandi. Using the example of the National Center for Tumor Diseases in Heidelberg (NCT), the current manuscript discusses the risks and opportunities of this new centralized form of oncological care in urology. Detailed knowledge of organizational structures, clinical operations and funding is a prerequisite for any partner of a CCC to succeed in such a highly demanding environment as a specialty instead of becoming mere surgical proceduralists.
Subject(s)
Models, Organizational , Oncology Service, Hospital/organization & administration , Translational Research, Biomedical/organization & administration , Urologic Neoplasms/diagnosis , Urologic Neoplasms/therapy , Urology/organization & administration , Germany , Humans , Organizational ObjectivesABSTRACT
The presentation of tumor patients to tumor boards has widely developed into a medical standard. The necessary compliance to the medical standard can lead to obligatory presentation if the complexity of a case dictates that this cannot be comprehensively covered by a single treating physician. The organization of a tumor board must be so that the structure and specialist competence guarantees an adequate consultative function of the represented specialties. Tumor board members are not automatically promoted to become part of the treating team just by participation and therefore do not have a guarantor position but do have the obligation of care of a consulting physician. Tumor board decisions have a recommendation character, are not binding in the legal sense and do not relieve the treating physician from the obligation to critically scrutinize the recommendations before implementation. On the other hand the treating physician must be able to justify not following the recommendations on the basis of the medical obligation to care. The tumor board must fulfil the same requirements for documentation as any other consultative activity.
Subject(s)
Clinical Competence , Cooperative Behavior , Interdisciplinary Communication , Neoplasms/therapy , Oncology Service, Hospital/legislation & jurisprudence , Oncology Service, Hospital/organization & administration , Professional Staff Committees/legislation & jurisprudence , Professional Staff Committees/organization & administration , Referral and Consultation/legislation & jurisprudence , Referral and Consultation/organization & administration , Clinical Competence/legislation & jurisprudence , Documentation/standards , Expert Testimony/legislation & jurisprudence , Expert Testimony/standards , Germany , Humans , Malpractice/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Patient Care Team/legislation & jurisprudence , Patient Care Team/organization & administrationABSTRACT
Cancer is a disease that impairs health of those who suffer it, affecting their quality of life. Chemotherapy produces deterioration on functional capacity as a result of the effects of therapy. Particularly affected are those patients who have to be admitted to receive treatment, by the very effects of hospitalization and prolonged rest. The deterioration of functional capacity (quality of life indicator) is explained by the alteration of physical capacity and ability to perform activities of daily living (ADLs) in an independent fashion, constituent elements of functional capacity. Given the prevalence of this disease, and the disability associated with both the disease and treatment, it is necessary to incorporate into daily practice interventions to reduce the impact on functionality, favoring the adequate reintegration of the person into his or her environment. The aim of this review is to describe the mechanisms that alter functional capacity, and the effects of physical training programs, complementary therapies and multidimensional interventions on symptomatology, well-being and quality of life of cancer patients in medical treatment. (AU)