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1.
Rev. enferm. UERJ ; 29: e52717, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224536

RESUMO

Objetivo: compreender a construção dos significados da morte pelos profissionais de saúde frente ao cuidado à pessoa com câncer. Método: estudo qualitativo realizado em ambiente online, com a participação de 34 profissionais de saúde. Foram realizadas entrevistas semiestruturadas, interpretadas segundo análise temática. Resultados: duas categorias analíticas emergiram dos dados, indicando que os significados atribuídos à morte pelos participantes foram: como um processo inerente ao ciclo da vida humana, passagem para a outra vida, e fim do sofrimento tanto do paciente quanto dos profissionais de saúde. As dificuldades que apontaram em lidar com a morte se referem à falta de suporte psicológico, escassez de conhecimento sobre morte, cuidados paliativos e comunicação de más notícias. Conclusão: os profissionais construíram diferentes significados à morte de seus pacientes, tais como um processo natural da vida, vontade de um ser superior, passagem para uma nova existência e término do sofrimento dessas pessoas.


Objective: to understand the construction of meanings of death by healthcare professionals caring for people with cancer. Method: this qualitative study was carried out in an online environment through semi-structured interviews of 34 health professionals, which were interpreted using thematic analysis. Results: two analytical categories emerged from the data, indicating that the meanings attributed to death by the participants were: a process inherent in the human life cycle, a transition to the next life, and an end to the suffering of both patient and health professionals. The difficulties they pointed to in dealing with death related to lack of psychological support, lack of knowledge about death, palliative care, and communicating bad news. Conclusion: the professionals constructed different meanings to their patients' deaths: a natural process of life, the will of a higher being, a transition to a new existence, and an end to these people's suffering.


Objetivo: comprender la construcción de los significados de la muerte desde el punto de vista de los profesionales de la salud ante el cuidado a la persona con cáncer. Metodología: estudio cualitativo realizado en un entorno online, con la participación de 34 profesionales de la salud. Se realizaron entrevistas semiestructuradas, interpretadas según análisis temático. Resultados: de los datos surgieron dos categorías analíticas que indicaron que los significados atribuidos a la muerte por los participantes fueron: como u proceso inherente al ciclo de vida humano, transición a otra vida y fin al sufrimiento tanto del paciente como de los profesionales de la salud. Las dificultades que señalaron para afrontar la muerte se refieren a la falta de apoyo psicológico, escasez de conocimiento sobre la muerte, cuidados paliativos y comunicación de malas noticias. Conclusión: los profesionales han construido diferentes significados para la muerte de sus pacientes: un proceso natural de la vida, la voluntad de un ser superior, un paso a una nueva existencia y el fin del sufrimiento de estas personas.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Prática Profissional , Atitude Frente a Morte , Pessoal de Saúde , Morte , Oncologistas , Neoplasias , Cuidados Paliativos , Pessoal de Saúde/psicologia , Pesquisa Qualitativa , Oncologistas/psicologia , Hospitais , Neoplasias/psicologia
2.
Trials ; 22(1): 636, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535162

RESUMO

BACKGROUND: Financial toxicity, the material and psychological burden of the cost of treatment, affects 30-50% of people with cancer, even those with health insurance. The burden of treatment cost can affect treatment adherence and, ultimately, mortality. Financial toxicity is a health equity issue, disproportionately affecting patients who are racial/ethnic minorities, have lower incomes, and are < 65 years old. Patient education about treatment cost and patient-oncologist cost discussions are recommended as ways to address financial toxicity; however, research shows cost discussions occur infrequently (Altice et al. J Natl Cancer Inst 109:djw205, 2017; Schnipper et al. J Clin Oncol 34:2925-34, 2016; Zafar et al. Oncologist 18:381-90, 2013; American Cancer Society Cancer Action Network 2010). Our overall goal is to address the burden of financial toxicity and work toward health equity through a tailorable education and communication intervention, the DISCO App. The aim of this longitudinal randomized controlled trial is to test the effectiveness of the DISCO App on the outcomes in a population of economically and racially/ethnically diverse cancer patients from all age groups. METHODS: Patients diagnosed with breast, lung, colorectal, or prostate cancer at a NCI-designated comprehensive cancer center in Detroit, MI, will be randomized to one of three study arms: one usual care arm (arm 1) and two intervention arms (arms 2 and 3). All intervention patients (arms 2 and 3) will receive the DISCO App before the second interaction with their oncologist, and patients in arm 3 will receive an intervention booster. The DISCO App, presented on an iPad, includes an educational video about treatment costs, ways to manage them, and the importance of discussing them with oncologists. Patients enter socio-demographic information (e.g., employment, insurance status) and indicate their financial concerns. They then receive a tailored list of questions to consider asking their oncologist. All patients will have up to two interactions with their oncologist video recorded and complete measures at baseline, after the recorded interactions and at 1, 3, 6, and 12 months after the second interaction. Outcome measures will assess discussions of cost, communication quality, knowledge of treatment costs, self-efficacy for treatment cost management, referrals for support, short- and longer-term financial toxicity, and treatment adherence. DISCUSSION: If effective, this intervention will improve awareness of and discussions of treatment cost and alleviate the burden of financial toxicity. It may be especially helpful to groups disproportionately affected by financial toxicity, helping to achieve health equity. TRIAL REGISTRATION: ClinicalTrials.gov NCT04766190. Registered on February 23, 2021.


Assuntos
Aplicativos Móveis , Oncologistas , Neoplasias da Próstata , Idoso , Comunicação , Custos de Cuidados de Saúde , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos
3.
Cesk Patol ; 57(3): 144-146, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34551561

RESUMO

Molecular genetic methods have evolved dramatically in the last decade. In particular, sequencing of the new generation - NGS has become a financially and technically available examination. Thus, it begins to be used in the clinical practice of many specializations, including oncology. The proper use of these methods is a way to personalized oncology - treatment of the patient based on the occurrence of specific genetic aberrations, which are confirmed in his cancer, regardless of the histopathological type of tumor. This principle is completely new in oncology and raises number of questions and problems. The interpretation of the results of molecular genetic examinations is very complex and demanding, and therefore new multidisciplinary teams, so-called molecular tumor boards, are being created. The worldwide standardization of these boards is currently underway. Recommendations regarding the indication of NGS examinations in oncology patients are also being set.At the European level in the form of ESMO recommendations and at the national level also. Personalized oncology is the future of this field, which will lead to the best treatment response and minimize side effects.


Assuntos
Neoplasias , Oncologistas , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Neoplasias/genética , Medicina de Precisão
4.
J BUON ; 26(4): 1659-1662, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34565033

RESUMO

PURPOSE: The novel coronavirus (COVID-19) was defined in China, leading an outbreak, impacted the organization, and maintained cancer care. Although the alterations of cancer treatment maintenance were evaluated, the difference in physicians' side was not determined. In this survey study, we tried to assess the alteration of Turkish oncologists' daily practice. METHODS: An online survey was prepared via Google forms and sent to oncologists registered to the Turkish Society of Medical Oncology. One hundred twenty-eight oncologists answered the online survey. RESULTS: Twenty-three percent of the oncologists moved their facilities to another place in the hospital after the pandemic, which was resulted in nearly 90% of worse patient services. Seventy percent of the oncologists did not receive any duties on COVID-19 services after Turkey's first case. Thirty-one percent of the oncologists stated their oncology practice was disturbed by working in the COVID-19 services. Three oncologists accepted they were responsible for cross-infection to oncology patients. Eighty-five percent of the oncologists declared oncology practice was disturbed by the other specialists' assignment in COVID-19 services. The leading areas were general surgery, pulmonary diseases, and ENT, according to oncologists. Twenty-two percent of the oncologists needed to send their patients to other oncology clinics due to the COVID-19 pandemic. CONCLUSION: Although oncologists tolerated oncological patient management alterations, the prolonged pandemic situation may harm oncology practice via the loss of oncologists' motivation and incomplete multi-disciplinary patient management. There is a need for follow-up studies to evaluate the situation for the alternation in the COVID-19 pandemic.​.


Assuntos
COVID-19 , Oncologia/tendências , Neoplasias/terapia , Oncologistas/tendências , Padrões de Prática Médica/tendências , Prestação Integrada de Cuidados de Saúde/tendências , Pesquisas sobre Serviços de Saúde , Humanos , Gerenciamento da Prática Profissional/tendências , Fatores de Tempo , Turquia
5.
J BUON ; 26(4): 1679-1682, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34565036

RESUMO

The SARS-CoV-2 (COVID-19) pandemic has led to the implementation of certain restrictions and rearrangements regarding the surgical oncology operations, thus affecting the surgical lists, the availability of surgical time, along with the consultations of oncologic patients. The purpose of the present study was to identify the differences in surgical oncology practices in Greece and Cyprus between the first and second pandemic waves. We designed a questionnaire for surgeons treating surgical oncology patients. A total of 104 surgeons participated in the present study by answering our questionnaire. According to our outcomes, there was a significant shift between the two waves in patients' willingness to undergo surgery and to present to consultations. Nonetheless, the availability of surgical services remained limited. The consequent mismatch in patients' needs and the availability of healthcare services, we demonstrate herein, is alarming and should be taken into consideration by the policymakers.


Assuntos
COVID-19 , Oncologistas/tendências , Padrões de Prática Médica/tendências , Cirurgiões/tendências , Oncologia Cirúrgica/tendências , Adolescente , Adulto , Idoso , Chipre , Feminino , Grécia , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Fatores de Tempo , Adulto Jovem
6.
Integr Cancer Ther ; 20: 15347354211043199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34581221

RESUMO

BACKGROUND: Increasingly, patients with cancer are asking for additional, complementary therapy options for treating the side effects of oncological therapy. Thus, the members of the Breast and Bowel Center Nahe at the Sankt Marienwörth Hospital Bad Kreuznach decided to define the content of this type of counseling for patients before treatment. METHODS: In 2018, a team of internal oncologists, gynecological oncologists, radio-oncologists, nutritionists, psycho-oncologists, and study nurses met several times to define the content of counseling. To inform the team, an intensive literature review was conducted. RESULTS: Counseling content was determined for complementary treatment options for the most frequent side effects of oncological therapies. Counseling sessions were formulated as frontal lectures (slide presentations), given at regular intervals for patients and relatives. These lectures were highly appreciated by patients. CONCLUSION: These counseling sessions increased patient understanding of both useful complementary measures and harmful measures they should not use.


Assuntos
Terapias Complementares , Oncologistas , Aconselhamento , Hospitais , Humanos , Oncologia
7.
BMC Cancer ; 21(1): 1014, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507552

RESUMO

BACKGROUND: Adjuvant immunotherapy is revolutionising care for patients with resected stage III and IV melanoma. However, immunotherapy may be associated with toxicity, making treatment decisions complicated. This study aimed to identify factors physicians and nurses considered regarding adjuvant immunotherapy for melanoma. METHODS: In-depth interviews were conducted with physicians (medical oncologists, surgeons and dermatologists) and nurses managing patients with resected stage III melanoma at three Australian tertiary melanoma centres between July 2019 and March 2020. Factors considered regarding adjuvant immunotherapy were explored. Recruitment continued until data saturation and thematic analysis was undertaken. RESULTS: Twenty-five physicians and nurses, aged 28-68 years, 60% females, including eleven (44%) medical oncologists, eight (32%) surgeons, five (20%) nurses, and one (4%) dermatologist were interviewed. Over half the sample managed five or more new resected stage III patients per month who could be eligible for adjuvant immunotherapy. Three themes about adjuvant immunotherapy recommendations emerged: [1] clinical and patient factors, [2] treatment information provision, and [3] individual physician/nurse factors. Melanoma sub-stage and an individual patient's therapy risk/benefit profile were primary considerations. Secondary factors included uncertainty about adjuvant immunotherapy's effectiveness and their views about treatment burden patients might consider acceptable. CONCLUSIONS: Patients' disease sub-stage and their treatment risk versus benefit drove the melanoma health care professionals' adjuvant immunotherapy endorsement. Findings clarify clinician preferences and values, aiding clinical communication with patients and facilitating clinical decision-making about management options for resected stage III melanoma.


Assuntos
Imunoterapia , Melanoma/terapia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Adulto , Fatores Etários , Atitude do Pessoal de Saúde , Austrália , Institutos de Câncer , Tomada de Decisão Clínica , Consultores , Dermatologistas , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Oncologistas , Medição de Risco , Cirurgiões
8.
Gan To Kagaku Ryoho ; 48(8): 1000-1006, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34404065

RESUMO

The SARS-CoV-2 was first identified in December 2019 in Wuhan, China. Since then, the ongoing COVID-19 pandemic has drastically changed the healthcare system, including cancer treatments worldwide. Since March 2020 in Japan, cancer patients faced a crisis; they suffered from delays or restrictions in cancer treatment during the initial outbreak. At present, we can perform cancer treatment as usual. Most of the treatments depend on continuous infection control by cancer patients and their families. However, the need to recognize cancer treatment management during the COVID-19 pandemic is crucial. Cancer treatment practice, purpose, risk factors, and the evidence during clinical trials should be comprehensively evaluated and adapted for each patient. Moreover, there is a need to discuss care planning between healthcare professionals, patients, and their families in advance. The COVID-19 vaccine could be essential for cancer patients. In this article, we review cancer treatment points for implementing whole-person care, including advanced care planning for patients with gastrointestinal malignancies, during the COVID-19 pandemic.


Assuntos
COVID-19 , Neoplasias Gastrointestinais , Oncologistas , Vacinas contra COVID-19 , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Gastrointestinais/terapia , Humanos , Pandemias , SARS-CoV-2
9.
Gan To Kagaku Ryoho ; 48(8): 1007-1011, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34404066

RESUMO

After the identification of the new coronavirus disease(COVID-19)in December 2019, it has spread rapidly around the world. The COVID-19 pandemic has forced medical systems to limit their services, promote telehealth, prolong visits to clinics, and postpone scheduled surgical operations. The mortality rate of COVID-19 in patients with lung cancer appears to be significantly higher than that of patients with other cancers. Medical care offered to patients with lung cancer should take into account the risk of COVID-19 associated with visits to clinics and treatments. This review outlines the efforts of lung cancer oncologists in the"With COVID-19"era based on the current evidence and statements from domestic and foreign academic societies and organizations.


Assuntos
COVID-19 , Neoplasias Pulmonares , Oncologistas , Telemedicina , Humanos , Neoplasias Pulmonares/terapia , Pandemias , SARS-CoV-2
10.
Cancer Treat Res Commun ; 28: 100445, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34425469

RESUMO

INTRODUCTION: Over half of the 1.5 million individuals globally who are diagnosed with colorectal cancer (CRC) present with stage II-III disease. Understanding clinician attitudes towards treatment for this group is paramount to contextualise real-world outcomes and plan future trials. The aim of this study was to assess clinician awareness of trials assessing the optimal duration of CRC adjuvant therapy, their attitudes towards shorter treatment and their self-reported practice. METHODS: A survey was developed using OnlineSurveys® and distributed to clinicians in April 2019, with a follow-up survey disseminated to a subset of respondents in August 2020. Microsoft Excel® and Stata® were used for analysis. RESULTS: 265 clinicians replied to the first survey, with the majority aware of findings from the International Duration Evaluation of Adjuvant Therapy collaboration and contributory trials. Practice change was greatest for patients under 70 with low-risk stage III CRC, with most uncertainty around using 3-months of doublet chemotherapy for high-risk stage II disease. In August 2020, clinicians (n = 106) were more likely to use 3-months of FOLFOX for low-risk stage III disease and 3-months of CAPOX for stage II disease compared to April 2019. There was no indication that the COVID-19 pandemic had enduring changes on treatment decisions beyond those made in response to trial evidence. DISCUSSION: Clinicians use a risk-stratified approach to treat CRC the adjuvant setting. Lower utilisation of doublet chemotherapy for older and stage II patients has affected the extent of trial implementation. Active dialogue regarding how trial results apply to these groups may improve consensus.


Assuntos
Ensaios Clínicos como Assunto , Neoplasias Colorretais/tratamento farmacológico , Padrões de Prática Médica , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , COVID-19 , Quimioterapia Adjuvante , Neoplasias Colorretais/patologia , Fluoruracila/uso terapêutico , Humanos , Leucovorina/uso terapêutico , Estudos Longitudinais , Oncologistas , Compostos Organoplatínicos/uso terapêutico , Guias de Prática Clínica como Assunto , Autorrelato , Inquéritos e Questionários , Fatores de Tempo
11.
J Immunother Cancer ; 9(7)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34281989

RESUMO

Expanding the US Food and Drug Administration-approved indications for immune checkpoint inhibitors in patients with cancer has resulted in therapeutic success and immune-related adverse events (irAEs). Neurologic irAEs (irAE-Ns) have an incidence of 1%-12% and a high fatality rate relative to other irAEs. Lack of standardized disease definitions and accurate phenotyping leads to syndrome misclassification and impedes development of evidence-based treatments and translational research. The objective of this study was to develop consensus guidance for an approach to irAE-Ns including disease definitions and severity grading. A working group of four neurologists drafted irAE-N consensus guidance and definitions, which were reviewed by the multidisciplinary Neuro irAE Disease Definition Panel including oncologists and irAE experts. A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness and accuracy on 9-point scales in electronic surveys and provided free text comments. Aggregated survey responses were incorporated into revised definitions. Consensus was based on numeric ratings using the RAND/University of California Los Angeles (UCLA) Appropriateness Method with prespecified definitions. 27 panelists from 15 academic medical centers voted on a total of 53 rating scales (6 general guidance, 24 central and 18 peripheral nervous system disease definition components, 3 severity criteria and 2 clinical trial adjudication statements); of these, 77% (41/53) received first round consensus. After revisions, all items received second round consensus. Consensus definitions were achieved for seven core disorders: irMeningitis, irEncephalitis, irDemyelinating disease, irVasculitis, irNeuropathy, irNeuromuscular junction disorders and irMyopathy. For each disorder, six descriptors of diagnostic components are used: disease subtype, diagnostic certainty, severity, autoantibody association, exacerbation of pre-existing disease or de novo presentation, and presence or absence of concurrent irAE(s). These disease definitions standardize irAE-N classification. Diagnostic certainty is not always directly linked to certainty to treat as an irAE-N (ie, one might treat events in the probable or possible category). Given consensus on accuracy and usability from a representative panel group, we anticipate that the definitions will be used broadly across clinical and research settings.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Inibidores de Checkpoint Imunológico/efeitos adversos , Imunoterapia/efeitos adversos , Doenças do Sistema Nervoso/diagnóstico , Guias de Prática Clínica como Assunto , Consenso , Humanos , Doenças do Sistema Nervoso/induzido quimicamente , Doenças do Sistema Nervoso/imunologia , Neurologistas/estatística & dados numéricos , Oncologistas/estatística & dados numéricos , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/estatística & dados numéricos
12.
JCO Oncol Pract ; 17(9): e1318-e1326, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34264741

RESUMO

PURPOSE: The use of telemedicine expanded dramatically in March 2020 following the COVID-19 pandemic. We sought to assess oncologist perspectives on telemedicine's present and future roles (both phone and video) for patients with cancer. METHODS: The National Comprehensive Cancer Network (NCCN) Electronic Health Record (EHR) Oncology Advisory Group formed a Workgroup to assess the state of oncology telemedicine and created a 20-question survey. NCCN EHR Oncology Advisory Group members e-mailed the survey to providers (surgical, hematology, gynecologic, medical, and radiation oncology physicians and clinicians) at their home institution. RESULTS: Providers (N = 1,038) from 26 institutions responded in Summer 2020. Telemedicine (phone and video) was compared with in-person visits across clinical scenarios (n = 766). For reviewing benign follow-up data, 88% reported video and 80% reported telephone were the same as or better than office visits. For establishing a personal connection with patients, 24% and 7% indicated video and telephone, respectively, were the same as or better than office visits. Ninety-three percent reported adverse outcomes attributable to telemedicine visits never or rarely occurred, whereas 6% indicated they occasionally occurred (n = 801). Respondents (n = 796) estimated 46% of postpandemic visits could be virtual, but challenges included (1) lack of patient access to technology, (2) inadequate clinical workflows to support telemedicine, and (3) insurance coverage uncertainty postpandemic. CONCLUSION: Telemedicine appears effective across a variety of clinical scenarios. Based on provider assessment, a substantial fraction of visits for patients with cancer could be effectively and safely conducted using telemedicine. These findings should influence regulatory and infrastructural decisions regarding telemedicine postpandemic for patients with cancer.


Assuntos
COVID-19 , Neoplasias , Oncologistas , Telemedicina , Feminino , Humanos , Neoplasias/terapia , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
13.
Adv Ther ; 38(9): 4722-4735, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34319551

RESUMO

INTRODUCTION: Squamous cell carcinomas of the head and neck (SCCHN) account for approximately 4% of all malignancies and are associated with high morbidity and poor prognosis. For patients who are not eligible for surgery or radiotherapy, treatment options are limited, especially for those with recurrent or metastatic (R/M) disease. Current European guidelines recommend first-line (1L) treatment with palliative chemotherapy, using biologic or platinum-based regimens. In the absence of new clinical trials in SCCHN, the use of real-world data has facilitated the assessment of treatment patterns and outcomes in different healthcare systems. This study reports on the 1L treatment of platinum-eligible patients with R/M SCCHN in Italy and Spain. METHODS: A point-in-time survey of the management of patients with R/M SCCHN was completed by clinical oncologists in Italy and Spain between October 2018 and February 2019. Patient demographics and clinical characteristics were obtained by retrospective chart review, whilst participating patients self-reported the impact of their disease on their quality of life (QoL) and well-being. RESULTS: A total of 436 patients were recruited from Italy (216) and Spain (220). Patient demographics for both countries comprised mostly male patients, aged 65 years in Italy and 63 in Spain on average. The primary site for the SCCHN was the pharynx and 36% of patients had metastatic disease overall. EXTREME or cetuximab-based regimens were the most common treatments administered at 1L (52% in Italy and 78% in Spain). Scores on the FACT-G in both countries were substantially lower than those of the general and other advanced cancer populations, while scores on the EQ-5D were clinically meaningfully lower than local population norms. CONCLUSION: Despite 1L treatment of platinum-eligible patients with R/M SCCHN in Italy and Spain following current European guidelines, patients' QoL remains poor, which highlights the need for alternative treatments that could improve clinical outcomes.


Assuntos
Neoplasias de Cabeça e Pescoço , Oncologistas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cetuximab/uso terapêutico , Feminino , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/epidemiologia , Humanos , Masculino , Recidiva Local de Neoplasia/tratamento farmacológico , Qualidade de Vida , Estudos Retrospectivos , Espanha/epidemiologia
14.
ESMO Open ; 6(4): 100215, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34325108

RESUMO

BACKGROUND: Young oncologists are at particular risk of professional burnout, and this could have a significant impact on their health and care of their patients. The coronavirus disease 2019 (COVID-19) pandemic has forced rapid changes in professionals' jobs and training, with the consequent physical and psychological effects. We aimed to characterize burnout levels and determinants in young oncologists, and the effects of the pandemic on their training and health. METHODS: Two online surveys were conducted among oncology residents and young oncology specialists in Spain. The first addressed professional burnout and its determinants before the COVID-19 pandemic, while the second analyzed the impact of the pandemic on health care organization, training, and physical and psychological health in the same population. RESULTS: In total, 243 respondents completed the first survey, and 263 the second; 25.1% reported significant levels of professional burnout. Burnout was more common among medical oncology residents (28.2%), mainly in their second year of training. It was significantly associated with a poor work-life balance, inadequate vacation time, and the burnout score. Nearly three-quarters of respondents (72%) were reassigned to COVID-19 care and 84.3% of residents missed part of their training rotations. Overall, 17.2% of this population reported that they had contracted COVID-19, 37.3% had scores indicating anxiety, and 30.4% moderate to severe depression. Almost a quarter of young oncologists (23.3%) had doubts about their medical vocation. CONCLUSIONS: Burnout affects a considerable number of young oncologists. The COVID-19 pandemic has had a profound impact on causes of burnout, making it even more necessary to periodically monitor it to define appropriate detection and prevention strategies.


Assuntos
Esgotamento Profissional , COVID-19 , Oncologistas , Esgotamento Profissional/epidemiologia , Esgotamento Psicológico/epidemiologia , Esgotamento Psicológico/prevenção & controle , Humanos , Oncologia , Pandemias , SARS-CoV-2
15.
Ann Palliat Med ; 10(8): 9229-9240, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34328017

RESUMO

OBJECTIVE: In this review we will focus on doctor-patient communication as one of the most important modifiable factors which may have a significant impact especially on the important transition between the ambulatory and terminal phases of cancer. BACKGROUND: High quality communication about prognosis for cancer patients is a critical component of advance care planning, and it plays a critical role among all the complex factors that affect end of life care decisions. In this review we focus on doctor-patient communication as the most important modifiable factor impacting the transitional period between the ambulatory phase and the terminal phase of cancer. We also discuss how prognostic understanding among advanced cancer patients influences decisions in regard to their cancer care. METHODS: We investigated studies that examined advanced cancer patients and prognosis-related communication. CONCLUSIONS: We believe that oncologists' skills, experience, and comfort level in managing patients' reactions to negative information is a principal barrier that contributes substantially to the deficit of high-quality prognosis-related communication described in the literature. We also believe that it is useful to categorize oncologists with regard to their ability to engage in high quality communication, and we suggest category-specific strategies to improve oncologists' skills to conduct more effective prognosis related communication with their patients.


Assuntos
Neoplasias , Oncologistas , Comunicação , Humanos , Neoplasias/terapia , Relações Médico-Paciente , Prognóstico
17.
JCO Oncol Pract ; 17(7): e427-e438, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34152789

RESUMO

INTRODUCTION: The COVID-19 pandemic is an unprecedented global crisis profoundly affecting oncology care delivery. PURPOSE: This study will describe the occupational and personal consequences of the COVID-19 pandemic on oncologist well-being and patient care. MATERIALS AND METHODS: Four virtual focus groups were conducted with US ASCO member oncologists (September-November 2020). Inquiry and subsequent discussions centered on self-reported accounts of professional and personal COVID-19 experiences affecting well-being, and oncologist recommendations for well-being interventions that the cancer organization and professional societies (ASCO) might implement were explored. Qualitative interviews were analyzed using Framework Analysis. RESULTS: Twenty-five oncologists were interviewed: median age 44 years (range: 35-69 years), 52% female, 52% racial or ethnic minority, 76% medical oncologists, 64% married, and an average of 51.5 patients seen per week (range: 20-120). Five thematic consequences emerged: (1) impact of pre-COVID-19 burnout, (2) occupational or professional limitations and adaptations, (3) personal implications, (4) concern for the future of cancer care and the workforce, and (5) recommendations for physician well-being interventions. Underlying oncologist burnout exacerbated stressors associated with disruptions in care, education, research, financial practice health, and telemedicine. Many feared delays in cancer screening, diagnosis, and treatment. Oncologists noted personal and familial stressors related to COVID-19 exposure fears and loss of social support. Many participants strongly considered working part-time or taking early retirement. Yet, opportunities arose to facilitate personal growth and rise above pandemic adversity, fostering greater resilience. Recommendations for organizational well-being interventions included psychologic or peer support resources, flexible time-off, and ASCO and state oncology societies involvement to develop care guidelines, well-being resources, and mental health advocacy. CONCLUSION: Our study suggests that the COVID-19 pandemic has adversely affected oncologist burnout, fulfillment, practice health, cancer care, and workforce. It illuminates where professional organizations could play a significant role in oncologist well-being.


Assuntos
COVID-19 , Oncologistas , Adulto , Esgotamento Psicológico , Grupos Étnicos , Feminino , Humanos , Masculino , Grupos Minoritários , Pandemias , SARS-CoV-2
18.
Jpn J Clin Oncol ; 51(7): 1023, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34142148
19.
Artigo em Inglês | MEDLINE | ID: mdl-34073341

RESUMO

Prognostic communication is essential for patients with advanced cancer to enable informed medical decision-making and end-of-life planning. Discussing prognosis is challenging, and might be especially complex for oncologists conducting a second opinion (SO). Survival data are often lacking, and consulting oncologists need to consider previously conveyed information and patients' relationship with the referring oncologist. We qualitatively investigated how advanced cancer patients and consulting oncologists discuss prognosis during audio-recorded SO consultations (N = 60), including prognostic information received from the referring oncologist. Our results show that patients regularly expressed implicit cues to discuss prognosis or posed explicit questions tentatively. Consulting oncologists were mostly unresponsive to patients' cues and cautious to prognosticate. They also seemed cautious when patients brought up the referring oncologist. Consulting oncologists checked which prognostic information patients had received from the referring oncologist, before estimating prognosis. They agreed with the first opinion or rectified discrepancies carefully. Altogether, this study exposes missed opportunities for open prognostic discussions in SOs. Consulting oncologists could explicitly explore patients' information preferences and perceptions of prognosis. If desired, they can provide tailored, independent information to optimise patients' prognostic awareness and informed medical decision-making. They may additionally support patients in dealing with prognosis and the uncertainties associated with it.


Assuntos
Neoplasias , Oncologistas , Comunicação , Humanos , Neoplasias/terapia , Relações Médico-Paciente , Encaminhamento e Consulta
20.
ESMO Open ; 6(3): 100131, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34144778

RESUMO

BACKGROUND: European Society for Medical Oncology Women for Oncology (ESMO W4O) research has previously shown under-representation of female oncologists in leadership roles. As early reports suggested disproportionate effects of the COVID-19 pandemic on women, the ESMO W4O Committee initiated a study on the impact of the pandemic on the lives of female and male oncologists. METHODS: A questionnaire was sent to ESMO members and put on the ESMO website between 8 June 2020 and 2 July 2020. Questions focused on the working (hospital tasks, laboratory tasks, science) and home (household management, childcare, parent care, personal care) lives of oncologists during and after COVID-19-related lockdowns. RESULTS: Of 649 respondents, 541 completed the questionnaire. Of these, 58% reported that COVID-19 had affected their professional career, 83% of whom said this was in a negative way (85% of women versus 76% of men). Approximately 86% reported that COVID-19 had changed their personal life and 82% their family life. Women were again significantly more affected than men: personal life (89% versus 78%; P = 0.001); family life (84% versus 77%; P = 0.037). During lockdowns, women reported increased time spent on hospital and laboratory tasks compared with men (53% versus 46% and 33% versus 26%, respectively) and a significantly higher proportion of women than men spent less time on science (39% versus 25%) and personal care (58% versus 39%). After confinement, this trend remained for science (42% versus 23%) and personal care (55% versus 36%). CONCLUSIONS: The COVID-19 pandemic has adversely affected the professional and home lives of oncologists, especially women. Reduced research time for female oncologists may have long-lasting career consequences, especially for those at key stages in their career. The gender gap for promotion to leadership positions may widen further as a result of the pandemic.


Assuntos
COVID-19 , Adulto , Controle de Doenças Transmissíveis , Feminino , Humanos , Masculino , Oncologia , Pessoa de Meia-Idade , Oncologistas , Pandemias , SARS-CoV-2 , Inquéritos e Questionários , Adulto Jovem
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