Oncologist burnout: causes, consequences, and responses

Although the practice of oncology can be extremely rewarding, it is also one of the most demanding and stressful areas of medicine. Oncologists are faced with life and death decisions on a daily basis, administer incredibly toxic therapies with narrow therapeutic windows, must keep up with the rapid pace of scientific and treatment advances, and continually walk a fine line between providing palliation and administering treatments that lead to excess toxicity. Personal distress precipitated by such work-related stress may manifest in a variety of ways including depression, anxiety, fatigue, and low mental quality of life. Burnout also seems to be one of the most common manifestations of distress among physicians, with studies suggesting a prevalence of 35% among medical oncologists, 38% among radiation oncologists, and 28% to 36% among surgical oncologists. Substantial evidence suggests that burnout can impact quality of care in a variety of ways and has potentially profound personal implications for physicians including suicidal ideation. In this review, we examine the causes, consequences, and personal ramifications of oncologist burnout and explore the steps oncologists can take to promote personal well-being and professional satisfaction.     

BONUS 5: 5th Annual Bone and The Oncologist New Updates

The 5th annual Bone and The Oncologist New Updates (bonus 5) conference, held at the National Arts Center, Ottawa, April 8–9, 2010, focused on innovative research into the mechanisms and consequences of increased bone turnover in the benign and metastatic settings alike. This year there was also a debate over the controversial use of bisphosphonates as an adjuvant treatment in patients with early-stage breast cancer. This meeting report highlights a few of the topics presented.     

The Hospitalist Model and Oncology: Oncologist Opinions About Inpatient Cancer Care Delivery

Hospitalists, rather than oncologists, are increasingly providing inpatient medical care to hospitalized patients with cancer, yet the opinions of oncologists regarding this model of care delivery are unknown. A survey was conducted assessing these opinions and experiences with inpatient cancer care delivery at a tertiary cancer center. Only 30% of oncologists agreed that caring for hospitalized patients with cancer was an efficient use of their time, and most believed a hospitalist service allowed them to pursue other interests. Most had a positive experience with hospitalists, agreeing that hospitalists can diagnose and manage toxicities of cancer therapy, exhibit professionalism, and communicate with them and their patients appropriately. Hematologic malignancy specialists were more likely to value inpatient service time and had less confidence in the ability of hospitalists. Overall, the hospitalist model was generally accepted by oncologists and will continue to be an important part of oncologic care delivery.     

The Australian Medical Oncologist Workforce Survey: The profile and challenges of medical oncology

Background

The aim of this study was to understand the current and future challenges for the Australian medical oncologist workforce.

The Hallmarks of Cancer and the Radiation Oncologist: Updating the 5Rs of Radiobiology

A comprehensive, mechanistic understanding of radiobiological phenomena that can be integrated within the broader context of cancer biology offers the prospect of transforming clinical practice in radiation oncology. In this review, we revisit the six established biological hallmarks of cancer and examine how they have provided insights into novel therapeutic strategies. In addition, we discuss the potential of two emerging hallmarks to continue to expand our understanding beyond the narrow confines of the traditional 5Rs of radiobiology.     

A Burnout Reduction and Wellness Strategy: Personal Financial Health for the Medical Trainee and Early Career Radiation Oncologist

PurposePhysician burnout is reported in more than one out of every 2 practicing clinicians and is just as prevalent in training physicians. Burnout severity is also associated with increasing levels of financial debt. Medical professionals are notable for their high and increasing levels of debt; despite this, financial literacy is poor among physicians, and financial education is largely absent from medical education. Radiation oncologists (ROs) are no different in this regard, with 33% of residents reporting high levels of burnout symptoms, 33% carrying >$200,000 of educational debt, and 75% reporting being unprepared to handle future financial decisions. To fill this gap, we reviewed the basic tenets of personal financial health for the early career RO.Methods and materialsThe core concept of financial independence (FI) is introduced, and we review 4 basic tenets of personal financial health for the young medical professional: debt, behavior, investment, and asset protection strategies.ResultsFI is achieved by saving until the desired quality of life can be maintained, independent of employment income. Debt strategy involves minimizing debt accrual, understanding student loans, and having a debt management plan. Behavioral strategy involves setting financial goals, calculating worth and a savings rate, budgeting, and frugal living. The basics of investing include asset allocation, diversification, rebalancing, and minimizing expenses. Finally, asset protection includes insuring against catastrophic events with disability, life, health, liability, and property insurance.ConclusionsHealthy financial practices can lead to FI and may facilitate professional and personal freedoms with the goal of mitigating burnout-associated stressors. The tenets of strong financial health for ROs in the early stages of their career include sound debt, behavioral, investment, and asset protection strategies. Furthermore, initial and continuing financial education is an overlooked but important curriculum component. ROs with their financial houses in order can devote more resources to learning and practicing good medicine while living healthy, rewarding lives.     

Breast Cancer: An Overview of Nuclear Medicine Imaging & Treatment

The purpose of this overview is to introduce the diagnostic and therapeutic procedures routinely used in the management of the patient with breast cancer and includes what some may consider being the future of nuclear medicine, positron emission tomography. Imaging the breast with ^99mTc MIBI to lymphatic mapping and the search for the sentinel lymph node for biopsy purposes, as well as bone scans used in the search for metastases will be discussed. Wall motion and ejection fraction studies are discussed as a monitoring tool for patients requiring cardiotoxic chemotherapy. The final section of the synopsis deals with the treatment of bone metastases for the purpose of palliation of this often debilitating disease.     

Personalized Medicine: Challenge and Promise

The new health care buzz words include “personalized or individualized medicine.” Populations such as American Indians and Alaska Natives potentially have much to gain from this new science to overcome the known health disparities in these populations. This will require participation and acceptance of diverse populations. This article reviews the promise and challenges of individualizing cancer care using principles of community-based participatory research.     

Liquid Biopsy at Home: Delivering Precision Medicine for Patients with Cancer During the COVID-19 Pandemic

CoronaVirus disease-2019 has changed the delivery of health care worldwide and the pandemic has challenged oncologists to reorganize cancer care. Recently, progress has been made in the field of precision medicine to provide to patients with cancer the best therapeutic choice for their individual needs. In this context, the Foundation Medicine (FMI)-Liquid@Home project has emerged as a key weapon to deal with the new pandemic situation. FoundationOne Liquid Assay (F1L) is a next-generation sequences-based liquid biopsy service, able to detect 324 molecular alterations and genomic signatures, from May 2020 available at patients’ home (FMI-Liquid@Home). We analyzed time and costs saving for patients with cancer, their caregivers and National Healthcare System (NHS) with FMI-Liquid@Home versus F1L performed at our Department. Different variables have been evaluated. Between May 2020 and August 2021, 218 FMI-Liquid@Home were performed for patients with cancer in Italy. Among these, our Department performed 153 FMI-Liquid@Home with the success rate of 98% (vs. 95% for F1L in the hospital). Time saving for patients and their caregivers was 494.86 and 427.36 hours, respectively, and costs saving was 13 548.70€. Moreover, for working people these savings were 1084.71 hours and 31 239.65€, respectively. In addition, the total gain for the hospital was 163.5 hours and 6785€, whereas for NHS was 1084.71 hours and 51 573.60€, respectively. FMI-Liquid@Home service appears to be useful and convenient allowing time and costs saving for patients, caregivers, and NHS. Born during the COVID-19 pandemic, it could be integrated in oncological daily routine in the future. Therefore, additional studies are needed to better understand the overall gain and how to integrate this service in different countries.     

Herbal Medicine: Current Status and the Future

The number of patients seeking alternate and herbal therapy is growing exponentially. Herbal medicines are the ‍synthesis of therapeutic experiences of generations of practicing physicians of indigenous systems of medicine for ‍over hundreds of years. Herbal medicines are now in great demand in the developing world for primary health care ‍not because they are inexpensive but also for better cultural acceptability, better compatibility with the human body ‍and minimal side effects. However, recent findings indicate that all herbal medicines may not be safe as severe ‍consequences are reported for some herbal drugs. Most herbal products on the market today have not been subjected ‍to drug approval process to demonstrate their safety and effectiveness. Thousand years of traditional use can provide ‍us with valuable guidelines to the selection, preparation and application of herbal formulation. To be accepted as ‍viable alternative to modern medicine, the same vigorous method of scientific and clinical validation must be applied ‍to prove the safety and effectiveness of a therapeutical product. In the present review we attempted to describe the ‍present scenario and project the future of herbal medicine.     

针药并用控制化疗呕吐临床观察

 采用3种方法控制恶性肿瘤联合化疗所致急性恶心、呕吐。方法　常规用药组(Ⅰ)、枢复宁组(Ⅱ)、针药并用组(Ⅲ)对391例国人不同类型恶性肿瘤进行临床观察,结果　Ⅱ、Ⅲ组疗效明显高于Ⅰ组(P＜0.05)、Ⅱ、Ⅲ组疗效相当,控制恶心效果,虽然最初24小时以Ⅱ组为高(84%)、Ⅲ组71%,但整个疗程,效果相当,且Ⅲ组对肝疾患者效果优于Ⅱ组,弥补了枢复宁的不足。结论　针药并用组,疗效显著,且中药药源广泛,价格低廉,针刺简便易行,是值得推广的一种方法。     

Cervical Cancer Screening Services at Tertiary Healthcare Facility: An Alternative Approach

Introduction: India fights massive cervical cancer burden. This article highlights an innovative feasible approachenabling tertiary hospitals to contribute to cancer prevention without compromising their primary mandate to providetreatment. Methodology: Since 1979, National Institute of Cancer Prevention and Research (NICPR) support a tertiaryhospital in cervical cancer screening through a satellite clinic. Record review of 5328 attendees of this clinic betweenJanuary-December 2016 was done. Pap-smear testing and reporting were performed by trained NICPR personnel. Patients’demographics, reproductive history, Pap-test date, cytology results were recorded and results were communicated torespective units for further management. Results: Among 5328 women screened, 2% (96/5328) had abnormal cytology,which included malignancy(33%; 32/96), Atypical Squamous Cells-Undetermined Significance(ASC-US) (20%;19/96), Atypical Glandular Cells(AGC) (23%; 22/96) with complaints of pain in lower abdomen 65.6%(59/90), whitedischarge per vaginum 46.7%(42/90) and backache 23.3%(21/90). In which, Muslims- 67% (65/96), illiterates- 58%(56/96). Age>35(p<0.001), parity>3(p<0.05), illiteracy (p<0.05), Muslim women (p<0.05) had positive association withabnormal cytology. Conclusion: Awareness about cervical cancer screening is the immediate need in resource-limitedcountries. Government hospitals in such countries should house dedicated preventive oncology unit for cancer screening.