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1.
Rinsho Ketsueki ; 63(8): 928-933, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36058864

RESUMO

After a long-term hospitalization following a ski accident in college, I decided to choose a specialty in hematology and oncology. In graduate school, after learning the basics of biostatistics and the methodology of clinical trials, I had the opportunity to go through a series of clinical trial tasks, from launching to writing a clinical study report, which led to the study drug approval. This has greatly motivated me to be actively involved in this field. At the Dana-Farber Cancer Institute, I studied outcomes research under a supervisor, and at a time of difficulty, my good role model, Dr. Stephanie Lee, had urged me, saying, "That which does not kill you makes you stronger." Subsequently, I devoted myself to the establishment of a data center for a Japanese pediatric leukemia/lymphoma study group, currently a subcommittee of the Japan Children's Cancer Group, and to develop an academic research organization for conducting ICH-GCP-compliant international clinical trials, including the originally developed EDC system. I was struggling in balancing work and parenting. Fortunately, I was supported by my encounters with respectable people.


Assuntos
Hematologia , Oncologistas , Criança , Aprovação de Drogas , Humanos , Oncologia , Controle de Qualidade
3.
Int J Mol Sci ; 23(15)2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35955851

RESUMO

In intermediate risk hormone receptor (HR) positive, HER2 negative breast cancer (BC), the decision regarding adjuvant chemotherapy might be facilitated by multigene expression tests. In all, 142 intermediate risk BCs were investigated using the PAM50-based multigene expression test Prosigna® in a prospective multicentric study. In 119/142 cases, Prosigna® molecular subtyping was compared with local and two central (C1 and C6) molecular-like subtypes relying on both immunohistochemistry (IHC; HRs, HER2, Ki-67) and IHC + tumor grade (IHC+G) subtyping. According to local IHC, 35.4% were Luminal A-like and 64.6% Luminal B-like subtypes (local IHC+G subtype: 31.9% Luminal A-like; 68.1% Luminal B-like). In contrast to local and C1 subtyping, C6 classified >2/3 of cases as Luminal A-like. Pairwise agreement between Prosigna® subtyping and molecular-like subtypes was fair to moderate depending on molecular-like subtyping method and center. The best agreement was observed between Prosigna® (53.8% Luminal A; 44.5% Luminal B) and C1 surrogate subtyping (Cohen's kappa = 0.455). Adjuvant chemotherapy was suggested to 44.2% and 88.6% of Prosigna® Luminal A and Luminal B cases, respectively. Out of all Luminal A-like cases (locally IHC/IHC+G subtyping), adjuvant chemotherapy was recommended if Prosigna® testing classified as Prosigna® Luminal A at high / intermediate risk or upgraded to Prosigna® Luminal B.


Assuntos
Neoplasias da Mama , Oncologistas , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/genética , Neoplasias da Mama/metabolismo , Quimioterapia Adjuvante , Feminino , Humanos , Imuno-Histoquímica , Estudos Prospectivos , Receptor ErbB-2/genética
4.
JAMA Netw Open ; 5(8): e2228524, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-36001314

RESUMO

Importance: Randomized clinical trial data have demonstrated that omission of surgical axillary evaluation does not affect overall survival in women 70 years and older with early-stage (clinical tumor category 1 [cT1] with node-negative [N0] disease) hormone receptor (HR)-positive and erb-B2 receptor tyrosine kinase 2 (ERBB2; formerly HER2)-negative breast cancer. Therefore, the Choosing Wisely initiative has recommended against routine use of sentinel lymph node biopsy (SLNB) in this population; however, retrospective data have revealed that more than 80% of patients eligible for SLNB omission still undergo the procedure. Multidisciplinary factors involved in these patterns remain unclear. Objective: To describe surgical, medical, and radiation oncologists' perspectives on omission of SLNB in women 70 years and older with cT1N0 HR-positive, ERBB2-negative breast cancer. Design, Setting, and Participants: This qualitative study used in-depth semi-structured interviews to explore the factors involved in oncologists' perspectives on providing care to older women who were eligible for SLNB omission. Purposive snowball sampling was used to recruit a sample of surgical, medical, and radiation oncologists representing a wide range of practice types and number of years in practice in the US and Canada. A total of 29 oncologists who finished training and were actively treating patients with breast cancer were interviewed. Interviews were conducted between March 1, 2020, and January 17, 2021. Main Outcomes and Measures: Recordings from semi-structured interviews were transcribed and deidentified. Thematic analysis was used to identify emergent themes. Results: Among 29 physicians (16 women [55.2%] and 13 men [44.8%]) who participated in interviews, 16 were surgical oncologists, 6 were medical oncologists, and 7 were radiation oncologists. Data on race and ethnicity were not collected. Participants had a range of experience (median [range] years in practice, 12.0 [0.5-30.0]) and practice types (14 academic [48.3%], 7 community [24.1%], and 8 hybrid [27.6%]). Interviews revealed that the decision to omit SLNB was based on nuanced patient- and disease-level factors. Wide variation was observed in oncologists' perspectives on SLNB omission recommendations and supporting data. In addition, participants' statements suggested that the multidisciplinary nature of cancer care may increase oncologists' anxiety regarding SLNB omission. Conclusions and Relevance: In this study, findings from interviews revealed that oncologists' perspectives may have implications for the largely unsuccessful deimplementation of SLNB in women 70 years and older with cT1N0 HR-positive, ERBB2-negative breast cancer. Interventions aimed at educating physicians, improving patient-physician communication, and facilitating preoperative multidisciplinary conversations may help to successfully decrease SLNB rates in this patient population.


Assuntos
Oncologistas , Neoplasias de Mama Triplo Negativas , Idoso , Axila , Feminino , Humanos , Masculino , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela
5.
Curr Oncol ; 29(8): 5579-5584, 2022 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-36005178

RESUMO

Pediatric oncologists have the privilege of caring for children and families facing serious, often life-threatening, illnesses. Providing this care is emotionally demanding and associated with significant risks of stress and burnout for oncologists. Traditional approaches to physician burnout and wellbeing have not emphasized the potential roles of education and training in mitigating this stress. In this commentary, we discuss the contribution that education, particularly in the areas of palliative and psychosocial oncology, can make in preparing oncologists for the work that they do. We argue that by adequately providing oncologists with the skills they need for their work, we can reduce their risk of burning out. We also discuss the importance of paying attention to hidden and formal curricula to ensure that messages provided in formal education programs are supported by informal training experiences.


Assuntos
Neoplasias , Oncologistas , Criança , Currículo , Humanos , Oncologia , Neoplasias/terapia , Cuidados Paliativos/psicologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-35960291

RESUMO

The paper considers issue of professional burnout of oncologists through the prism of their relationship with patients and their close relatives. The study was carried out using direct and online sociological survey method. The sample included 534 specialists being in constant contact with cancer patients. The results revealed pronounced prevalence of such main burnout domains as emotional exhaustion (55%), depersonalization (19%), reduction of professional achievements (22%). The most common methods of dealing with stress were recreation, sports, communication with immediate relatives, hobbies, walking (7-20%), 4% used alcohol. The high frequency of patient requests to oncologist for psychological support (88%) was established as well as difficulties in communication between doctor and patient because available communication skills are not always sufficient for 76% of oncologists. The majority of respondents support idea of patient need for psychological support and its effectiveness for their treatment and physical and emotional conditions. The similar trends were found in case of close relatives of patients. At the same time some oncologists expressed negative, stigmatizing attitudes towards patients in need of psychological support that requires additional educational work. In oncologists, even when need for psychological support is expressed by patient, willingness to seek it is low: a third of respondents are "rather not ready" to see psychologist even if they had this opportunity. The results meet data of other researches data and reveal that interaction with patients and their relatives is one of the main factors affecting the emotional state of oncologists. Based on study results as well as on publication analysis, comprehensive solution was proposed to implement psychological oncologic service in Russia, which, on one hand, will allow to provide support to cancer patients and their relatives, and on the other hand, will conduct specific training for oncologists concerning skills of psychologically safe communication with patients and coping with negative experiences.


Assuntos
Esgotamento Profissional , Neoplasias , Oncologistas , Esgotamento Profissional/epidemiologia , Emoções , Humanos , Neoplasias/terapia , Oncologistas/psicologia , Inquéritos e Questionários
7.
Cancer Treat Rev ; 109: 102442, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35932549

RESUMO

Radiotherapy is a linchpin in head and neck squamous cell carcinoma (HN-SCC) treatment. Modulating tumour and/or normal tissue biology offers opportunities to further develop HN-SCC radiotherapy. The microbiota, which can exhibit homeostatic properties and be a modulator of immunity, has recently received considerable interest from the Oncology community. Microbiota research in head and neck oncology has also flourished. However, available data are difficult to interpret for clinical and radiation oncologists. In this review, we focus on how microbiota research can contribute to the improvement of radiotherapy for HN-SCC, focusing on how current and future research can be translated back to the clinic. We include in-depth discussions about the microbiota, its multiple habitats and relevance to human physiology, mechanistic interactions with HN-SCC, available evidence on microbiota and HNC oncogenesis, efficacy and toxicity of treatment. We discuss clinically-relevant areas such as the role of the microbiota as a predictive and prognostic biomarker, as well as the potential of leveraging the microbiota and its interactions with immunity to improve treatment results. Importantly, we draw parallels with other cancers where research is more mature. We map out future directions of research and explain clinical implications in detail.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Microbiota , Oncologistas , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Resultado do Tratamento
8.
J Neurooncol ; 159(2): 233-242, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35913556

RESUMO

INTRODUCTION: Supratotal resection (SpTR) of glioblastoma may be associated with improved survival, but published results have varied in part from lack of consensus on the definition and appropriate use of SpTR. A previous small survey of neurosurgical oncologists with expertise performing SpTR found resection 1-2 cm beyond contrast enhancement was an acceptable definition and glioblastoma involving the right frontal and bilateral anterior temporal lobes were considered most amenable to SpTR. The general neurosurgical oncology community has not yet confirmed the practicality of this definition. METHODS: Seventy-six neurosurgical oncology members of the AANS/CNS Tumor Section were surveyed, representing 34.0% of the 223 members who were administered the survey. Participants were presented with 11 definitions of SpTR and rated each definition's appropriateness. Participants additionally reviewed magnetic resonance imaging for 10 anatomically distinct glioblastomas and assessed the tumor location's eloquence, perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans. RESULTS: Most neurosurgeons surveyed agree that gross total plus resection of some non-contrast enhancement (n = 57, 80.3%) or resection 1-2 cm beyond contrast enhancement (n = 52, 73.2%) are appropriate definitions for SpTR. Cases were divided into three anatomically distinct groups by perceived equipoise between gross total and SpTR. The best clinical trial candidates were thought to be right anterior temporal (n = 58, 76.3%) and right frontal (n = 55, 73.3%) glioblastomas. CONCLUSION: Support exists among neurosurgical oncologists with varying familiarity performing SpTR to adopt the proposed consensus definition of SpTR of glioblastoma and to potentially investigate the utility of SpTR to treat right anterior temporal and right frontal glioblastomas in a clinical trial. A smaller proportion of general neurosurgical oncologists than SpTR experts would personally treat a left anterior temporal glioblastoma with SpTR.


Assuntos
Neoplasias Encefálicas , Glioblastoma , Oncologistas , Neoplasias Encefálicas/cirurgia , Consenso , Glioblastoma/cirurgia , Humanos , Neurocirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários
9.
BMJ Open ; 12(8): e055460, 2022 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-36038175

RESUMO

BACKGROUND: The increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care and the need to find alternative models of care. Shared cancer follow-up care in general practice is a safe option in terms of quality of life and cancer recurrence; however, there are barriers to translating this into practice. This review aimed to identify factors that influence the translation of shared cancer follow-up care into clinical practice. METHODS: Systematic review. Seven electronic databases: MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psychinfo, Health Source: Nursing/Academic Edition and Psychology and Behavioural Sciences Collection, were searched for published papers between January 1999 and December 2021. The narrative review included papers if they were available in full-text, English, peer-reviewed and focused on shared cancer follow-up care. RESULTS: Thirty-eight papers were included in the final review. Five main themes emerged: (1) reciprocal clinical information sharing is needed between oncologists and general practitioners, and needs to be timely and relevant; (2) responsibility of care should be shared with the oncologist overseeing care; (3) general practitioners skills and knowledge to provide cancer follow-up care; (4) need for clinical management guidelines and rapid referral to support general practitioners to provide shared follow-up care and (5) continuity of care and satisfaction of care is vital for shared care. CONCLUSION: The acceptability of shared cancer follow-up care is increasing. Several barriers still exist to translating this into practice. Work is required to develop a shared-care model that can support general practitioners, while the oncologist can oversee the care and implement two-way communication between general and oncologists' clinics. The move towards integrating electronic healthcare records and web-based platforms for information exchange provides a promise to the timely exchange of information. PROSPERO REGISTRATION NUMBER: CRD42020191538.


Assuntos
Clínicos Gerais , Neoplasias , Oncologistas , Assistência ao Convalescente , Humanos , Neoplasias/terapia , Qualidade de Vida/psicologia
10.
Pediatr Blood Cancer ; 69(10): e29891, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35949170

RESUMO

This cross-sectional study evaluated the magnitude of personal payments made by pharmaceutical companies to pediatric hematologist-oncologists (PHOs) board-certified by the Japanese Society of Pediatric Hematology/Oncology (JSPHO), using publicly disclosed data. Among all 307 PHOs, 215 (70.0%) PHOs received $916 703 personal payments from 54 pharmaceutical companies between 2016 and 2019 in total. Median four-year payments per PHO was $1440 (interquartile range, $523-$4015). Payments per PHO significantly increased during the study period, by 23.8% (95% confidence interval: 15.3%-32.8%, P < 0.001) annually. Furthermore, leading PHOs, including university professors, society board members, and clinical practice guideline authors, received far larger personal payments from the companies.


Assuntos
Conflito de Interesses , Oncologistas , Criança , Estudos Transversais , Indústria Farmacêutica , Humanos , Japão , Preparações Farmacêuticas
11.
Anticancer Res ; 42(7): 3743-3751, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35790267

RESUMO

BACKGROUND/AIM: Although clinicians are expected to set a higher threshold for administering adjuvant chemotherapy to older than younger patients with breast cancer, the extent to which older patients are less likely to be offered adjuvant chemotherapy and the medico-social factors that influence decision-making are unclear. PATIENTS AND METHODS: We retrospectively evaluated the correlations of clinicopathological factors, including age (≥75 years vs. <75 years), for all candidates for adjuvant chemotherapy, and of additional medico-social factors, including the number of family members living together, for older patients, with the rate of referral from breast surgeons to medical oncologists. RESULTS: Among 872 candidates for adjuvant chemotherapy, age ≥75 years was significantly correlated with a lower referral rate (24 % vs. 44%, p<0.001). In the analysis by age group, we did not identify specific medicosocial factors that were differentially emphasized, but older patients who lived with ≥2 other family members tended not to be referred to a medical oncologist compared to those who lived alone or with one family member (1/23 vs. 15/47). Although 5 of 22 older patients (23%) who were referred to a medical oncologist actually received adjuvant chemotherapy (vs. 60% of younger patients), all needed treatment modifications. CONCLUSION: Breast surgeons regard age ≥75 years as a key factor for avoiding adjuvant chemotherapy but they also consider similar medico-social factors irrespective of the patient's age regarding the decision to refer patients to medical oncologists.


Assuntos
Neoplasias da Mama , Oncologistas , Idoso , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante , Feminino , Humanos , Estudos Retrospectivos , Fatores Sociais
12.
JCO Glob Oncol ; 8: e2200030, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35802838

RESUMO

PURPOSE: Multidisciplinary molecular tumor boards (MTBs) help in interpreting complex genomic data generated by molecular tumor profiling and improve patients' access to targeted therapies. The purpose of this study was to assess the impact of our institution's MTB on the clinical management of patients with cancer. METHODS: This study was conducted at a tertiary cancer center in India. Cases to be discussed in the MTB were identified by molecular pathologists, scientists, or oncologists. On the basis of the clinical data and molecular test reports, a course of clinical management was recommended and made available to the treating oncologist. We determined the proportion of patients who were recommended a change in the clinical management. We also assessed compliance of the treating oncologists with MTB recommendations. RESULTS: There were 339 discussions for 328 unique patients. The median age of the cohort was 54 years (range 17-87), and the majority of the patients were men (65.1%). Of 339 cases, 133 (39.2%) were recommended continuation of ongoing therapy while the remaining 206 (60.7%) were recommended a change in clinical management. Compliance with MTB recommendations for a change in clinical management was 58.5% (79 of 138 evaluable cases). Compliance and implementation for MTB's recommendation to start a new therapy in 104 evaluable cases were 60.5% and 44.2%, respectively. A total of 248 biopsies had at least one actionable mutation. A total of 646 mutations were identified in the cohort, with EGFR being the most frequently altered gene. CONCLUSION: MTBs help in interpreting results of molecular tests, understanding the significance of molecular abnormalities, and assessing the benefits of available targeted therapies and clinical trials in the management of patients with targetable genetic alterations.


Assuntos
Neoplasias , Oncologistas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Genômica , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Mutação , Neoplasias/tratamento farmacológico , Neoplasias/terapia , Adulto Jovem
13.
Curr Oncol ; 29(7): 4665-4677, 2022 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-35877230

RESUMO

BACKGROUND: Immune checkpoint inhibitor (ICI)-associated hypothalamic-pituitary-adrenal axis disruption can lead to hypocortisolism. This is a life-threatening but difficult to diagnose condition, due to its non-specific symptoms that overlap with symptoms of malignancy. Currently, there is no consensus on how to best screen asymptomatic patients on ICI therapy for hypophysitis with serum cortisol. METHODS: A retrospective chart review of patients treated with ICI in a tertiary care centre was conducted to assess the rate of screening with cortisol and whether this had an impact on diagnosis of ICI-hypophysitis in the preclinical stage. Patients were identified as having hypophysitis with an adrenocorticotropin hormone (ACTH) deficiency based on chart review of patients with cortisol values ≤ 140 nmol/L (≤5 mcg/dL). We also assessed what proportion of cortisol values were drawn at the correct time for interpretation (between 6 AM and 10 AM). RESULTS: Two hundred and sixty-five patients had 1301 cortisol levels drawn, only 40% of which were drawn correctly (between 6 and 10 AM). Twenty-two cases of hypophysitis manifesting with ACTH deficiency were identified. Eight of these patients were being screened with cortisol following treatment and were detected in the outpatient setting. The remaining 14 patients were not screened and were diagnosed when symptomatic, after an emergency room visit or hospital admission. Sixty percent of the cortisol tests were uninterpretable as they were not drawn within the appropriate time window. CONCLUSION: Measuring morning serum cortisol in asymptomatic patients on ICI therapy is a fast and inexpensive way to screen for hypophysitis and should become the standard of care. Random serum cortisol measurement has no clinical value. Education needs to be provided on when to correctly perform the test and how to interpret it and we provide an algorithm for this purpose. The adoption and validation of such an algorithm as part of routine practice could significantly reduce morbidity and mortality in patients, especially as ICI therapy is becoming increasingly commonplace.


Assuntos
Doença de Addison , Hipofisite , Oncologistas , Insuficiência Adrenal , Hormônio Adrenocorticotrópico , Humanos , Hidrocortisona , Hipofisite/induzido quimicamente , Hipofisite/patologia , Sistema Hipotálamo-Hipofisário/patologia , Inibidores de Checkpoint Imunológico , Sistema Hipófise-Suprarrenal/patologia , Estudos Retrospectivos
14.
J Gynecol Oncol ; 33(5): e61, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35882604

RESUMO

OBJECTIVE: The practices pertaining to hereditary breast and ovarian cancer (HBOC) in Japan have been rapidly changing owing to the clinical development of poly(ADP-ribose) polymerase inhibitors, the increasing availability of companion diagnostics, and the broadened insurance coverage of HBOC management from April 2020. A questionnaire of gynecologic oncologists was conducted to understand the current status and to promote the widespread standardization of future HBOC management. METHODS: A Google Form questionnaire was administered to the members of the Japan Society of Gynecologic Oncology. The survey consisted of 25 questions in 4 categories: respondent demographics, HBOC management experience, insurance coverage of HBOC management, and educational opportunities related to HBOC. RESULTS: A total of 666 valid responses were received. Regarding the prevalence of HBOC practice, the majority of physicians responded in the negative and required human resources, information sharing and educational opportunities, and expanded insurance coverage to adopt and improve HBOC practice. Most physicians were not satisfied with the educational opportunities provided so far, and further expansion was desired. They remarked on the psychological burdens of many HBOC managements. Physicians reported these burdens could be alleviated by securing sufficient time to engage in HBOC management, creating easy-to-understand explanatory material for patients, collaboration with specialists in genetic medicine, and educational opportunities. CONCLUSION: Gynecologic oncologists in Japan are struggling to deal with psychological burdens in HBOC practice. To promote the clinical practice of HBOC management, there is an urgent need to strengthen human resources and improve educational opportunities, and expand insurance coverage for HBOC management.


Assuntos
Oncologistas , Neoplasias Ovarianas , Neoplasias da Mama , Carcinoma Epitelial do Ovário , Feminino , Humanos , Japão , Inquéritos e Questionários
15.
Bull Cancer ; 109(9): 938-947, 2022 Sep.
Artigo em Francês | MEDLINE | ID: mdl-35788272

RESUMO

INTRODUCTION: The announcement of the cessation of cancer treatments is a moment unanimously recognized as difficult for oncologists. More rarely analyzed, the announcement of a transfer to palliative care units is just as much. However, understanding the experience of oncologists during this announcement could make it possible to optimize it. MATERIALS AND METHODS: Qualitative, prospective, monocentric study with medical oncologists. Semi-structured interviews with 7 open questions. RESULTS AND DISCUSSION: Twelve interviews were conducted with a sex ratio of seven women for five men and an average age of 41.9 years. Six themes emerge after horizontal analysis of the verbatim and triangulation of the data. The experience of oncologists is dominated by a feeling of guilt, of fear of causing death anxiety in the patient, and of failure and helplessness in in front of a short-term vital risk. There is also a feeling of frustration at not being able to go through with the care. Facing the escape of the disease, oncologists feel resigned. We also observe projections on the part of oncologists with patients and paramedics. Finally, the existential question of death is an omnipresent concern with the feeling of abandoning the patient and a questioning of skills. However, it seems that the collaboration with the mobile palliative care team (EMSP) and the prospect of creating an internal palliative care unit (USP) at the center are perceived as a help.


Assuntos
Neoplasias , Oncologistas , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Neoplasias/terapia , Cuidados Paliativos/métodos , Estudos Prospectivos , Encaminhamento e Consulta
16.
Oncologist ; 27(7): 517, 2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35790115

Assuntos
Oncologistas , Humanos
18.
Ann Surg Oncol ; 29(11): 6497-6500, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35838905

RESUMO

Cancer is emerging as a major public health challenge globally. Recently, IARC (International Association of Research on Cancer) published global cancer burden using GLOBOCAN 2020 estimates for 36 cancers in 185 countries of the world. As per the estimates of the World Health Organization (WHO) in 2019, cancer is the first or second leading cause of death in 112 of 183 countries. The major takeaways of the GLOBOCAN 2020 report relevant to the surgical oncology community include the rising global burden of cancer, global disparity in cancer incidence and mortality in different geographic regions, and the impact of the human development index (HDI) on cancer incidence and projected global cancer burden by 2040. In this article, we discuss the implications of the GLOBOCAN report on future global cancer control strategies and the role of surgical oncologists in the fight against cancer.


Assuntos
Neoplasias , Oncologistas , Oncologia Cirúrgica , Saúde Global , Humanos , Incidência , Neoplasias/epidemiologia , Neoplasias/cirurgia
19.
Br J Radiol ; 95(1138): 20220266, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35856792

RESUMO

The modern management of spinal metastases requires a multidisciplinary approach that includes radiation oncologists, surgeons, medical oncologists, and diagnostic and interventional radiologists. The diagnostic radiologist can play an important role in the multidisciplinary team and help guide assessment of disease and selection of appropriate therapy. The assessment of spine metastases is best performed on MRI, but imaging from other modalities is often needed. We provide a review of the clinical and imaging features that are needed by the multidisciplinary team caring for patients with spine metastases and stress the importance of the spine radiologist taking responsibility for synthesizing imaging features across multiple modalities to provide a report that advances patient care.


Assuntos
Oncologistas , Neoplasias da Coluna Vertebral , Humanos , Imageamento por Ressonância Magnética , Radiologistas , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/terapia , Coluna Vertebral
20.
Cancer ; 128(18): 3400-3407, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-35866716

RESUMO

BACKGROUND: Goals of care (GOC) documentation is important but underused. We aimed to improve oncologist GOC documentation and end-of-life (EOL) care. METHODS: In April 2020, our cancer center launched a GOC note template, including optional fields for documenting discussion with the patient about: cancer natural history, goals, and/or EOL (resuscitation preferences, hospice receptivity). Associations between GOC notes and EOL care were evaluated. RESULTS: Among 1721 patients dying between June 1, 2020 and June 30, 2021, median days from first GOC note (± with documentation of EOL discussion) to death was 92, whereas a GOC note including EOL discussion ("GOC EOL note"), specifically, was 31. Patients with a first GOC note >60 days before death spent fewer days inpatient (6.7 vs 10.6 days, p < .001). Among patients with GOC EOL notes, those with such documentation >30 days before death had fewer inpatient (5 vs 11, p < .001) and intensive care unit days (0.5 vs 1.5, p < .001), more hospice referrals (57% vs 44%, p = .003), and less chemotherapy ≤14 days before death (6% vs 11%, p = .010). Of 925 admissions of patients dying within ≤30 days, those with GOC EOL notes were shorter (7 vs 9 days, p = .013) but not associated with more hospice discharge (30% vs 25%, p = .163). Oncologist (vs nononcologist) GOC documentation and earlier documentation of EOL discussion were associated in subset analyses with less inpatient care and more hospice referrals. CONCLUSIONS: Documentation of GOC, including EOL discussions, is associated with favorable performance on accepted indicators of quality EOL care.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Oncologistas , Assistência Terminal , Documentação , Humanos , Planejamento de Assistência ao Paciente
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