Six months in: COVID-19 and its impact on oncology social work practice.

The extent to which oncology social workers (OSWs) are available and adapting to disruptions in service delivery throughout the COVID-19 pandemic is unknown.Objectives: The purpose of this report is to outline the initial impact of COVID-19 on oncology social work practice during the first six months of the pandemic.Methods: As part of a nationwide investigation of workforce conditions for OSWs, three professional organizations surveyed their members to assess the effects of COVID-19 on changes to work hours, employment status, work setting, pay, and mode for patient contact (e.g., telephone or videoconference).Findings: Among 939 OSWs, 20% reported a reduction in work hours, and two-thirds indicated a temporary shift in work to home, with most patient contact occurring primarily via telephone or videoconference.Implications: Results speak to the essential nature of oncology social work and the need for evidence to inform OSW training and advocacy efforts for however long the pandemic continues.

The Relationship Between Safety Culture and Voluntary Event Reporting in a Large Regional Ambulatory Care Group.

OBJECTIVES: The safety culture in the workplace may affect event reporting. We evaluated the relationship of safety culture and voluntary event reporting within a large network of ambulatory practices, most of which provided primary care. METHODS: This study was an observational, retrospective cohort study. Patient safety event reporting rates for 35 ambulatory practices were collected using a standard tool (UHC Patient Safety Net [PSN]) and normalized based on the number of patient visits in each practice. The overall and domain-specific safety culture of each practice was measured with a validated instrument (Safety Attitudes Questionnaire [SAQ]), distributed to 828 employees in 2013. We compared safety culture scores and the average event reporting rates during a 4-month window before and after the survey distribution. Poisson regression analyses were performed to determine the relationship between PSN reporting rates and SAQ results. RESULTS: The SAQ response rate was 87%. Practices varied widely in rates of reporting events, from 0.00 to 6.99 reports per 1000 total patient visits per month. Regression analyses indicated a positive association between PSN reporting rates and SAQ scores for the domains of overall culture (incidence rate ratio [IRR], 1.019; P = 0.004) and 4 safety culture domains: teamwork climate (IRR, 1.016; P = 0.019), safety climate (IRR, 1.018; P = 0.004), working conditions (IRR, 1.017; P = 0.006), and perceptions of local management (IRR, 1.016; P = 0.040). CONCLUSIONS: Our work provides new evidence to show that in the ambulatory setting more events and near misses are reported when there is a strong culture of safety.

Comprehensive cancer control: promoting survivor health and wellness.

PURPOSE: As of 2016, an estimated 15.5 million cancer survivors were living in the United States and the number of cancer survivors is expected to increase to 20.3 million by 2026. Numerous clinical studies have shown that comorbidities, such as obesity and diabetes, and unhealthy lifestyle choices, such as physical inactivity and heavy smoking, negatively influence overall quality of life and long-term survival of cancer survivors. Accordingly, survivorship programs seek to focus on overall wellness, including symptom management, monitoring for late effects of treatment, monitoring for recurrence, helping patients adapt healthy behaviors, and quality of life. This paper provides a broad overview of public health efforts to address the needs of cancer survivors. METHODS: To describe a range of examples of survivorship initiatives in comprehensive cancer control, we analyzed documents from comprehensive cancer control programs and coalitions and solicited detailed examples from several national partners. RESULTS: Comprehensive cancer control programs, coalitions, and partners are undertaking myriad initiatives to address cancer survivorship and building upon evidence-based interventions to promote healthy behaviors for cancer survivors across the country. CONCLUSION: A coordinated public health approach to caring for the growing population of cancer survivors can help address the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families.

Collaborating to conquer cancer: the role of partnerships in comprehensive cancer control.

Comprehensive cancer control celebrated its twentieth anniversary in 2018. A dedicated group of national partners formed the Comprehensive Cancer Control National Partnership (CCCNP) at the same time that CDC's National Comprehensive Cancer Control Program was formed. The CCCNP has supported the development and growth of comprehensive cancer control from its inception. The CCCNP mirrors how coalitions function at the state, tribe, territory, and Pacific Island Jurisdiction level. We provide a national example of how 19 leading cancer organizations work together with a unified vision to support cancer control efforts in the United States (U.S.). What follows is an overview of the CCCNP, its vision, mission, and structure and a description of how this partnership has evolved over the past 20 years. The importance of collaboration is highlighted. Two states, South Dakota and Kansas, provide examples of how working with partners through the cancer coalition has advanced their state's cancer control agenda. Closing thoughts on the future work of the CCCNP are provided, including a continued focus on supporting health equity; better engagement and support of CCC coalition leaders; and informing efforts to develop a national cancer control plan for the United States.

Patient-centering approaches for the surgical oncologist: palliative care, patient navigation, and distress screening.

Surgeons can more effectively meet the public's increased expectation of patient-centered care by directing attention to pain, non-pain symptoms, including depression and anxiety, in addition to the patient's personal preferences, resources, and support needs. Patient navigation and palliative care, both pioneered by surgeons, provide complementary frameworks for the screening, assessment and intervention needed to achieve enhanced patient outcomes including adherence to care, improved quality of life and patient satisfaction.

CRTC3 links catecholamine signalling to energy balance.

The adipose-derived hormone leptin maintains energy balance in part through central nervous system-mediated increases in sympathetic outflow that enhance fat burning. Triggering of ß-adrenergic receptors in adipocytes stimulates energy expenditure by cyclic AMP (cAMP)-dependent increases in lipolysis and fatty-acid oxidation. Although the mechanism is unclear, catecholamine signalling is thought to be disrupted in obesity, leading to the development of insulin resistance. Here we show that the cAMP response element binding (CREB) coactivator Crtc3 promotes obesity by attenuating ß-adrenergic receptor signalling in adipose tissue. Crtc3 was activated in response to catecholamine signals, when it reduced adenyl cyclase activity by upregulating the expression of Rgs2, a GTPase-activating protein that also inhibits adenyl cyclase activity. As a common human CRTC3 variant with increased transcriptional activity is associated with adiposity in two distinct Mexican-American cohorts, these results suggest that adipocyte CRTC3 may play a role in the development of obesity in humans.

Targeted disruption of the CREB coactivator Crtc2 increases insulin sensitivity.

Under fasting conditions, increases in circulating concentrations of pancreatic glucagon maintain glucose homeostasis through induction of gluconeogenic genes by the CREB coactivator CRTC2. Hepatic CRTC2 activity is elevated in obesity, although the extent to which this cofactor contributes to attendant increases in insulin resistance is unclear. Here we show that mice with a knockout of the CRTC2 gene have decreased circulating glucose concentrations during fasting, due to attenuation of the gluconeogenic program. CRTC2 was found to stimulate hepatic gene expression in part through an N-terminal CREB binding domain that enhanced CREB occupancy over relevant promoters in response to glucagon. Deletion of sequences encoding the CREB binding domain in CRTC2 (-/-) mice lowered circulating blood glucose concentrations and improved insulin sensitivity in the context of diet-induced obesity. Our results suggest that small molecules that attenuate the CREB-CRTC2 pathway may provide therapeutic benefit to individuals with type 2 diabetes.

A randomized trial of interpersonal therapy versus supportive therapy for social anxiety disorder.

Seventy patients seeking treatment for social anxiety disorder (SAD) were randomly assigned to 14 weekly individual sessions of interpersonal therapy (IPT) or supportive therapy (ST). We hypothesized that IPT, a psychotherapy with established efficacy for depression and other psychiatric disorders, would lead to greater improvement than ST. Patients in both groups experienced significant improvement from pretreatment to posttreatment. However, improvement with IPT was not superior to improvement with ST. Mean scores on the Liebowitz Social Anxiety Scale decreased from 67.7 to 46.9 in the IPT group and 64.5 to 49.8 in the ST group. There were also no differences in proportion of responders between IPT and ST. Only for a scale measuring concern about negative evaluation (Brief Fear of Negative Evaluation Scale) was IPT superior. Limitations of this initial controlled trial of IPT include a nonsequential recruitment strategy and overlap in the administration of the two therapies. It is recommended that future studies of IPT for SAD include a more carefully defined control therapy condition, different therapists administering each therapy, a larger sample, and a more rigorous strategy for long-term follow-up assessments.

An open pilot study of interpersonal psychotherapy for panic disorder (IPT-PD).

Interpersonal psychotherapy (IPT) is a time-limited psychotherapy initially developed to treat depression. It has yet to be studied systematically for treatment of panic disorder. We modified IPT for the treatment of panic disorder and tested this treatment in an open clinical trial with 12 patients seeking treatment of DSM-IV panic disorder. Patients were assessed before during and after treatment. At completion of treatment, nine patients (75%) were independently categorized as responders (i.e., rated as much improved or very much improved on the Clinical Global Impression-Change Scale). Substantial improvement was found for panic symptoms, associated anxiety and depressive symptoms, and physical and emotional well-being. Degree of change in this sample approximated that obtained in studies using established treatments such as cognitive behavioral therapy. Results, though preliminary, suggest that IPT may have efficacy as a primary treatment of panic disorder. Further study is warranted.

Conducting intervention research through the Cancer Information Service: a feasibility study.

PURPOSE/OBJECTIVES: To determine the feasibility of conducting trials of educational interventions regarding pain and quality of life (QOL) with people who call the National Cancer Institute's Cancer Information Service (CIS). DESIGN: Descriptive. SETTING: North Central CIS, located at the University of Wisconsin Comprehensive Cancer Center in Madison. SAMPLE: Callers to the North Central CIS who self-identified as people diagnosed with cancer or as family members or friends of people diagnosed with cancer were eligible. 102 people with cancer and 103 significant others answered questions concerning the feasibility of a pain study, and 101 significant others completed questions about the feasibility of a QOL study. METHODS: Eligible CIS callers were invited at the end of usual service to participate in a research study. Those who agreed were asked structured questions regarding pain or QOL. MAIN RESEARCH VARIABLES: Response rate, length of time to complete recruitment, concerns about reporting pain and using analgesics, concerns about QOL, demographic variables, and willingness to join a hypothetical study. FINDINGS: The majority of callers had concerns about pain and QOL, and the vast majority (78%-89%) of participants indicated a willingness to join a future educational intervention study. CONCLUSIONS: Using subjects recruited through CIS, conducting trials of brief telephone interventions designed to help patients overcome barriers to pain management or assist families in addressing QOL concerns may be feasible. IMPLICATIONS FOR NURSING: Researchers may wish to consider the opportunities afforded by collaborating with CIS colleagues in planning and conducting studies of educational interventions.