Prognostic Model for Intracranial Progression after Stereotactic Radiosurgery: A Multicenter Validation Study.

Stereotactic radiosurgery (SRS) is a standard of care for many patients with brain metastases. To optimize post-SRS surveillance, this study aimed to validate a previously published nomogram predicting post-SRS intracranial progression (IP). We identified consecutive patients completing an initial course of SRS across two institutions between July 2017 and December 2020. Patients were classified as low- or high-risk for post-SRS IP per a previously published nomogram. Overall survival (OS) and freedom from IP (FFIP) were assessed via the Kaplan−Meier method. Assessment of parameters impacting FFIP was performed with univariable and multivariable Cox proportional hazard models. Among 890 patients, median follow-up was 9.8 months (95% CI 9.1−11.2 months). In total, 47% had NSCLC primary tumors, and 47% had oligometastatic disease (defined as ≤5 metastastic foci) at the time of SRS. Per the IP nomogram, 53% of patients were deemed high-risk. For low- and high-risk patients, median FFIP was 13.9 months (95% CI 11.1−17.1 months) and 7.6 months (95% CI 6.4−9.3 months), respectively, and FFIP was superior in low-risk patients (p < 0.0001). This large multisite BM cohort supports the use of an IP nomogram as a quick and simple means of stratifying patients into low- and high-risk groups for post-SRS IP.

Opioid Use in Patients With Cervical Cancer at Two Urban Medical Centers.

Purpose: Patients with cervical cancer are at high risk for opioid use. This study aimed to characterize opioid prescribing patterns at 2 urban hospitals. Methods and Materials: Data from patients with cervical cancer treated with curative intent from 2011 to 2018 were retrospectively collected. Women with unrelated chronic opioid use before diagnosis, persistent/recurrent disease at 3 months after initiation of treatment, or initiation of opioids >6 months after treatment were excluded. Demographics, disease characteristics, treatment, and outpatient prescription practices were collected. Endpoints included duration of opioid use ≥6 and ≥12 months. Results: There were 106 women included, of whom 83% received definitive radiation. Most patients (n = 91, 85.8%) received outpatient opioids. Most common timing of prescriptions were before cancer therapy (35.9%), postprocedure (26.4%), and during radiation therapy (17.0%). Median duration was 3 (interquartile range, 1-11) months; 35.2% of these patients received opioids ≥6 months and 22% received opioids ≥12 months. Greater International Federation of Gynaecology and Obstetrics (FIGO) stage, recurrent/residual disease, initiation of opioids before treatment, history of depression or anxiety, and use of gabapentin or steroids were associated with long-term opioid use. Conclusions: Most patients were prescribed outpatient opioids, many of whom used opioids for 12 months. Improvement in provider communication and education, increased posttreatment monitoring, and further evaluation of nonopioid therapies are needed in this patient population to reduce long-term opioid use.

Qualitative Study of Interprofessional Collaboration in Radiation Oncology Clinics: Is There a Need for Further Education?

PURPOSE: Interprofessional education (IPE) is gaining recognition as a means of improving health care delivery and patient outcomes. A primary goal of IPE is improved interprofessional collaboration (IPC). The multidisciplinary team in the radiation oncology clinic requires effective IPC for optimal delivery of radiation therapy. However, there are limited data on IPE and IPC in radiation oncology. This qualitative study aims to characterize IPC in radiation oncology. METHODS AND MATERIALS: Semistructured phone interviews were performed from June to August 2019 with radiation oncologists, nurses, dosimetrists, radiation therapists, medical physicists, and medical students across a single academic medical center and affiliated network sites. Interviews were recorded, de-identified, and transcribed verbatim. Resulting transcripts were analyzed using thematic analysis. RESULTS: Seventeen interviews were performed with 4 radiation oncologists, 2 nurses, 2 dosimetrists, 4 radiation therapists, 2 medical physicists, and 3 medical students. Thematic analysis identified 4 themes: (1) management of the radiation oncology clinic, (2) potential impact of interprofessional training in radiation oncology, (3) current climate of interprofessional education in radiation oncology, and (4) creating an interprofessional training program in radiation oncology. Each theme elicited between 2 and 7 subthemes. CONCLUSIONS: From the analytical themes that emerged, it is hypothesized that misunderstanding professionals' roles can lead to communication breakdown, which creates less efficient clinic management and disorganized patient care. Although other medical professionals shadow physicians during their training, physicians are not learning about other professions in the same way. Interviewees from each professional category recommend a formal shadowing program for radiation oncology trainees at the medical student or resident level. Having structured opportunities for IPE is important given competing demands of learners during medical student rotations and residency. This study suggests an unmet need for exposure of radiation oncology medical trainees to IPE with the ultimate goal of improving IPC in the radiation oncology clinic.

Assessing the Efficacy of Certificate of Need Laws Through Total Joint Arthroplasty.

ABSTRACT: Lawmakers suggest Certificate of Need (CON) laws' main goals are increasing access to healthcare, increasing quality of healthcare, and decreasing healthcare costs. This retrospective database study aims to evaluate the effectiveness of CON through analysis of total knee, hip, and shoulder arthroplasty (TKA, THA, and TSA, respectively). A review was performed using the Humana Insurance PearlDiver national database from 2007 to 2015. Access to care was approximated by the rates of total joint arthroplasty (TJA) in patients diagnosed with arthritis to the corresponding joint. The quality of care was assessed using complication rates after TJA. The total cost of TJA was approximated from average reimbursement to the healthcare facility per procedure. Patients in states without CON programs received TKA, THA, and TSA more frequently (p < .0001, p = .250, p = .019). No significant difference was found in studied complication rates between CON and non-CON states. Similarly, there was no trend found when comparing the cost of each procedure in CON versus non-CON states. These findings are consistent with other recent studies detailing the impact of CON regulation on THA and TKA. The apparent nonsuperiority of CON states in achieving their purported goals may call into question the effectiveness of additional bureaucracy and regulation, suggesting a need for further examination.

The Radiation Oncology Education Collaborative Study Group 2020 Spring Symposium: Is Virtual the New Reality?

PURPOSE: Because of the COVID-19 pandemic, the Radiation Oncology Education Collaborative Study Group (ROECSG) hosted its annual international symposium using a virtual format in May 2020. This report details the experience of hosting a virtual meeting and presents attendee feedback on the platform. METHODS AND MATERIALS: The ROECSG symposium was hosted virtually on May 15, 2020. A postsymposium survey was distributed electronically to assess attendee demographics, participation, and experience. Attendee preference and experience were queried using 3-point and 5-point Likert-type scales, respectively. Symplur LLC was used to generate analytics for the conference hashtag (#ROECSG). RESULTS: The survey was distributed to all 286 registrants, with a response rate of 67% (191 responses). Seventeen nonattendee responses were omitted from this analysis, for a total of 174 included respondents. Eighty-two attendees (47%) were present for the entire symposium. A preference for a virtual symposium was expressed by 78 respondents (45%), whereas 44 (25%) had no preference and 52 (30%) preferred an in-person meeting. A total of 150 respondents (86%) rated the symposium as "extremely" well organized. Respondents who had not attended a prior in-person ROECSG symposium were more likely to prefer the virtual format (P = .03). Seventy-eight respondents (45%) reported a preference for the virtual platform for reviewing scholarly work, and 103 (59%) reported a preference for an in-person platform for networking. On the day of the symposium, #ROECSG had 408 tweets and 432,504 impressions. CONCLUSIONS: The 2020 ROECSG symposium was well received and can serve as a framework for future virtual meetings. Although the virtual setting may facilitate sharing research, networking aspects are more limited. Effort is needed to develop hybrid virtual and in-person meetings that meet the needs of participants in both settings. Social media is a significant avenue for dissemination and discussion of information and may be valuable in the virtual setting.

Recruitment in Surgery and Interventional Radiology: Factors in Female Trainees' Specialty Decisions.

OBJECTIVE: This study aims to identify factors influencing female medical students' decision-making about specialties, specifically surgery and interventional radiology (IR), in an effort to inform future recruitment and professional development strategies. DESIGN: An electronic survey was created to assess both qualitative and quantitative data. SETTING: The survey was sent prior to a symposium for trainees interested in pursuing IR or surgery, held at University of Chicago (Chicago, IL) in February 2019. PARTICIPANTS: The 90 female trainees who registered were sent the survey, and 48 (53%) responded voluntarily. RESULTS: All respondents were female, 46% planned to pursue surgery or IR. Students pursuing surgery/IR were less concerned about being valued by their colleagues (p = 0.0073), being in charge of patients' lives (p = 0.0017), radiation exposure (p = 0.0171), chemical exposure (p = 0.0223), emotional stress (p = 0.0244), or shift work (p = 0.0045), compared to the nonsurgery/IR students. No differences were found in ranking of motivating factors, personal strengths or weaknesses, deciding factors, areas for seeking mentorship, or gender diversity. Top motivations among all respondents were intellectual rigor of medicine and becoming a mentor, while concerns were personal physical health, managing a career, pay equity, and gender-based biases. Students most often sought mentors and clerkship experience for making specialty decisions. They reported greatest strengths in empathy and resilience, and weaknesses in negotiating and public speaking. CONCLUSIONS: Female medical students planning to pursue surgery/IR expressed greater confidence in their contributions to patient care and lower concerns about workplace hazards. Regardless of specialty intent, female students shared scholarship motivations for a career in medicine, valued the role of mentorship, and expressed persistent concerns about gender discrimination, personal health, and skills-based weaknesses. Identifying factors influential in career decision-making is important in order to recruit and retain a more gender-diverse physician workforce.

Communicating the External Beam Radiation Experience (CEBRE): Perceived Benefits of a Graphic Narrative Patient Education Tool.

PURPOSE: Current radiation oncology patient education materials exceed national readability recommendations. A graphic narrative educational tool, the Communicating the External Beam Radiation Experience (CEBRE) discussion guide, was developed to facilitate patient-provider communication. A pilot study evaluated perceived benefits of CEBRE for patients and physicians. METHODS AND MATERIALS: CEBRE was designed through a collaboration between physicians and designers. Designers interviewed patients, family members, and the clinical team. Interviews were coded for themes, leading to the design principles that drove the design of CEBRE, including a graphic narrative component. CEBRE explains the radiation therapy care path. Readability was measured using the Flesch-Kincaid test. Patients receiving radiation therapy or in follow-up and practicing radiation oncologists reviewed CEBRE and completed independent surveys. Each survey included modified versions of the Systems Usability Score (SUS) and Spielberger State-Trait Anxiety Inventory (STAI) short form, along with questions unique to CEBRE. Likert-type scores are reported as median (interquartile range). RESULTS: CEBRE scores at a 5.4 Flesch-Kincaid grade level. Thirty-four patients and 15 radiation oncologists completed surveys. Patients had completed a high school/general equivalency degree (18%), a 2-year degree or some college (50%), or at least 4 years of college (32%). Patient and physician responses were concordant. On a scale of 1 to 5 for modified SUS and 1 to 4 for modified STAI ("strongly disagree" to "strongly agree") the SUS scores were 4 (4-5) and 4 (4-5) and STAI scores were 3 (3-4) and 3 (3-3.5) for patients and providers, respectively. This indicates CEBRE is usable and would decrease anxiety. Compared with text, the graphic narrative component of CEBRE was rated as "quite helpful" (4 [4-5]). CONCLUSIONS: CEBRE, a graphic narrative education tool developed through a novel collaboration between designers and radiation therapy stakeholders, is accessible for patients and practical to facilitate patient-provider discussion. Perceived benefits demonstrating high usability and the potential to decrease patient anxiety warrant further prospective investigation of CEBRE in the clinical setting.

Envenomations as a novel drug-seeking method.

Drug seekers have often sought narcotics and benzodiazepines through subjective reports of severe pain. We report 2 patients who claimed repeated envenomation to receive narcotic administration; 1 claimed black widow bite on 8 occasions at 7 separate healthcare facilities, the other claimed to have been bitten by a copperhead snake on 7 occasions at 4 separate healthcare facilities. A 3rd patient complained of lionfish envenomation with no tissue reaction and was refused analgesia. Inconsistent clinical presentations of envenomations may signal drug-seeking behaviors.