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1.
Lancet Oncol ; 24(2): e96-e101, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36725154

RESUMO

Health-care systems in sub-Saharan Africa are considered to be new markets for pharmaceutical companies. This perception is particularly relevant within oncology, as the pharmaceutical industry has changed strategic priorities in the past 10 years to focus on cancer. Since the 1930s, pharmaceutical companies have used advertisements, sample drugs, gifts, paid speaking engagements, advisory boards, and trips to conferences to influence clinical practice and policy. A large amount of literature describes the commonness of these practices and their effects on the behaviour of doctors. However, these data come almost exclusively from high-income countries. Industry-doctor relationships are increasingly common in sub-Saharan Africa and other low-income and middle-income countries. Although there are undoubtedly risks of industry engagement in low-income and middle-income countries, many programmes with educational, research, and clinical value would not occur in these countries without industry support. Thus, what is known about these relationships in high-income countries will not necessarily apply in low-income and middle-income countries. There is a need for widespread discussion about industry-oncologist interactions across the African continent and context-specific data to understand the potential risks and benefits of these relationships.


Assuntos
Medicina , Oncologistas , Humanos , África ao Sul do Saara/epidemiologia , Indústria Farmacêutica , Preparações Farmacêuticas
2.
JCO Clin Cancer Inform ; 7: e2200137, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36657092

RESUMO

PURPOSE: Matching patients with cancer to precision medicine clinical trials on the basis of their tumor genotype has the potential to improve outcomes for patients who have exhausted standard-of-care treatment options. However, the matching process presents a substantial challenge because of the number of clinical trials available. We describe a free, open source research tool designed to extract relevant trial information to support oncologists in the matching process, and we illustrate its utility with recent case studies of patients who were matched to trials using this tool. METHODS: Trial records are sourced from ClinicalTrials.gov and indexed using natural language processing techniques, including named entity recognition, term normalization, and relationship extraction. Relationships between trials and genetic alterations are assigned scores on the basis of a rule-based system. All data are updated daily. A user interface is provided via R Shiny app. RESULTS: An instance of the trial match tool, configured for UK clinical trials, is hosted by the digital Experimental Cancer Medicine Team (see link in Data Sharing Statement). Users select the relevant cancer type and genetic alteration(s). Matching studies are ranked according to the score assigned for the selected genetic alterations. Results may be downloaded and attached to the patient's health record if desired. The tool is currently being used to support the ongoing TARGET National study, which aims to match up to 6,000 patients to early phase clinical trials. We present three case studies that exemplify relationships between genetic alterations and studies. CONCLUSION: With increasing numbers of precision medicine treatments and as comprehensive molecular profiling of tumor samples becomes more common, decision support tools are likely to become increasingly important. This work represents an important step toward the development and wider implementation of such systems.


Assuntos
Neoplasias , Oncologistas , Humanos , Mutação , Neoplasias/diagnóstico , Neoplasias/genética , Neoplasias/terapia , Medicina de Precisão , Ensaios Clínicos como Assunto
3.
Intern Med J ; 53(1): 131-135, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36693646

RESUMO

Venous thromboembolism (VTE) has a significant adverse impact on the outcomes of patients with active solid malignancies. Prophylaxis is indicated for cancer-associated VTE (CA-VTE) using the Khorana score for risk stratification. We surveyed medical oncology fellows and trainees regarding their practice in CA-VTE. Regarding treatment of CA-VTE, practice was consistent with guidelines. However, regarding prophylaxis for CA-VTE, there was a high degree of uncertainty, which highlights the need for ongoing education.


Assuntos
Neoplasias , Oncologistas , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Fatores de Risco , Neoplasias/terapia , Neoplasias/tratamento farmacológico , Inquéritos e Questionários , Anticoagulantes/uso terapêutico
4.
Medicina (Kaunas) ; 59(1)2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36676768

RESUMO

Background and objectives: As is well known, cancer patients require extensive medical attention as they undergo surgery, chemotherapy, radiotherapy, and supportive care. The importance of high-quality cancer-directed nursing, combined with precision medicine, to maximize their survival outcomes and help them achieve a better quality of life cannot be overemphasized. In this context, we offered a new cancer-oriented comprehensive nursing system to our inpatients and reviewed its clinical outcomes in comparison with those from the preexisting general cancer ward. Materials and Methods: From March 2019 to February 2020, a total of 102 cancer patients and 42 nurses were enrolled in this pilot study. We aimed to analyze their performance in three main categories: structure, process, and patient/nurse outcomes. Results: First, structural (nurse staffing and environment) upgrades were installed in the cancer-oriented comprehensive nursing ward, including an improved nurse-patient ratio (1:8 in the comprehensive ward as compared with 1:14 in the general ward), wider space between beds (1.5 m versus 1.0 m), fully automatic beds with fall prevention sensors, etc. Second, the nursing process was improved (missed care 0.1 event/month vs. 1.3 event/month). Third, both patient and nurse outcomes showed preferable results in the comprehensive ward. The patient satisfaction level was higher in the comprehensive nursing ward than in the general ward (willing to revisit: 91.7% and 78.4%, respectively; willing to recommend to others: 95.0% and 76.8%, respectively). Pressure ulcers, as a patient safety indicator, were also decreased (0.3 events/month vs. 0.8 events/month). However, the fall incidence was similar in both groups (1.6 events/month vs. 1.5 events/month). In terms of nurse outcomes, turnover intention was stabilized and nurses' job satisfaction in the comprehensive ward was superior to that of their counterparts. Conclusions: Our study was a pilot study to demonstrate that cancer patient-oriented comprehensive nursing services can be helpful in improving the quality of cancer treatment and nurses' job satisfaction. Continued interest in and efforts to improve nursing care delivery are also crucial in achieving and maintaining the best possible cancer patient care.


Assuntos
Neoplasias , Oncologistas , Humanos , Projetos Piloto , Qualidade de Vida , Satisfação do Paciente , República da Coreia , Inquéritos e Questionários , Neoplasias/terapia
5.
Curr Oncol Rep ; 25(2): 131-134, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36626037

RESUMO

PURPOSE OF REVIEW: The aim of this review is defining burnout in medical oncologists, analyzing the causes, and evaluating both individual and institutional approaches to overcome burnout. RECENT FINDINGS: Burnout is defined as a reaction to long-term work-related stress, which is a serious condition and has negative consequences at both personal and professional levels. In recent years, there has been a greater emphasis on burnout in medicine in general and specifically in oncology given the complexity of care provided to oncology patients. More research is being done in this field and more coping strategies are evolving to help oncologists reduce the amount of stress and burnout they are experiencing. Oncologists need to recognize and acknowledge burnout and use different strategies to find joy in their work while maintaining their work-life balance. Strategies like individual-directed interventions and organizational-directed interventions, such as providing support and resources to oncologists to relieve their work-related stress may have a positive impact on oncologists' well-being, their patients' care, and satisfaction.


Assuntos
Esgotamento Profissional , Neoplasias , Estresse Ocupacional , Oncologistas , Humanos , Esgotamento Profissional/prevenção & controle , Estresse Ocupacional/complicações , Oncologia , Neoplasias/terapia , Neoplasias/complicações , Inquéritos e Questionários
6.
R I Med J (2013) ; 106(1): 39-41, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36706207

RESUMO

BACKGROUND: Continuity of care is a cornerstone of the patient-practitioner relationship. Previously, patient satisfaction has been related to perceived provider communication skills and competence. Our study assessed the relationship between the inpatient continuity visit (ICV), a face-to-face patient-provider interaction with the primary oncologist, and patient satisfaction. METHODS: Subjects were adult inpatients on the oncology unit at The Miriam Hospital who had an oncologist at the hospital-based cancer center. A survey, given at discharge, included a 5-point Likert scale ranging from greatly worsened to greatly improved satisfaction to assess the impact of the ICV on patient satisfaction. RESULTS: Of 75 participants, 43 (57.3%) reported a visit by their outpatient oncologist. Of these, 39 (90.7%) reported that this visit either greatly or somewhat improved satisfaction with their hospital stay. Of subjects who had a single ICV, 93.7% reported either greatly or somewhat improved satisfaction compared to 88.9% who had more than one visit. Of 32 (43.3%) subjects who did not receive a visit, 15.6% reported that the lack of visit either greatly or somewhat worsened their satisfaction during their hospital stay, while 84.4% reported no impact. CONCLUSIONS: Our study suggests that an ICV improves satisfaction of care in cancer patients on a hospitalist service, and a lack of ICV negatively impacted satisfaction. There was no improvement in satisfaction for multiple versus single ICVs. While the practicality of this intervention should be reassessed with the emergence of more accessible telehealth modalities, the efficacy of a single visit to improve satisfaction is informative.


Assuntos
Médicos Hospitalares , Neoplasias , Oncologistas , Adulto , Humanos , Tempo de Internação , Alta do Paciente , Neoplasias/terapia , Satisfação do Paciente
7.
Clin Med (Lond) ; 23(1): 9-15, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36697012

RESUMO

OBJECTIVE: Genomics is rapidly changing treatment paradigms for cancers, obligating oncologists to have good genomics knowledge. Through this survey, we aimed to assess the current understanding of cancer genomics among UK oncologists. METHODS: We conducted a web-based nation-wide self-assessment survey of the cancer genomics knowledge of UK clinical and medical oncology trainees and consultants. RESULTS: In total, 150 oncologists (81 consultants and 69 trainees) responded, representing 10% of UK oncologists.Formal training in genomics had not been received by 38.7% of oncologists and 92.7% identified a need for additional genomics training.In total, 71.3% self-reported to have good knowledge of defining somatic and germline mutations, falling to 35.3% for understanding principles of gene expression and regulation. Knowledge of cancer-predisposing syndromes was highest for Lynch syndrome (40.7% good knowledge) and lowest for multiple endocrine neoplasia (14.0% good knowledge).Overall, 49.0% of respondents had consented patients for germline testing, but 80.7% reported a lack of training in genetic counselling. CONCLUSION: Large knowledge gaps have been identified through this survey, highlighting the need for incorporation of improved formal training in cancer genomics for consultants and trainees, with an aim to equip oncologists for advances in clinical practice and to take up genetic mainstreaming confidently.


Assuntos
Neoplasias , Oncologistas , Humanos , Oncologia/educação , Genômica , Inquéritos e Questionários , Neoplasias/genética , Neoplasias/terapia , Reino Unido
8.
Pediatr Blood Cancer ; 70(2): e29946, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36495229

RESUMO

BACKGROUND: Isolated neutropenia is a common referral to pediatric hematology oncology (PHO) physicians. There are no established consensus guidelines in the diagnosis and management of patients with isolated, asymptomatic, and incidentally discovered neutropenia. METHODS: A survey was distributed to PHO physicians on the American Society of Pediatric Hematology Oncology member discussion page to determine the common diagnostic and management decisions regarding patients with isolated neutropenia and to explore beliefs regarding the term "benign ethnic neutropenia." RESULTS: One hundred twenty-six PHO attending physicians completed the survey. The most common tests reportedly ordered for this patient population included complete blood cell count (CBC) (98%), peripheral smear (75%), antineutrophil antibody testing (29%), and immunoglobulins (24%). Providers were more likely to order an antineutrophil antibody in toddlers (p = .0085), and antinuclear antibody (ANA) panels in adolescents (p < .001). Half of providers do not request additional CBCs prior to their initial consultation, and most suggest referring patients with mild neutropenia after confirming a declining absolute neutrophil count (ANC) (51%). The three most important factors influencing ongoing follow-up included: history of recurrent/severe infections (98%), family history of blood disorders (98%), and more severe/progressively worsening neutropenia (97%). Seventy percent of respondents have diagnosed patients with "benign ethnic neutropenia," and 75% support replacement of the term to "typical neutrophil count with Fy(a-/b-) status," if confirmed with red cell phenotyping. CONCLUSION: We identified practice patterns of PHO physicians for the diagnosis and management of patients referred for asymptomatic and isolated neutropenia. These data provide the framework to conduct cost-effectiveness studies.


Assuntos
Neutropenia , Oncologistas , Adolescente , Humanos , Neutropenia/diagnóstico , Neutropenia/terapia , Inquéritos e Questionários , Oncologia , Contagem de Leucócitos
10.
Surg Oncol Clin N Am ; 32(1): 13-25, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36410913

RESUMO

Investigator-initiated trials (IITs) are designed by principal investigators who identify important, unaddressed clinical gaps and opportunities to answer these questions through clinical trials. Surgical oncologists are poised to lead IITs due to their multidisciplinary clinical practice and substantial research background. The process of developing, organizing, and implementing IITs is multifaceted and involves important steps including (but not limited to) navigating regulatory requirements, obtaining funding, and meeting enrollment targets. Here, the authors explore the steps, methodology, and barriers of IIT development by surgical oncologists and highlight the importance of IITs in oncology.


Assuntos
Oncologistas , Oncologia Cirúrgica , Humanos , Pesquisadores , Oncologia
11.
Int J Gynecol Cancer ; 32(10): 1321-1326, 2022 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-36515563

RESUMO

The management of radiation-induced secondary malignancies in the female genital tract after pelvic radiation treatment for a primary gynecological tumor is a challenge for multidisciplinary teams that follow survivors. Considering the lack of data on the incidence of this disease and the absence of guidelines for its management, in this review, the available literature is analyzed to determine the characteristics and the clinical management of gynecological radiation-induced secondary malignancies. Gynecological radiation-induced secondary malignancies were found to be predominantly more aggressive, poorly differentiated, and had rare histologic types compared with sporadic tumors. The management is influenced by previous radiation doses and the localization of the radiation-induced secondary malignancies. Surgery, when feasible, was the cornerstone; re-irradiation was an option when a surgical approach was not feasible and high-dose conformal techniques should be preferred considering the need to spare previously irradiated surrounding normal tissues. Clinical outcomes, when reported, were poor in terms of local control and survival. Given the difficulty in managing these uncommon malignancies, a centralization of care in sites that are connected to research networks actively partaking in international discussions and with higher expertise in complicated surgery or radiotherapy should be considered to improve clinical outcomes.


Assuntos
Neoplasias dos Genitais Femininos , Ginecologia , Segunda Neoplasia Primária , Oncologistas , Feminino , Humanos , Segunda Neoplasia Primária/etiologia , Segunda Neoplasia Primária/epidemiologia , Neoplasias dos Genitais Femininos/radioterapia , Neoplasias dos Genitais Femininos/cirurgia , Neoplasias dos Genitais Femininos/complicações
12.
Asian Pac J Cancer Prev ; 23(12): 4275-4284, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36580010

RESUMO

BACKGROUND: Chemotherapy resistance is caused by a multiplicity of reasons; some of which can be avoided and others that are beyond the scope of current treatment methods. Since chemotherapy is administered under the supervision of health personnel, the role of oncologists cannot be undermined, and yet none is known about their knowledge and perspective. This research is the first-ever study aiming to develop a valid and reliable tool to determine oncologists' knowledge, attitude, and practice (KAP) toward chemotherapy resistance. METHODS: Based on information gathered from literature searches, in-depth interviews with oncologists, and discussions with experts, an English-language questionnaire was developed. The questionnaire was tested for validity and reliability. A final version of the questionnaire (63 items) was piloted among 64 practicing oncologists and oncology trainees via convenient sampling. Data analysis was done using SPSS. RESULTS: Correlation coefficients for each of the questionnaire's domains were more than 0.7 (P<0.001), which suggests that the questionnaire had strong test-retest reliability. The overall internal consistency (Cronbach's alpha) for knowledge (0.728), attitude (0.722), and practice (0.716) were greater than 0.7 indicating good internal consistency. Participants demonstrated a low level of knowledge and a positive attitude toward chemotherapy resistance. A statistically significant difference was noted between the knowledge score and education level, years of experience in the medical and oncology field, and experiencing resistance cases. CONCLUSION: The developed questionnaire was found to be valid and reliable and can be used as an assessment tool for assessing oncologists' knowledge, attitude, and practice toward chemotherapy resistance in future studies. This study also reported that the oncologists have low knowledge on chemotherapy resistance and a predominantly positive attitude towards fighting chemotherapy resistance. Thus, it is essential for current practices in chemotherapy to be optimized to reduce the risk of chemotherapy resistance.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Oncologistas , Humanos , Reprodutibilidade dos Testes , Atitude do Pessoal de Saúde , Inquéritos e Questionários
13.
JAMA Netw Open ; 5(12): e2245995, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36525275

RESUMO

Importance: Physician headcounts provide useful information about the cancer care delivery workforce; however, efforts to track the oncology workforce would benefit from new measures that capture how essential a physician is for meeting the multidisciplinary cancer care needs of the region. Physicians are considered linchpins when fewer of their peers are connected to other physicians of the same specialty as the focal physician. Because they are locally unique for their specialty, these physicians' networks may be particularly vulnerable to their removal from the network (eg, through relocation or retirement). Objective: To examine a novel network-based physician linchpin score within nationwide cancer patient-sharing networks and explore variation in network vulnerability across hospital referral regions (HRRs). Design, Setting, and Participants: This cross-sectional study analyzed fee-for-service Medicare claims and included Medicare beneficiaries with an incident diagnosis of breast, colorectal, or lung cancer from 2016 to 2018 and their treating physicians. Data were analyzed from March 2022 to October 2022. Exposures: Physician characteristics assessed were specialty, rurality, and Census region. HRR variables assessed include sociodemographic and socioeconomic characteristics and use of cancer services. Main Outcomes and Measures: Oncologist linchpin score, which examined the extent to which a physician's peers were connected to other physicians of the same specialty as the focal physician. Network vulnerability, which distinguished HRRs with more linchpin oncologists than expected based on oncologist density. χ2 and Fisher exact tests were used to examine relationships between oncologist characteristics and linchpin score. Spearman rank correlation coefficient (ρ) was used to measure the strength and direction of relationships between HRR network vulnerability, oncologist density, population sociodemographic and socioeconomic characteristics, and cancer service use. Results: The study cohort comprised 308 714 patients with breast, colorectal, or lung cancer. The study cohort of 308 714 patients included 161 206 (52.2%) patients with breast cancer, 76 604 (24.8%) patients with colorectal cancer, and 70 904 (23.0%) patients with lung cancer. In our sample, 272 425 patients (88%) were White, and 238 603 patients (77%) lived in metropolitan areas. The cancer patient-sharing network included 7221 medical oncologists and 3573 radiation oncologists. HRRs with more vulnerable networks for medical oncology had a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.19; 95% CI, 0.08 to 0.29). HRRs with more vulnerable networks for radiation oncology had a higher percentage of beneficiaries living in poverty (ρ, 0.17; 95% CI, 0.06 to 0.27), and a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.21; 95% CI, 0.09 to 0.31), and lower rates of cohort patients receiving radiation therapy (ρ, -0.18; 95% CI, -0.28 to -0.06; P = .003). The was no association between network vulnerability for medical oncology and percent of cohort patients receiving chemotherapy (ρ, -0.03; 95% CI, -0.15 to 0.08). Conclusions and Relevance: This study found that patient-sharing network vulnerability was associated with poverty and lower rates of radiation therapy. Health policy strategies for addressing network vulnerability may improve access to interdisciplinary care and reduce treatment disparities.


Assuntos
Acesso aos Serviços de Saúde , Mão de Obra em Saúde , Oncologistas , Idoso , Humanos , Neoplasias Colorretais/terapia , Estudos Transversais , Neoplasias Pulmonares/terapia , Medicare , Estados Unidos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Oncologistas/provisão & distribuição , Feminino , Neoplasias da Mama/terapia , Mão de Obra em Saúde/estatística & dados numéricos
14.
Gan To Kagaku Ryoho ; 49(11): 1200-1204, 2022 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-36412020

RESUMO

Chronic kidney disease(CKD)associated with cancer and its treatment affects life after cancer treatment. There is inconclusive opinion on whether CKD treatment in survivors after cancer treatment needs special care differently than in the general population with CKD. Several topics were discussed by nephrologists, urologists and medical oncologists, pediatricians, pharmaceutical specialists, and others based on the results of a literature search, and the consensus was documented in the "Clinical Practice Guidelines for the Management for Kidney Injury During Anticancer Drug Therapy, 2022". The prevalence of CKD among adult cancer survivors is reported to be 4-7%. The characteristics include(1)elderly and physically impaired patients(, 2)a high risk of cancer recurrence, and(3)frequently cancer treatment-related CKD. Although there are no cancer survivor-specific indications or contraindications in the selection of renal replacement therapy, renal transplantation is often preferred in pediatric cancer survivors. It was determined that it is not appropriate to recommend or not recommend the administration of erythropoietin stimulating agents for renal anemia in cancer survivors based on a systematic review and discussion between panelists. When used in individual cases, its application should be well examined and consideration should be given to avoiding high hemoglobin level and to monitoring for cancer development.


Assuntos
Sobreviventes de Câncer , Neoplasias , Oncologistas , Insuficiência Renal Crônica , Adulto , Idoso , Humanos , Criança , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Sobreviventes , Consenso , Neoplasias/complicações , Neoplasias/terapia
16.
Ann Palliat Med ; 11(11): 3542-3554, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36366900

RESUMO

BACKGROUND AND OBJECTIVE: Several professional societies have recommended incorporating palliative care into routine oncology care, yet palliative care remains underutilized among women with gynecologic cancers. This narrative review highlights current evidence regarding utilization of palliative care in gynecologic oncology care. Additionally, the authors offer recommendations to increase early integration and utilization of palliative care services, improve education for current and future gynecologic oncology providers, and expand the palliative care workforce. METHODS: The authors reviewed studies of palliative care interventions in oncology settings, with an emphasis on studies that included women with gynecologic malignancies. A panel of author/experts were gathered for a semi-structured interview to discuss the future of palliative care in gynecologic cancer care. The interview was recorded and reviewed to highlight themes. KEY CONTENT AND FINDINGS: Data supports routine integration of palliative care into gynecologic oncology practice. To expand delivery of palliative care, additional research that investigates implementation of palliative care across different healthcare settings is needed. There is a shortage of palliative care providers in the United States. Therefore, it is critical for gynecologic oncologists to receive a robust education in primary palliative care skillsets. Additionally, to expand the specialty palliative care workforce, palliative medicine leaders should recruit more gynecologic oncologists and other surgeons into palliative care fellowship programs. CONCLUSIONS: Expanded utilization of palliative care offers an opportunity to improve quality of care and outcomes for women with gynecologic cancers.


Assuntos
Neoplasias dos Genitais Femininos , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Oncologistas , Feminino , Humanos , Cuidados Paliativos , Neoplasias dos Genitais Femininos/terapia , Oncologia/educação
17.
J Womens Health (Larchmt) ; 31(11): 1519-1525, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36356183

RESUMO

Background: Treatment by a gynecologic oncologist is an important part of ovarian cancer care; however, implementation strategies are needed to increase care by these specialists. We partnered with National Comprehensive Cancer Control Programs in Iowa, Michigan, and Rhode Island in a demonstration project to deepen the evidence base for promising strategies that would facilitate care for ovarian cancer by gynecologic oncologists. Methods: Five main implementation strategies (increase knowledge/awareness; improve models of care; improve payment structures; increase insurance coverage; enhance workforce) were identified in the literature and used to develop initiatives. Specific activities were chosen by state programs according to feasibility and needs. Results: Activities included: (1) qualitative interviews with patients to determine barriers to receipt of specialized care; (2) development of patient/provider educational materials; (3) creation of patient/provider checklists to facilitate appropriate referrals; (4) expansion of a toll-free patient navigation hotline for ovarian cancer patients; (5) training of the health care workforce. The programs developed resources (educational handouts, toolkits, 2 webinars, 2 podcasts); trained 167 medical and nursing students during 8 Survivors Teaching Students® workshops; and conducted 3 provider education sessions reaching 362 providers in 45 states. Evaluations showed increases in providers' knowledge, awareness, abilities, and intentions to refer ovarian cancer patients to a gynecologic oncologist. Conclusion: The state program resources we discussed are available for other cancer control programs interested in initiating or expanding activities to improve access/referrals to gynecologic oncologists for ovarian cancer care. They serve as a valuable repository for public health professionals seeking to implement similar interventions.


Assuntos
Oncologistas , Neoplasias Ovarianas , Humanos , Feminino , Estados Unidos , Carcinoma Epitelial do Ovário , Neoplasias Ovarianas/prevenção & controle , Encaminhamento e Consulta , Centers for Disease Control and Prevention, U.S.
18.
JCO Glob Oncol ; 8: e2200138, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36332171

RESUMO

PURPOSE: In the Philippines, a lower middle-income country in Southeast Asia, 6 of 10 Filipinos die without seeing a doctor. To ensure universal access to cancer care, providers must be equitably distributed. Therefore, we evaluated the distribution of oncologists across all 17 regions in the Philippines. METHODS: We gathered data from the official websites of national medical societies on their members' regional area of practice: Philippine Society of Medical Oncology, Philippine Radiation Oncology Society, Surgical Oncology Society of the Philippines, Society of Gynecologic Oncologists of the Philippines, and Philippine Society of Hospice and Palliative Medicine. We compared this with the regional census to determine the number of board-certified oncologists per 100,000 Filipinos. RESULTS: For a population of almost 110 million, the Philippines has a total of 348 medical oncologists, 164 surgical oncologists, 99 radiation oncologists, 142 gynecologic oncologists, and 35 hospice and palliative medicine (HPM) specialists. This translates to 0.32 medical oncologists, 0.15 surgical oncologists, 0.09 radiation oncologists, 0.13 gynecologic oncologists, and 0.03 HPM specialists for every 100,000 Filipinos. The number of oncologists is highest in the National Capital Region in Luzon and lowest in the Bangsamoro Autonomous Region in Muslim Mindanao. All regions have at least one medical and gynecologic oncologist. Two regions (12%) have no surgical oncologists, five regions (29%) have no radiation oncologists, and eight regions (47%) have no HPM specialists. CONCLUSION: Efforts are needed to increase the number of oncologists and improve equity in their distribution to ensure universal access to cancer care in the Philippines.


Assuntos
Neoplasias , Oncologistas , Medicina Paliativa , Feminino , Humanos , Filipinas/epidemiologia , Oncologia , Radio-Oncologistas , Neoplasias/epidemiologia , Neoplasias/terapia
19.
BMC Cancer ; 22(1): 1109, 2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-36316675

RESUMO

BACKGROUND: Most patients with cancer and their caregivers desire honest, clear prognostic communication, yet oncologists often disclose prognosis inconsistently. Prognostic communication becomes even more challenging when disease progression is unclear or equivocal. Presently, oncologist approaches for discussing uncertain disease findings are poorly understood. METHODS: In this prospective, longitudinal study, we audio-recorded serial disease reevaluation conversations between children with high-risk cancer, their families, and their primary oncologists over 24 months and conducted content analysis at recorded timepoints when oncologists categorized disease progression as equivocal. RESULTS: Of the 265 medical discussions recorded across the illness course for 33 patient-parent dyads, a total of 40 recorded discussions took place at equivocal timepoints, comprising > 500 min of medical dialogue. Prognosis talk encompassed < 3% of dialogue and was absent in nearly half of equivocal discussions (17/40, 42.5%). Curability statements were identified in only two conversations. Inductive content analysis of dialogue revealed four distinct patterns for communicating equivocal disease status: (1) up-front reassurance, (2) softening the message, (3) describing possible disease progression without interpretation, (4) expressing uncertainty without discussing the bigger picture. CONCLUSION: Oncologists rarely discuss prognosis with children with high-risk cancer and their families at timepoints when disease progression is not definitive. Formal guidance is needed to better support oncologists in navigating uncertainty while sharing honest, person- and family-centered information about prognosis.


Assuntos
Neoplasias , Oncologistas , Relações Médico-Paciente , Revelação da Verdade , Criança , Humanos , Comunicação , Progressão da Doença , Estudos Longitudinais , Neoplasias/diagnóstico , Neoplasias/terapia , Estudos Prospectivos , Incerteza , Prognóstico
20.
JAMA Netw Open ; 5(11): e2239766, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36318206

RESUMO

Importance: The expanded access (EA) pathway permits patients to be treated with investigational medical products outside clinical trials. Because cancer care is a common indication for which EA is sought and these efforts require physician management, understanding oncologists' perspectives can help illuminate factors influencing patient access. Objective: To learn how oncologists practicing at academic medical centers (AMCs) perceive EA and their role in offering it. Design, Setting, and Participants: This qualitative study used data from semistructured interviews conducted from February 2020 to September 2021 with a purposive sample of oncologists recruited from large, urban AMCs in the northeast United States. Oncologists who had submitted at least 1 single-patient EA request to the institutional review boards at the University of Pennsylvania, Children's Hospital of Philadelphia, NYU Langone Health, and Dana-Farber Cancer Institute from January 1, 2014, through January 31, 2020, were eligible to participate. Data were analyzed from July 2021 to March 2022. Main Outcomes and Measures: Interviews focused on oncologist practice demographics, experience with EA, factors relevant to decisions to pursue EA and comfort with those decisions, perspectives on oncologists' role in EA, perspectives on the FDA's role, and the Right to Try pathway to access investigational drugs. Results: Eligible oncologists were interviewed until thematic saturation was reached, resulting in 25 interviews; most participants were women (15 participants [60%]), reported primarily treating adult patients (15 participants [60%]), had more than 10 years of clinical experience (16 participants [64%]), and had submitted at least 2 single-patient EA requests to their institutional review boards during the relevant period (14 participants [56%]). Oncologists viewed EA as an important tool for securing what they determined to be the best treatment option for their patients based on their own expert assessment of available data. Interviewees reported that they would rather access interventions as commercially available products or through clinical trials; however, if the preferred option was not available through these means, they viewed pursuit of EA as part of their obligation to patients, while often recognizing the potential for inequities in the broader patient population beyond their institutions. Participating oncologists felt confident pursuing investigational drugs for treatment use, despite the absence of FDA marketing approval, and did not necessarily view EA as a last resort. Conclusions and Relevance: These findings indicate that oncologists practicing in large academic settings sought to treat patients with the interventions they deemed most likely to be beneficial, regardless of approval status. As such, they viewed EA as an unexceptional means to obtain promising products, although it remains unclear whether their confidence in evaluating investigational treatments was justified. Future research should examine whether oncologists outside large AMCs share this confidence, as differences may influence patient access to the EA treatment pathway.


Assuntos
Drogas em Investigação , Oncologistas , Adulto , Criança , Humanos , Feminino , Masculino , Ensaios de Uso Compassivo , Organizações , Projetos de Pesquisa
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