Roadmap for Connecting Cancer Rehabilitation With Survivorship to Improve Patient Outcomes and Clinical Efficiency.

ABSTRACT: An evolved model of comprehensive cancer care is needed that begins at cancer diagnosis to proactively manage cancer treatment toxicities and optimize patient health, function, and well-being. Building new care models requires connecting oncology, primary care, and specialized clinicians from many disciplines including cancer rehabilitation. Having a vision for an evolved standard of comprehensive cancer care is a requirement, but it is not enough to bring an innovative clinical program to life and sustain it over the long term. To inform the development of new clinical programs, two example programs are presented that successfully integrate cancer rehabilitation services along with details of a three-step process these programs used to facilitate their success and build robust business models that ensure their sustainability. Following the roadmap for growth presented here, gaining input from stakeholders and ensuring their buy-in, leveraging existing programmatic priorities, as well as developing a strategic growth plan can help clinical innovators ensure that new programs anticipate and continually meet the needs of oncology, primary care, subspecialty care, and programs, while addressing the business needs of administrators and improving the experience for patients.

The Evaluation and Management of Visceral Complications in Radiation Fibrosis Syndrome Part 1.

Abstract: External beam ionizing radiation is a fundamental component of cancer treatment and is incorporated into approximately 50% of cancer treatments. Radiation therapy causes cell death directly by apoptosis and indirectly by disruption of mitosis. Purpose of Review: This study aims to inform rehabilitation clinicians of the visceral toxicities of radiation fibrosis syndrome and how to detect and diagnose these complications. Recent Findings: Latest research indicates that radiation toxicity is primarily related to radiation dose, patient co-morbidity, and concomitant use of chemotherapies and immunotherapies for the treatment of cancer. While cancer cells are the primary target, surrounding normal cells and tissues are also affected. Radiation toxicity is dose dependent, and tissue injury develops from inflammation that may progress to fibrosis. Thus, radiation dosing in cancer therapy is often limited by tissue toxicity. Although newer radiotherapeutic modalities aim to limit delivery of radiation to non-cancerous tissues, many patients continue to experience toxicity. Summary: To ensure early recognition of radiation toxicity and fibrosis, it is imperative that all clinicians are aware of the predictors, signs, and symptoms of radiation fibrosis syndrome. Here, we present part 1 of the visceral complications of radiation fibrosis syndrome, addressing radiation-related toxicity in the heart, lungs, and thyroid gland.

Twelve tips for developing and maintaining a successful peer mentoring program for junior faculty in academic medicine.

Effective mentorship is widely believed to be an important factor in career satisfaction and advancement. Adequate mentorship has been linked to perceived institutional support, research productivity, and protects against burnout. Despite these facts, less than half of junior faculty in academic medicine feel as if they have adequate mentorship. Given that the current landscape in academic medicine has a paucity of available mentors, both in rank and representation for true dyadic mentorship, junior faculty clinician educators may need mentorship and paths to sponsorship. The importance of peer networks has become increasingly recognized, and some institutions have begun to use peer mentoring as a means of addressing mentorship and sponsorship needs. This model can potentially circumvent some of the main barriers to mentorship by providing protected time, ameliorating power differentials, creating an environment where members have shared goals, and mitigating the need for senior faculty mentorship. The following are twelve tips to create and maintain a successful peer mentoring group for junior faculty clinician educators in academic medicine which can serve to complement the dyadic mentorship model.

A Graduate Medical Education Curriculum to Introduce the Concept of Cancer Survivorship.

Introduction: The growing number of cancer survivors has expanded the need for physicians familiar with survivorship care outside the subspecialty of oncology. However, primary care providers have historically not been comfortable managing the growing number of cancer survivors and their long-term sequela. To date, there is no current ambulatory curriculum designed as a workshop to discuss general concepts of cancer survivorship with internal medicine resident physicians. Methods: This was a 3-day workshop series given over 5 weeks. Residents were given a simulated case following a geriatric breast cancer survivor. Session 1 consisted of creating a survivorship care plan and discussing secondary cancer screening. Session 2 included a discussion on primary tumor recurrence and short-term side effects of cancer treatments. Finally, Session 3 incorporated mental health adjustment and long-term side effects of various cancer treatments. Knowledge and attitude assessments were administered during Sessions 1 and 3. Results: Eighty-seven residents participated, with 59 completing the survey on Session 1, and 36 completing the same survey on Session 3. Prior to the curriculum, two residents reported comfort in creating a survivorship care plan compared to 23 after the curriculum. Similarly, comfort in screening for excess mortality increased from three residents to 19. General knowledge of common side effects from cancer treatment modalities was well known prior to the curriculum. Discussion: Survivorship care heavily incorporates the basics of primary care. This curriculum successfully raised awareness among resident physicians regarding survivorship terminology, which, in turn, improved their comfort in the long-term management of the cancer survivor.