JCO oncology practice最新文献

Purpose: To better understand burnout in oncology and clinician well-being along the career continuum starting with training, we sought to characterize the professional well-being of physicians training in medical oncology in 2023 and to identify trends over time comparing to fellows from a decade prior.

Methods: All US medical oncology fellows taking the 2023 ASCO Medical Oncology In-Training Exam (ITE) were invited to complete an optional post-exam survey evaluating fatigue, satisfaction with work-life integration (WLI), emotional exhaustion and depersonalization. 2023 ITE survey responses were compared to the 2013 ASCO post-ITE survey (n=1345). Two sample t tests and analysis of variance tests (continuous variables) and Chi-square tests (categorical variables) were used to assess differences in well-being dimensions between groups.

Results: Of the 2217 fellows who took the 2023 ITE, 1589 (71%) answered the post-ITE survey's well-being items (33% first-year, 36% second-year, and 31% third-year fellows). In 2023, one in five fellows (20%) reported burnout (compared to 34% of fellows in 2013, P < .01) and 50% of fellows in 2023 reported satisfaction with WLI (v 34% in 2013, P < .01). High emotional exhaustion was reported in 18% of all fellows in 2023 with the highest among first years (21%), compared to third (17%) and second years (16%, P = .04). High depersonalization was reported by 11% of fellows in 2023 without a significant difference across the years. Finally, in 2023, 93% (n = 1459) of medical oncology fellows reported that they would choose oncology again as their field, increasing significantly from 89% (n = 1056) in 2013 (P < .01).

Conclusion: Although US medical oncology fellows are doing better than in 2013, burnout and work-life integration continue to be issues. These findings underscore the significance of optimizing WLI and the need to better understand the drivers mediating a positive workplace experience and its evolution once in practice.

Purpose: Although publicly available cancer-related information online and offline could help patients make informed decisions, it also poses challenges due to prevalent misinformation. Patients need proper provider guidance to ensure they use valid and relevant information in decisions. We identify effective communication approaches for providers when (1) discussing patient-identified information and (2) disagreeing with it.

Methods: From June to August 2023, people living with cancer were reached via online communities and asked first about their actual experiences discussing patient-identified information with their providers. Respondents were then randomly assigned into an experiment with three hypothetical scenarios where providers disagreed with patient-identified information. Provider responses included (1) dismissal, (2) explanation, and (3) explanation with relationship-building elements. Pearson correlation and multivariable analysis of variance were used to evaluate differences in patient perceptions.

Results: One hundred seventy-five respondents completed the survey. Mean age: 53 years; 45% female; and 88% White, 10% Black, and 2% others. Forty-six percent held Bachelor's degrees or higher, 11% lived rurally, 36% reported financial difficulties, and 46% rated their health as good/excellent. Between 31% and 37% of respondents reported their provider used communication approaches that negatively correlated with discussion outcomes. The approaches included avoidance of such conversations due to limited time, discouragement of future information searches, or judgmental comments. In the experiment, respondents randomly assigned to receive relationship-building elements were significantly more comfortable sharing information, felt more satisfied, respected, and trusted their provider's opinion more than those receiving the dismissal scenario. The explanation scenario was not perceived differently compared with the dismissal scenario.

Conclusion: More than a third of respondents reported negative communication when sharing patient-identified information with their provider. Provider prioritization of relationship-building alongside explanations could foster trust and facilitate open information exchange, supporting informed decisions.

Purpose: Financial toxicity (FT) has been linked to higher symptom burden and poorer clinical outcomes for patients with cancer. Despite the availability of validated tools to measure FT, a simple screen remains an unmet need. We evaluated item 12 ("My illness has been a financial hardship to my family and me") of the COmprehensive Score for Financial Toxicity (COST) measure as a single-item FT screening measure.

Methods: In this secondary analysis, 711 patients with cancer (690 with breast cancer) were recruited via a web-based survey from a philanthropic organization. COST items 1-11 were scored according to Functional Assessment of Chronic Illness Therapy scoring guidelines, with lower scores indicating worse FT. Analyses focused on establishing a correlation, examining item properties, and sensitivity/specificity of item 12 relative to the total COST score.

Results: Item 12 had a correlation of r = 0.53 with the COST-11 score, and an increase of one point on item 12 is associated with a decrease of approximately three total points on the full scale (b, 3.35; P < .001; adjusted R², 0.28). Item analysis with the graded-response item in response theory modeling showed very good discrimination (a, 2.096) for item 12, indicating that it can reliably distinguish between low and high FT in patients. Sensitivity ranged between 75.6% and 95.7% on all item 12 thresholds to screen positive for FT using two COST cutoffs as criteria. Maximizing both sensitivity and specificity was to be found for higher item 12 scores.

Conclusion: To our knowledge, this is the first validation of a single-item screening measure for FT. Overall, these results illustrate that item 12 from the COST measure is a good candidate for a single-item screener. Clinicians can choose among item 12 screening thresholds depending on their tolerance for low specificity.

Purpose: Older adults with cancer have unique needs, which likely influence surgical outcomes in the geriatric oncology population. We conducted a systematic review to describe the literature focused on perioperative supportive care interventions for older adults with cancer undergoing surgery.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases for literature published from January 2010 to October 2023. We included randomized controlled trials (RCTs) focusing on supportive care interventions that enrolled adults older than 60 years with cancer.

Results: We included 11 RCTs with 2,177 patients in this review. Patients' age ranged from 60 to 95, and the median number of patients per study was 147 (range, 44-690). Most studies included patients with colorectal cancer (81.8%). Half of the studies (54.5%) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (27.2%), nutrition optimization (9.1%), and patient empowerment (9.1%). Primary outcomes included postoperative complications, quality of life, feasibility of exercise programs, inspiratory muscle endurance, and hospital length of stay, among others. All studies had postoperative complications as a primary or secondary outcome. We found implementation challenges that influenced several studies, including high dropout rates and intervention fidelity.

Conclusion: We found 11 studies focused on perioperative supportive care interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. We also found heterogeneity in intervention modality and outcome assessment, thus demonstrating a need for ongoing work to address the unique needs of the geriatric oncology population.

Purpose: To explore strategies related to cancer-related financial toxicity (FT) from the perspectives of cancer survivors and stakeholders in China and to evaluate their views within the context of the social ecological model (SEM).

Methods: Between March and July 2022, we conducted a descriptive qualitative study with semistructured interviews of 23 cancer survivors and 14 stakeholders. Qualitative content analysis on the basis of the SEM was used to analyze the data with NVivo 12.

Results: Guided by the SEM, we identified 12 subthemes that described how to mitigate FT. Individual-level strategies included increasing cost-related health literacy, strengthening adherence to standardized treatments, and improving resilience to cancer and financial changes. Interpersonal-level strategies included strengthening family support and social networks. Organizational-level strategies included using evidence-based treatments, effective communication of costs, and providing financial information support. Community-level strategies included improving symptom management throughout survivorship and providing psychosocial support. Policy-level strategies included optimizing health insurance policies and promoting collaboration among medical institutions.

Conclusion: Our findings provide a comprehensive understanding of strategies pertaining to FT, offering insights that could support the development of future interventions. This research suggests that interventions that encompass multiple levels-individual, interpersonal, organizational, community, and policy-rather than focusing on only one level might be the most beneficial for managing FT.

Purpose: The Hematology Oncology Pharmacist Association Oral Chemotherapy Collaborative (HOPA OCC) developed practice-based tools to use in program development and improvement for the management of patients receiving oral anticancer agents (OAAs).

Methods: These tools include a baseline OAA program assessment, clinical OAA adherence tool, and OAA dashboard. HOPA OCC distributed these tools to teams participating in the 6-month HOPA ASCO Quality Training Programs (QTPs). Barriers in the delivery of OAA services across practice sites were determined through the use of baseline assessments, and the following domains were evaluated: (1) side-effect monitoring, (2) adherence monitoring, (3) use of patient-reported outcomes, (4) social determinants of health, and (5) collaborative practice agreements for oncology pharmacists. The OAA adherence tool offers clinical patient adherence questions and guidance for supporting adherence in practice. Finally, the dashboard includes multiple metrics that may be helpful for practices to measure their program outcomes. HOPA OCC used the Consolidated Framework for Implementation Research to assess tool usefulness by the QTP participants.

Results: Barriers to implementation include deficits in information technology, resources, and competing priorities.

Conclusion: Standardized OAA tools can inform and support quality improvement initiatives and improve the care of patients receiving OAAs.

Purpose: Previous studies have described barriers to and facilitators of healthy eating and being physically active among patients with cancer, but few have done so in a safety-net community oncology setting.

Materials and methods: To understand multiple perspectives on the factors that influence diet and exercise in patients with cancer treated in safety-net settings, we conducted semistructured interviews between June and November 2021 with patients and oncology clinic medical professionals at a safety-net hospital in Houston, TX.

Results: Thirty-one patients with cancer were interviewed, including 11 patients on active treatment and 20 survivors, as well as 21 care health care professionals. Most patients thought that they had a healthy diet but did not exercise enough, mainly because of cancer-related symptoms. The majority stated that they would like to participate in healthy living programs and follow their doctor's recommendations although only half noted receiving any recommendations from their provider. Health care professionals perceived patients' barriers to healthy diet and exercise as lack of knowledge, low access to resources, and low motivation, potentially impacting adherence to lifestyle recommendations.

Conclusion: Patients with cancer in a safety-net oncology clinic were motivated to participate in healthy living activities. However, health care professionals believed that patients faced barriers with the potential to impact adherence to health care professional recommendations. Further research is needed to better understand and optimize lifestyle counseling in a safety-net oncology setting and explore potential referral pathways to healthy living programs for patients.