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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.
Front Public Health ; 9: 677915, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34660505

RESUMO

Objectives: The purpose of this study was to provide a scoping review on how to address and mitigate burnout in the profession of clinical oncology. Also, it examines how artificial intelligence (AI) can mitigate burnout in oncology. Methods: We searched Ovid Medline, PubMed, Scopus, and Web of Science, for articles that examine how to address burnout in oncology. Results: A total of 17 studies were found to examine how burnout in oncology can be mitigated. These interventions were either targeted at individuals (oncologists) or organizations where the oncologists work. The organizational interventions include educational (psychosocial and mindfulness-based course), art therapies and entertainment, team-based training, group meetings, motivational package and reward, effective leadership and policy change, and staff support. The individual interventions include equipping the oncologists with adequate training that include-communication skills, well-being and stress management, burnout education, financial independence, relaxation, self-efficacy, resilience, hobby adoption, and work-life balance for the oncologists. Similarly, AI is thought to be poised to offer the potential to mitigate burnout in oncology by enhancing the productivity and performance of the oncologists, reduce the workload and provide job satisfaction, and foster teamwork between the caregivers of patients with cancer. Discussion: Burnout is common among oncologists and can be elicited from different types of situations encountered in the process of caring for patients with cancer. Therefore, for these interventions to achieve the touted benefits, combinatorial strategies that combine other interventions may be viable for mitigating burnout in oncology. With the potential of AI to mitigate burnout, it is important for healthcare providers to facilitate its use in daily clinical practices. Conclusion: These combinatorial interventions can ensure job satisfaction, a supportive working environment, job retention for oncologists, and improved patient care. These interventions could be integrated systematically into routine cancer care for a positive impact on quality care, patient satisfaction, the overall success of the oncological ward, and the health organizations at large.


Assuntos
Esgotamento Profissional , Oncologistas , Inteligência Artificial , Esgotamento Profissional/prevenção & controle , Humanos , Satisfação no Emprego , Oncologia
3.
PLoS One ; 16(10): e0257794, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34705826

RESUMO

RATIONALE: Implicit racial bias affects many human interactions including patient-physician encounters. Its impact, however, varies between studies. We assessed the effects of physician implicit, racial bias on their management of cancer-related pain using a randomized field experiment. METHODS: We conducted an analysis of a randomized field experiment between 2012 and 2016 with 96 primary care physicians and oncologists using unannounced, Black and White standardized patients (SPs)who reported uncontrolled bone pain from metastatic lung cancer. We assessed implicit bias using a pain-adaptation of the race Implicit Association Test. We assessed clinical care by reviewing medical records and prescriptions, and we assessed communication from coded transcripts and covert audiotapes of the unannounced standardized patient office visits. We assessed effects of interactions of physicians' implicit bias and SP race with clinical care and communication outcomes. We conducted a slopes analysis to examine the nature of significant interactions. RESULTS: As hypothesized, physicians with greater implicit bias provided lower quality care to Black SPs, including fewer renewals for an indicated opioid prescription and less patient-centered pain communication, but similar routine pain assessment. In contrast to our other hypotheses, physician implicit bias did not interact with SP race for prognostic communication or verbal dominance. Analysis of the slopes for the cross-over interactions showed that greater physician bias was manifested by more frequent opioid prescribing and greater discussion of pain for White SPs and slightly less frequent prescribing and pain talk for Black SPs with the opposite effect among physicians with lower implicit bias. Findings are limited by use of an unvalidated, pain-adapted IAT. CONCLUSION: Using SP methodology, physicians' implicit bias was associated with clinically meaningful, racial differences in management of uncontrolled pain related to metastatic lung cancer. There is favorable treatment of White or Black SPs, depending on the level of implicit bias.


Assuntos
Dor do Câncer/epidemiologia , Neoplasias/epidemiologia , Médicos de Atenção Primária/ética , Racismo/ética , Afro-Americanos/psicologia , Analgésicos Opioides/uso terapêutico , Atitude do Pessoal de Saúde , Dor do Câncer/tratamento farmacológico , Dor do Câncer/etiologia , Dor do Câncer/patologia , Grupos de Populações Continentais/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Oncologistas , Relações Médico-Paciente/ética , Médicos/ética , Médicos/psicologia , Médicos de Atenção Primária/psicologia , Racismo/psicologia , Inquéritos e Questionários
4.
BMJ Open ; 11(10): e049259, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34615676

RESUMO

OBJECTIVE: Cancer survival rates have improved over the past few decades, yet socioeconomic disparities persist. Social determinants of health (SDOH) have consistently been shown to correlate with health outcomes. The objective of this study was to characterise oncologists' perceptions of the impact of SDOH on their patients, and their opinions on how these effects could be remediated. DESIGN: Cross-sectional survey of physicians. SETTING: Web-based survey completed prior to live meetings held between February and April 2020. PARTICIPANTS: Oncologists/haematologists from across the USA. EXPOSURE: Clinical practice in a community-based or hospital-based setting. MAIN OUTCOME AND MEASURE: Physician responses regarding how SDOH affected their patients, which factors represented the most significant barriers to optimal health outcomes and how the impact of SDOH could be mitigated through assistance programmes. RESULTS: Of the 165 physicians who completed the survey, 93% agreed that SDOH had a significant impact on their patients' health outcomes. Financial security/lack of insurance and access to transportation were identified most often as the greatest barriers for their patients (83% and 58%, respectively). Eighty-one per cent of physicians indicated that they and their staff had limited time to spend assisting patients with social needs, and 76% reported that assistance programmes were not readily accessible. Government organisations, hospitals, non-profit organisations and commercial payers were selected by 50% or more of oncologists surveyed as who should be responsible for delivering assistance programmes to patients with social needs; 42% indicated that pharmaceutical manufacturers should also be responsible. CONCLUSION: Our survey found that most oncologists were aware of the impact of SDOH on their patients but were constrained in their time to assist patients with social needs. The physicians in our study identified a need for more accessible assistance programmes and greater involvement from all stakeholders in addressing SDOH to improve health outcomes.


Assuntos
Neoplasias , Oncologistas , Médicos , Estudos Transversais , Humanos , Neoplasias/terapia , Determinantes Sociais da Saúde
5.
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
6.
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
7.
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
8.
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
9.
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
10.
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
11.
BMC Palliat Care ; 20(1): 142, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521393

RESUMO

BACKGROUND: There is a need for more insight into how to address challenges of information-provision for women with advanced breast cancer. We aimed to explore oncologists' and patients' views on (i) the challenges of information-provision, and (ii) possible strategies to address these challenges, meanwhile (iii) exploring the possible facilitating role of positive expectations and empathy. METHODS: Semi-structured interviews were held with oncologists (n = 10) and women with advanced breast cancer (n = 14). Principles of Thematic Analysis were followed, with two researchers analyzing transcribed data, supported by Atlas.ti software. RESULTS: Taken together the data from oncologists and patients, we found that when communicating with patients with advanced cancer, oncologists face challenges, including handling patients' unrealistic disease (status) beliefs, and choosing approaches for discussing available treatment options and their side effects. Possible strategies to address these challenges include balancing information with acceptance of denial, and using medical expertise to guide treatment discussions. A sensitive issue is whether to discuss the option of no anti-cancer treatment. Meanwhile, approaches and preferences for discussions of side effects vary. Positive expectations and empathy can facilitate information-provision by creating space and helping patients to open up more. CONCLUSIONS: Integrating oncologists' and patients' views, oncologists can provide realistic information while also, temporarily, accepting denial, and can use their medical expertise to address challenges around unrealistic beliefs and discussion of treatment options. Finding ways to tailor discussions of no anti-cancer treatment and side-effect information are needed. Positive expectations and empathy might facilitate - tailored - information-provision, leading ultimately to patient-centered care lying at the heart of medicine.


Assuntos
Neoplasias da Mama , Neoplasias , Oncologistas , Neoplasias da Mama/terapia , Comunicação , Empatia , Feminino , Humanos , Relações Médico-Paciente , Pesquisa Qualitativa
12.
BMC Cancer ; 21(1): 1036, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530765

RESUMO

BACKGROUND: Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists' discussions with patients about these costs. METHODS: We searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument. RESULTS: Twenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden. CONCLUSIONS: Current clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients' ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.


Assuntos
Comunicação , Efeitos Psicossociais da Doença , Neoplasias/economia , Oncologistas , Relações Médico-Paciente , Guias de Prática Clínica como Assunto/normas , Estresse Financeiro/diagnóstico , Estresse Financeiro/terapia , Custos de Cuidados de Saúde , Humanos , Neoplasias/terapia , Sociedades Médicas
13.
Oncology ; 99(11): 722-731, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34515198

RESUMO

Interventional oncology plays a major role within modern oncological patient management. Image-guided thermal ablation has been recognized as a successful local therapeutic option in patients with primary and secondary malignant liver diseases, as also recalled by the recent European Society of Medical Oncology (ESMO) guidelines on colorectal metastases. As image-guided treatments may be as effective as surgery in selected patients with liver lesions, the clinical oncologist should be familiar with the indications, risks, and technical aspects of liver ablation in order to provide their patients with the best outcomes. This article provides a broad overview of the most commonly used ablation techniques and highlights the most relevant technical aspects such as the ideal setting in the operating theatre; which image-guided methods are available, including the growing application of fusion imaging; or contrast-enhanced ultrasound for guiding/monitoring the procedure. A further aim is to expand the knowledge among medical oncologists about liver ablation procedures and to provide insights into the future perspectives of percutaneous minimally invasive procedures in the liver.


Assuntos
Criocirurgia/métodos , Eletroporação/métodos , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Hipertermia Induzida/métodos , Neoplasias Hepáticas/cirurgia , Oncologistas , Ablação por Radiofrequência/métodos , Cirurgia Assistida por Computador/métodos , Terapia Combinada/métodos , Humanos , Oncologia Cirúrgica/métodos , Resultado do Tratamento
14.
J Med Internet Res ; 23(9): e30549, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34499046

RESUMO

Electronic patient-reported outcome (ePRO) systems for symptom monitoring in patients with cancer have shown quality of life and survival benefits in controlled trials. They are beginning to be used in routine oncology practice. Many software developers provide software solutions for clinicians, but how should clinicians decide which system to use? We propose a synthesis of the main questions regarding the effectiveness, safety, and functionality of an ePRO system that a clinician should ask software providers to assist in the selection of a software product in order to obtain the best value tools for their patients and their practice.


Assuntos
Neoplasias , Oncologistas , Eletrônica , Humanos , Neoplasias/terapia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida
15.
Lancet Oncol ; 22(10): 1367-1377, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34560006

RESUMO

BACKGROUND: The WHO Essential Medicines List (EML) identifies priority medicines that are most important to public health. Over time, the EML has included an increasing number of cancer medicines. We aimed to investigate whether the cancer medicines in the EML are aligned with the priority medicines of frontline oncologists worldwide, and the extent to which these medicines are accessible in routine clinical practice. METHODS: This international, cross-sectional survey was developed by investigators from a range of clinical practice settings across low-income to high-income countries, including members of the WHO Essential Medicines Cancer Working Group. A 28-question electronic survey was developed and disseminated to a global network of oncologists in 89 countries and regions by use of a hierarchical snowball method; each primary contact distributed the survey through their national and regional oncology associations or personal networks. The survey was open from Oct 15 to Dec 7, 2020. Fully qualified physicians who prescribe systemic anticancer therapy to adults were eligible to participate in the survey. The primary question asked respondents to select the ten cancer medicines that would provide the greatest public health benefit to their country; subsequent questions explored availability and cost of cancer medicines. Descriptive statistics were used to compare access to medicines between low-income and lower-middle-income countries, upper-middle-income countries, and high-income countries. FINDINGS: 87 country-level contacts and two regional networks were invited to participate in the survey; 46 (52%) accepted the invitation and distributed the survey. 1697 respondents opened the survey link; 423 were excluded as they did not answer the primary study question and 326 were excluded because of ineligibility. 948 eligible oncologists from 82 countries completed the survey (165 [17%] in low-income and lower-middle-income countries, 165 [17%] in upper-middle-income countries, and 618 [65%] in high-income countries). The most commonly selected medicines were doxorubicin (by 499 [53%] of 948 respondents), cisplatin (by 470 [50%]), paclitaxel (by 423 [45%]), pembrolizumab (by 414 [44%]), trastuzumab (by 402 [42%]), carboplatin (by 390 [41%]), and 5-fluorouracil (by 386 [41%]). Of the 20 most frequently selected high-priority cancer medicines, 19 (95%) are currently on the WHO EML; 12 (60%) were cytotoxic agents and 13 (65%) were granted US Food and Drug Administration regulatory approval before 2000. The proportion of respondents indicating universal availability of each top 20 medication was 9-54% in low-income and lower-middle-income countries, 13-90% in upper-middle-income countries, and 68-94% in high-income countries. The risk of catastrophic expenditure (spending >40% of total consumption net of spending on food) was more common in low-income and lower-middle-income countries, with 13-68% of respondents indicating a substantial risk of catastrophic expenditures for each of the top 20 medications in lower-middle-income countries versus 2-41% of respondents in upper-middle-income countries and 0-9% in high-income countries. INTERPRETATION: These data demonstrate major barriers in access to core cancer medicines worldwide. These findings challenge the feasibility of adding additional expensive cancer medicines to the EML. There is an urgent need for global and country-level policy action to ensure patients with cancer globally have access to high priority medicines. FUNDING: None.


Assuntos
Antineoplásicos/provisão & distribuição , Medicamentos Essenciais/provisão & distribuição , Saúde Global , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Oncologistas , Adulto , Antineoplásicos/economia , Estudos Transversais , Custos de Medicamentos , Medicamentos Essenciais/economia , Feminino , Saúde Global/economia , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade
17.
Ann Palliat Med ; 10(10): 10293-10312, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34412494

RESUMO

BACKGROUND: Palliative care evidently increases the quality of life among the patients with advanced cancer. However, there are very few studies on the aspects of the physicians' ideas, conceptions, or the effects of their ideas in palliative care quality, especially in Asian countries. This study aimed to evaluate the conception and perspective on palliative care in Thai gynecologic oncologists. METHODS: The online survey was distributed to all certificated Thai gynecologic oncologists. The survey could be accessed via working email address, hyperlink, or QR code during May 2020 and January 2021. A 5-point Likert scale captured the perspectives and concepts of palliative care. The association between respondents' characteristics and their choices of content in palliative care, together with their decision making in specified clinical scenarios was analyzed. RESULTS: A total of 207 completed surveys from 320 Thai gynecologic oncologists were received (64.69% participation rate). They prospected a willingness to give the advices to both patients and their families (85.50%), and strongly agreed to introduce palliative care in any stage of cancer at the time of diagnosis (75.80%). The numbers of their palliative cases per year were 5-20 (57.97%) and the palliative care teams were available in their hospitals. They decided to offer early palliative care and do-not-resuscitate, especially for the elders, or patients with advance stages, or recurrent disease. We found that gynecologic oncologists who previously experienced a palliative care training did not show any difference in decision making in specified clinical scenarios, compared with who did not. CONCLUSIONS: Thai gynecologic oncologists responded to the conceptions and perspectives in palliative care. Their concepts of early and willingness to offer a palliative care especially in the elders, advanced stage, or recurrent patients were proven, regardless of the experience in palliative care training.


Assuntos
Oncologistas , Cuidados Paliativos , Idoso , Atitude do Pessoal de Saúde , Feminino , Humanos , Qualidade de Vida , Tailândia
18.
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
19.
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
20.
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
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