Radiation therapy: Regulatory framework and constraints.

The purpose of this article is to describe the regulatory framework of the radiotherapy practice in France.

Quality/risk management system in radiotherapy: Changes afoot.

The French sanitary and regulatory context in which radiotherapy centres are comprised is evolving. Risk and quality management systems are currently adapting to these evolutions. The French nuclear safety agency (ASN) decision of July 1st 2008 on quality assurance obligations in radiotherapy has reached 10 years of age, and the French high authority of health (HAS) certification system 20 years now. Mandatory tools needed for the improvement of quality and safety in healthcare are now well known. From now on, the focus of healthcare policies is oriented towards evaluation of efficiency of these new organisations designed following ASN and HAS nationwide guidelines.

"Absurd" Contract Dodge Rejected: Court Lets Cancer Center's Debt-Collection Suit Proceed.

Appeals court denies "free speech" challenge to cancer center's debt-collection suit.

Direct-to-Consumer Advertising for Cancer Centers and Institutes: Ethical Dilemmas and Practical Implications.

In the United States, many cancer centers advertise their clinical services directly to the public. Although there are potential public benefits from such advertising, including increased patient awareness of treatment options and improved access to care and clinical trials, there is also potential for harm through misinformation, provision of false hope, inappropriate use of health care resources, and disruption in doctor-patient relationships. Although patient education through advertising is appropriate, misleading patients in the name of gaining market share, boosting profits, or even boosting trial accrual is not. It is critical that rigorous ethical guidelines are adopted and that oversight is introduced to ensure that cancer center marketing supports good patient care and public health interests. Patients with cancer have been identified as an especially vulnerable population because of fears and anxiety related to their diagnosis and the very real need to identify optimal sources of care. Cancer organizations have a fiduciary duty and a moral and legal obligation to provide truthful information to avoid deceptive, inaccurate claims associated with treatment success. In this article, actionable recommendations are provided for both the oncologist and the cancer center's marketing team to promote ethical marketing of services to patients with cancer. This tailored guidance for the oncology community includes explicit communication on (1) ensuring fair and balanced promotion of cancer services, (2) avoiding exaggeration of claims in the context of reputational marketing, (3) providing data and statistics to support direct and implied assertions of treatment success, and (4) defining eligible patient groups in the context of marketing for research. These recommendations for cancer centers are designed to promote ethical quality marketing information to patients with cancer.

Radiotherapy workflow and protection procedures during the Coronavirus Disease 2019 (COVID-19) outbreak: Experience of the Hubei Cancer Hospital in Wuhan, China.

The epidemic of Coronavirus Disease 2019 (COVID-19) first broke out in Wuhan in December 2019, and reached its peak in Wuhan in February 2020. It became a major public health challenge for China, and evolved into a global pandemic in March 2020. For radiation oncology departments, the COVID-19 pandemic presents a unique challenge for disease protection and prevention for both patients and staff, owing to the weakened immune systems of cancer patients and the need to deliver timely and uninterrupted radiotherapy. At the Hubei Cancer Hospital, the only hospital in Wuhan that specializes in oncology, we organized an emergency infection control team to lead special efforts to combat COVID-19 during this challenging time. Under its lead, the following measures were implemented in the radiation oncology department: the radiotherapy clinic was divided into different infection control zones with varying levels of protection; special staff and patient infection control training sessions were conducted and appropriate measures deployed; daily symptom testing criteria were implemented for patients undergoing treatment; special rotating schedules and infection control methods were implemented for various staff members such as medical physicists/dosimetrists and radiation therapists; modified radiotherapy workflow and specialized treatment area cleaning and disinfection policies and procedures were designed and executed; and special medical waste disposal methods were implemented. We began treating patients using this new COVID-19 radiotherapy treatment workflow and infection control measures on January 30, 2020. During more than one and a half months of uninterrupted radiation oncology clinical operation through the worst of the Wuhan outbreak, no known COVID-19 infection occurred at our radiotherapy center to our patients or employees. This report may provide valuable information for other radiation oncology departments during this unprecedented public health crisis.

Técnicas e procedimentos de controle de infecções de cateteres venosos em onco-hematologia infantil: aspectos clínico-epidemiológicos e microbiológicos e prevalência de Corynebacterium spp. - Instituto Nacional de Câncer, RJ / Techniques and procedures central line infections control in childhood cancer patients: clinical and epidemiological aspects, microbiological and prevalence of Corynebacterium spp. - Instituto Nacional de Câncer, RJ

Estudo descritivo retrospectivo realizado no Instituto Nacional do Câncer José Alencar Gomes da Silva, HCI-Rio de Janeiro, Brasil, (INCA-HCI-RJ), no qual foram avaliadas infecções relacionadas aos acessos venosos para tratamento oncológico, nos setores Onco-Hematológicos pediátricos. A infecção representa uma importante complicação em pacientes oncológicos em tratamento. Devido ao tratamento oncológico que envolve: procedimentos cirúrgicos muitas vezes mutilantes, tratamento com quimioterápicos que ocasionam períodos de imunossupressão e neutropenia, e tratamento radioterápico com radiação e lise celular. O uso de dispositivos venosos associados a períodos de imunossupressão pode levar a infecção da corrente sanguínea e outras complicações (por exemplo trombose). No presente estudo foram investigados aspectos clínico-epidemiológicos das infecções e da susceptibilidade antimicrobiana em amostras clínicas obtidas de processos infecciosos associados ao uso de cateteres venosos de longa permanência no tratamento oncológico em pacientes do Hospital do Câncer José de Alencar Gomes da Silva, HCI/INCA, Rio de Janeiro Brasil. Foram avaliadas: a) prevalência das espécies diversas relacionadas aos quadros infecciosos identificados nestes pacientes oncológicos; b) prevalência de casos de complicações e outras infecções invasivas relacionadas ao uso de cateteres de longa permanência; c) perfis de susceptibilidade a antimicrobianos e ocorrência de multirresistência. O desenvolvimento deste projeto de pesquisa possibilitou a observação análise e validação da evolução dos processos envolvidos nos quadros de infecções nosocomiais em pacientes oncológicos pediátricos na prevenção de complicações que envolvem todo o sistema de saúde, além de contribuir na escolha de antimicrobianos e estratégias terapêuticas mais efetivas para o tratamento de infecções em cateteres por espécies multirresistentes de Corynebacterium.

Retrospective descriptive study conducted at the National Cancer Institute José Alencar Gomes da Silva, INCA / HCI-Rio de Janeiro, Brazil, (INCA-HCI-RJ). Infection represents an important complication in cancer patients. This group is more prone to infections due to the cancer treatment that involves: surgical procedures often mutilating, treatment with chemotherapy that cause periods of immunosuppression even with neutropenia, and radiotherapy treatment with radiation and cell lysis. The vascular devices associated with these periods can lead to bloodstream infection besides others complication as thrombosis. The number of reports of infections in hospitalized cancer patients increases morbidity and mortality rates. In the present study clinical and epidemiological aspects of infections were identified and antimicrobial susceptibility were investigated in clinical exams and samples from blood patients and venous catheter in children oncological patients at the José de Alencar Gomes da Silva, HCI / INCA, Rio de Janeiro Brazil. It was possible evaluate a) prevalence of various species infections in cancer patients; b) prevalence of cases of complications and other invasive infections related to the use of long-term catheters; c) antimicrobial susceptibility profiles and occurrence of multidrug resistance. The development of this research project in nosocomial infections in pediatric cancer patients was enabled analysis and validation of some process involved to prevent vascular complications that involve entire health system. In addition to contributing to the choice of antimicrobials and the most effective therapeutic strategies for the treatment of multi-resistant Corynebacterium sp.

Data managers: A survey of the European Society of Breast Cancer Specialists in certified multi-disciplinary breast centers.

The European Society of Breast Cancer Specialists (EUSOMA) requires that the breast centers' core team includes a trained person responsible for data collection and analysis. We addressed a questionnaire to the data managers of the EUSOMA breast centers network in order to acquire information with regard to their education, training, role, activity, recognition, and satisfaction. Breast centers' data managers are highly educated individuals with a variety of backgrounds carrying out, more frequently part-time and as temporary employees, a job for which they received little specific training. These findings support the importance of defining a core curriculum and a training program.

No Ifs, No Butts: Compliance with Smoking Cessation in Secondary Care Guidance (NICE PH48) by Providers of Cancer Therapies (Radiotherapy and Chemotherapy) in the UK.

Background: Legislation preventing smoking in public places was introduced in England in July 2007. Since then, smoke-free policies have been extended to the majority of hospitals including those providing cancer therapies. Whilst studies have been conducted on the impact and effectiveness of hospital smoke-free policy in the UK and other countries, there have not been any studies with a focus on cancer care providers. Cancer patients are a priority group for smoking cessation and support and this study aimed to examine implementation of the National Institute Clinical Excellence (NICE) guidance (PH48) in acute cancer care trusts in the UK. Methods: Participants were recruited from UK radiotherapy and chemotherapy departments (total 80 sites, 65 organisations) and asked to complete a 15 min online questionnaire exploring the implementation of NICE guidance at their hospital site. Results: Considerable variability in implementation of the NICE guidance was observed. A total of 79.1% trusts were smoke-free in theory; however, only 18.6% were described as smoke-free in practice. Areas of improvement were identified in information and support for patients and staff including in Nicotine Replacement Therapy (NRT) provision, staff training and clarity on e-cigarette policies. Conclusions: While some trusts have effective smoke-free policies and provide valuable cessation support services for patients, improvements are required to ensure that all sites fully adopt the NICE guidance.

Accountability in the ontario cancer services system: a qualitative study of system leaders' perspectives.

Cancer Care Ontario (CCO), the provincial cancer agency, operates under a model of accountable governance that has been hailed as exemplary. We explored cancer system leaders' views on the balance and perceived efficacy of approaches to accountability in this context. Semi-structured interviews were conducted with 19 participants (MOHLTC=5, CCO=14). Adopting a qualitative descriptive approach, we coded data for four policy instruments used in approaches to accountability. Financial incentives are a key lever used by both parties to effect change. Cancer-specific regulations were somewhat weak, but agency-wide directives were a necessary nuisance that had great force. The effect of public reporting on mobilizing consumer sovereignty was questioned; however, transparency for its own sake was highly valued. Professionalism and stewardship, with an emphasis on trust-based partnerships and clinical engagement, were critical to CCO's success. These approaches were seen to work together, but what made each have force was reliance on professionalism and stewardship.

Progressive development and enhancement of palliative care services in Japan: nationwide surveys of designated cancer care hospitals for three consecutive years.

CONTEXT: Policymaking plays an important role in national palliative care services. The Japanese Cancer Control Act was implemented in 2006. OBJECTIVES: To evaluate changes in the structure and processes of palliative care services after implementation of the Cancer Control Act. METHODS: We conducted annual nationwide surveys in designated cancer care hospitals (DCCHs, n = 349) between 2008 and 2010. The 65-item questionnaire was divided into seven domains: institutional framework, information to patient and family, practice of palliative care, activities of the palliative care teams (PCTs), members of PCTs, regional medical cooperation, and education. Increasing trends were tested using generalized estimating equation models. RESULTS: The response rates were ≥ 99%. All domains showed an increasing trend (P < 0.001). There were significant increases in full-time PCT physicians (27.4%-45.7%, P(trend) < 0.001), full-time PCT nurses (38.9%-88.0%, P(trend) < 0.001), and the median number of annual referrals to PCTs (60-80 patients, P < 0.001). Essential drugs were available in most DCCHs from baseline. Although outpatient clinics increased significantly (27.0%-58.9%, P(trend) < 0.001), community outreach programs did not (9.0%-12.6%, P = 0.05). Basic education was actively introduced for in-hospital physicians and nurses (78.2% and 91.4% in 2010), but often unavailable for regional health care providers (basic education for regional physicians and nurses: 63.9% and 71.1% in 2010). CONCLUSION: The Cancer Control Act promoted the development and enhancement of palliative care services in DCCHs. Regional medical cooperation and education are the future challenges of palliative care in Japan.

[Nurse hygienist, a role in everyone's interest]. / Infirmière hygiéniste, une fonction au service de tous.

Pascale Auguste has been working as a nurse hygienist for four years. Her managerial and pedagogical skills, specialised and up-to-date knowledge and human qualities enable her to work efficiently with the nursing teams. The diversity of the missions which she carries out makes her practice in hospital hygiene, not only complex but also very interesting.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the administration of vaccines by nursing staff as well as the CoPs for critical access hospitals relating to the provision of acute care inpatient services. We are finalizing proposals issued in two separate proposed rules that included payment policies related to patient status: payment of Medicare Part B inpatient services; and admission and medical review criteria for payment of hospital inpatient services under Medicare Part A.

[Certification of colorectal cancer units -- a critical overview on the basis of unsettled aspects]. / Zertifizierung von Darmkrebszentren - eine kritische Standortbestimmung anhand ungeklärter Aspekte.

In this contribution the rational of colorectal cancer centre certification is discussed on the basis of previously published literature and several unsettled factors which are not yet considered as influencing the quality of cancer treatment. The representation of the theme cannot be comprehensive or complete. The readers should be stimulated by one or the other topic to reach their own critical assessment. Due to several limitations of the published literature and the various unsettled aspects, the purpose of colorectal cancer centre certification is called into question.