Influential factors for post-fellowship career decision-making: an NCCN survey.

Insight into factors important to fellows' decision-making about their career paths is critical to successfully developing program curricula, making capacity projections, and recruiting oncology physicians. This study was performed to determine the factors associated with post-fellowship career decision-making. Program evaluation surveys were administered to oncology fellows who attended the Fellows Recognition Program at the 2009 NCCN Annual Conference. A total of 125 (75%) fellows completed the initial survey. Overall, 73% of fellows reported participating in clinical research and 58% received formal training as part of their fellowship program. Receipt of formal training was correlated with greater program satisfaction (r(s) = 0.20; P = .03), feeling more prepared for a post-fellowship career (r(s) = 0.30; P < .001), and greater interest in clinical research post fellowship (r(s) = 0.32; P < .001). Interest in post-fellowship clinical research (r(s) = 0.49; P < .001) and importance of protected academic time (r(s) = 0.57; P < .001) were strongly correlated with interest in practicing in an academic environment, whereas institutional reputation (r(s) = 0.18; P = .04) and a multidisciplinary practice environment (r(s) = 0.22; P = .02) were moderately associated with interest. Location, salary, multidisciplinary environment, and flexible scheduling were the most important controllable lifestyle (CL) factors. These results suggest that fellowship programs may be able to foster a desire to participate in research and subsequent interest in practicing in an academic institution through providing opportunities for formal training in clinical research skills. However, even in an academic setting, CL factors are important to attracting and retaining faculty.

Practice and productivity of physician assistants and nurse practitioners in outpatient oncology clinics at national comprehensive cancer network institutions.

PURPOSE: It is expected that over the next 10 to 15 years, demand for oncology services will increase, potentially surpassing the supply of available oncologists. Physician assistants (PAs) and nurse practitioners (NPs) have the potential to address the anticipated shortage in physician supply. The two objectives of this study were to define how National Cancer Institute (NCI) -designated comprehensive cancer centers use PAs/NPs and to pilot a self-reported PA/NP productivity tool. METHODS: An online survey addressing practice patterns and productivity in 4-hour outpatient oncology clinics was administered to PAs/NPs practicing at 15 National Comprehensive Cancer Network member institutions. RESULTS: A total of 206 PAs/NPs were included in the final analysis. NPs and PAs reported similar clinical activities, with the following exceptions: NPs reported spending more time on telephone triage, and PAs reported spending more time on procedures. Overall, PAs/NPs reported seeing more follow-up (mean, 6.1; standard deviation [SD], 3.5) than new patients (mean, 1.2; SD, 1.3) per clinic. NPs with a medical oncology specialty reported a marginally greater productivity among follow-up patients than did PAs. Otherwise, NPs and PAs saw a similar number of patients regardless of specialty. CONCLUSION: To our knowledge, this is the first study attempting to characterize PA/NP clinical activities and define productivity benchmarks at NCI-designated comprehensive cancer centers. Given the increasing complexity of oncologic care and the increased population of patients with cancer and cancer survivors requiring that care, PAs/NPs have the potential to fill important roles in both outpatient and inpatient care settings.

Insights and perspectives in the clinical and operational management of cancer-related anemia.

Management of anemia in patients with cancer presents challenges from clinical, operational, and economic perspectives. Clinically, anemia in these patients may result from treatment (chemotherapy, radiation therapy, or surgical interventions) or from the malignancy itself. Anemia not only contributes to cancer-related fatigue and other quality of life issues, but also affects prognosis. From the operational perspective, a patient with cancer who is also anemic may consume more laboratory, pharmacy, and clinical resources than other patients with cancer.

NCCN Task Force Report: Specialty Pharmacy.

The use of specialty pharmacies is expanding in oncology pharmacy practice. Specialty pharmacies provide a channel for distributing drugs that, from the payor perspective, creates economies of scale and streamlines the delivery of expensive drugs. Proposed goals of specialty pharmacy include optimization of pharmaceutical care outcomes through ensuring appropriate medication use and maximizing adherence, and optimization of economic outcomes through avoiding unwarranted drug expenditure. In oncology practice, specialty pharmacies have become a distribution channel for various agents. The use of a specialty pharmacy, and the addition of the pharmacist from the specialty pharmacy to the health care team, may not only provide benefits for care but also present challenges in oncology practice. The NCCN Specialty Pharmacy Task Force met to identify and examine the impact of specialty pharmacy practice on the care of people with cancer, and to provide recommendations regarding issues discussed. This report provides recommendations within the following categories: education and training of specialty pharmacy practitioners who care for individuals with cancer, coordination of care, and patient safety. Areas for further evaluation are also identified.

Report on the NCCN Third Annual Patient Safety Summit.

The issues of patient safety and preventing medical errors routinely make headlines, with reports of thousands of preventable deaths and costs in the billions of dollars per year. Far less noticeable, but potentially more important, is the work taking place on a daily basis to develop new systems and processes of safety and use of technology in the effort to reduce preventable adverse events. The NCCN Third Annual Patient Safety Summit examined 3 processes central to maintaining patient safety in the oncology setting: medication reconciliation, communication during patient hand-offs, and reporting of events, including "near-miss" events that do not reach a patient or result in harm. The NCCN Patient Safety Summit included a multidisciplinary audience of safety experts, clinicians, and hospital administrators from NCCN member institutions, with speakers from member institutions sharing clinical and practical experiences in implementing safety improvements. Common themes included transitions from paper to electronic systems, education and training for individuals and teams as new methods are put into place, and the need for all members of the multidisciplinary care team to recognize their impact on patient safety.