Medical Student Knowledge of Oncology and Related Disciplines: a Targeted Needs Assessment

Despite increasing numbers of cancer survivors, non-oncology physicians report discomfort and little training regarding oncologic and survivorship care. This pilot study assesses medical student comfort with medical oncology, surgical oncology, radiation oncology, hospice/palliative medicine, and survivorship care. A survey was developed with input from specialists in various fields of oncologic care at a National Cancer Institute-designated comprehensive cancer center. The survey included respondent demographics, reports of experience with oncology, comfort ratings with oncologic care, and five clinical vignettes. Responses were yes/no, multiple choice, Likert scale, or free response. The survey was distributed via email to medical students (MS1–4) at two US medical schools. The 105 respondents were 34 MS1s (32 %), 15 MS2s and MD/PhDs (14 %), 26 MS3s (25 %), and 30 MS4s (29 %). Medical oncology, surgical oncology, and hospice/palliative medicine demonstrated a significant trend for increased comfort from MS1 to MS4, but radiation oncology and survivorship care did not. MS3s and MS4s reported the least experience with survivorship care and radiation oncology. In the clinical vignettes, students performed the worst on the long-term chemotherapy toxicity and hospice/palliative medicine questions. Medical students report learning about components of oncologic care, but lack overall comfort with oncologic care. Medical students also fail to develop an increased self-assessed level of comfort with radiation oncology and survivorship care. These pilot results support development of a formalized multidisciplinary medical school oncology curriculum at these two institutions. An expanded national survey is being developed to confirm these preliminary findings.     

Qualit?tssicherung und Qualit?tsindikatoren

Quality assurance in oncology is subject to a rapid process of change. Nowadays, instruments for the permanent observation of care reality have to be introduced. Therefore, quality indicators as quality measures are essential. Quality indicators rely on the acceptance and participation of medical experts and should be used in particular in the context of voluntary benchmarking processes. The costs and terms of indicator-based quality assurance require the development of a systematic quality research in Germany.     

Quality indicators in breast cancer care: An update from the EUSOMA working group

In 2010, EUSOMA published a position paper, describing a set of benchmark quality indicators (QIs) that could be adopted by breast centres to allow standardised auditing and quality assurance and to establish an agreed minimum standard of care. Towards the end of 2014, EUSOMA decided to update the paper on QIs to consider and incorporate new scientific knowledge in the field. Several new QIs have been included to address the need for improved follow-up care of patients following primary treatments. With regard to the management of elderly patients, considering the complexity, the expert group decided that, for some specific quality indicators, if centres fail to meet the minimum standard, older patients will be excluded from analysis, provided that reasons for non-adherence to the QI are specified in the clinical chart and are identified at the review of the clinical records. In this way, high standards are promoted, but centres are able to identify and account for the effect of non-standard treatment in the elderly. In the paper, there is no QI for outcome measurements, such as relapse rate or overall survival. However, it is hoped that this will be developed in time as the databases mature and user experience increases. All breast centres are required to record outcome data as accurately and comprehensively as possible to allow this to occur. In the paper, different initiatives undertaken at international and national level to audit quality of care through a set of QIs have been mentioned.     

Current and future trends in imaging informatics for oncology

Clinical imaging plays an essential role in cancer care and research for diagnosis, prognosis, and treatment response assessment. Major advances in imaging informatics to support medical imaging have been made during the last several decades. More recent informatics advances focus on the special needs of oncologic imaging, yet gaps still remain. We review the current state, limitations, and future trends in imaging informatics for oncology care including clinical and clinical research systems. We review information systems to support cancer clinical workflows including oncologist ordering of radiology studies, radiologist review and reporting of image findings, and oncologist review and integration of imaging information for clinical decision making. We discuss informatics approaches to oncologic imaging including, but not limited to, controlled terminologies, image annotation, and image-processing algorithms. With the ongoing development of novel imaging modalities and imaging biomarkers, we expect these systems will continue to evolve and mature.     

Neues aus der Onkologischen Trainings- und Bewegungstherapie

Scientific evidence for the efficacy of therapeutic exercise interventions in oncology is, in part, so convincing that the next step would have to be implementation of quality assured exercise programs within the organs of oncologic care. It has been demonstrated that targeted physical activity can positively influence fatigue syndrome, urinary incontinence in prostate cancer patients, and physical performance in general. Furthermore, in this context, there are strong indications for beneficial effects on secondary lymphedema and chemotherapy-induced polyneuropathy. Ideally, oncologic exercise therapy should be implemented before the start of medical treatment, in order to stabilize the patients and, by this means, minimize complications and side effects during the acute phase, as supported by initial studies (prehabilitation). The available data on therapeutic exercise inventions in pediatric oncologic diseases are still very heterogeneous; however, all demonstrate the feasibility and necessity of exercise therapy and sport in pediatric oncology, and also exclude adverse events.     

Hidden in Plain Sight: Clinical Informaticians are the Oncology Subspecialists You Did Not Know You Needed

Clinical informatics is a young, diverse and rapidly growing field. We asked eight clinical informaticians from a variety of oncology specialties, training pathways and careers for personal narratives to illustrate the wide spectrum of clinical informatics careers. Primary clinical specialties included radiation oncology, medical/haematology oncology and palliative care. Training pathways included fellowship, non-fellowship formal training and informal training. Careers included clinical care, research, operations and industry. We summarised common themes and advice for trainees. We hope to raise awareness of clinical informatics among trainees and oncologists to reveal new career opportunities and to avoid inadvertently taking clinical informatics and informaticians for granted.     

Proposed agenda for the measurement of quality-of-care outcomes in oncology practice.

Cancer is an important disease, and health care services have the potential to improve the quality and quantity of life for cancer patients. The delivery of these services also has recently been well codified. Given this framework, cancer care presents a unique opportunity for clinicians to develop and test outcome measures across diverse practice settings. Recently, the Institute of Medicine released a report reviewing the quality of cancer care in the United States and called for further development and monitoring of quality indicators. Thus, as we move into the 21st century, professional and regulatory agencies will be seeking to expand process measures and develop and validate outcomes-oriented measures for cancer and other diseases. For such measures to be clinically relevant and feasible, it is key that the oncology community take an active leadership role in this process. To set the stage for such activities, this article first reviews broad methodologic concerns involved in selecting measures of the quality of care, using breast cancer to exemplify key issues. We then use the case of breast cancer to review the different phases of cancer care and provide examples of phase-specific measures that, after careful operationalization, testing, and validation, could be used as the basis of an agenda for measuring the quality of breast cancer care in oncology practice. The diffusion of process and outcome measures into practice; the practicality, reliability, and validity of these measures; and the impact that these indicators have on practice patterns and the health of populations will be key to evaluating the success of such quality-of-care paradigms. Ultimately, improved quality of care should translate into morbidity and mortality reductions.     

Measuring the quality of care in radiation oncology

Quality care is one of the dominant issues in health care today. In this article, we will review the key concepts underlying quality measures and discuss how measures are developed and defined. We will next examine how these measures are currently being used and will conclude with some thoughts regarding the steps necessary to use quality measures to improve the quality of care in radiation oncology.     

Rapid Implementation of Telemedicine During the COVID-19 Pandemic: Perspectives and Preferences of Patients with Cancer

IntroductionThe use of telemedicine in oncology practice is rapidly expanding and is considered safe and cost effective. However, the implications of telemedicine on patient‐physician interaction, patient satisfaction, and absence of the personal touch have not been studied to date. Following the spread of COVID‐19, telemedicine services were rapidly incorporated at the Oncology Division of Tel Aviv Medical Center. We aimed to evaluate patients'' perspectives and preferences regarding telemedicine and to assess whether this virtual communication platform affects the patient‐physician relationship.MethodsBetween March 2020 and May 2020, adult cancer patients who conducted at least one successful telemedicine meeting were interviewed by trained medical personnel. The interview was based on validated patient satisfaction questionnaires and focused on patient‐physician interaction in relation to the last in‐patient visit.ResultsOf 236 patients, 172 (74%) patients agreed to participate. The study population comprised mainly patients with gastrointestinal malignancies (n = 79, 46%) with a median age of 63 years (range 21–88). The majority of patients were male (n = 93, 54%). Eighty‐nine (51.7%) patients were receiving active oncologic treatment, and 58 (33.7%) were under routine surveillance following completion of active therapy. Almost all had a sense of secured privacy (n = 171, 96%), the majority of patients affirmed that their concerns were met (n = 166, 93%) and perceived that eye contact with the treating physician was perceived (n = 156, 87%). Only a minority felt that the absence of physical clinic visits harmed their treatment (n = 36, 20%). Most patients (n = 146, 84.9%) wished to continue telemedicine services. A multivariate analysis revealed that higher satisfaction and visits for routine surveillance were both predictors of willingness to continue future telemedicine meetings over physical encounters (odds ratio [OR] = 2.41, p = .01; OR = 3.34, p = .03, respectively).ConclusionTelemedicine is perceived as safe and effective, and patients did not feel that it compromised medical care or the patient‐physician relationship. Integration of telemedicine is ideal for patients under surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.Implications for PracticeDuring the COVID‐19 pandemic, telemedicine was rapidly implemented worldwide to facilitate continuity of quality care and treatment. Despite many potential setbacks, telemedicine has become a useful and safe tool for oncology practitioners to care for their patients. The use of telemedicine regarding patients'' perspectives, emotions, and patient‐physician communication in daily oncology practice has not been studied to date. This study demonstrated telemedicine is perceived as safe and effective and does not compromise medical care or the patient‐physician relationship. Its use is ideal for surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.     

Palliative medicine and medical oncology

Traditionally, medical oncology and palliative care have been considered two distinct and separate disciplines, both as regards treatment objectives and delivery times. Palliative care in terminal stages, aimed exclusively at evaluating and improving quality of life, followed antitumor therapies, which concentrated solely on quantitative results (cure, prolongation of life, tumoral mass shrinkage). Over the years, more modern concepts have developed on the subject. Medical oncology, dealing with the skills and strategic co-ordination of oncologic interventions from primary prevention to terminal phases, should also include assessment and treatment of patients subjective needs. Anticancer therapies should be evaluated in terms of both the quantitative and qualititative impact on patients lives. Hence, the traditional view of palliative care has to be modified: it constitutes a philosophical and methodological approach to be adopted from the early phases of illness. It is not the evident cultural necessity of integrating medical oncology with palliative medicine that may be a matter of argument, but rather the organizational models needed to put this combined care into practice: should continuous care be guaranteed by a single figure, the medical oncologist, or rather by an interdisciplinary providers team, including full-time doctors well-equipped for palliative care? In this paper the needs of cancer patients and the part that a complete oncologist should play to deal with such difficult and far-reaching problems are firstly described. Then, as mild provocation, data and critical considerations on the ever increasing needs of palliative care, the present shortcomings in quality of life and pain assessment and management by medical oncologists, and the uncertain efficacy of interventional programmes to change clinical practice are described. Finally, a model of therapeutic continuity is presented, which in our view is realistic and feasible: an Oncologic Programme as the unifying process, and the Comprehensive Cancer Centre, or the Oncologic Department, the delivering structure.     

The systematic application of quality measures and process control in clinical radiation oncology

There has been growing emphasis on quality measures and process analysis techniques that may be implemented in the daily practice of radiation oncology to improve the overall quality of patient care. In this work, quality measures are a form of monitoring that should be actionable and specific to guide process improvement efforts. They are most effective when used to determine the level of execution proficiency against a standard. Control charts are an effective way to separate a change in the process from process noise such that the user can focus on issues that are more likely to improve quality. The field of radiotherapy would benefit from a common dashboard of quality measures for the different processes in radiation oncology clinics, and some suggestions are provided. The dashboard would be used to provide continuous feedback on a clinic's capability to maintain or exceed standards.     

Methodology of research and practice for the third millennium: evidence-based medicine

In the past 10 years there have been significant scientific advances in biological sciences and health care. The growth in basic and translational research data to guide medical practice, which has an impact on health care costs has made it critical for clinicians to appraise and use published evidence for medical decisions. Evidence-based medicine should be strengthened and promoted to enhance the rationale and quality of medical care provided to our patients. Basic laboratory research and properly designed, relevant and timely prospective clinical trials should be strongly supported; patient participation must be increased to acquire more accurate information to develop innovative therapeutic strategies in oncology. New avenues in cancer detection and staging, as well as therapy, suggested by basic and translational laboratory research, must be vigorously pursued and adequately funded. Methodology for accurate cost accounting of medical care and cost-benefit studies needs further development. Technology assessment will substantially contribute to better utilization of scarce health care resources.     

Interdisziplinäre ambulante Versorgung

The ambulatory care provided by private physicians specialized in oncology – which has been accelerated by progress in diagnostics and therapy – is pivotal for the care of cancer patients. Alongside the general practitioner (GP), the ambulatory care of cancer patients is mainly provided by haematologists and medical oncologists. The respective cooperative infrastructure was begun in the early 1990s based on the “oncology agreement” of 1994. The physicians responsible for oncologic care were able to further develop collaborative structures with other specialists as well as with GPs. Hence, today’s reality of ambulatory cancer care is shaped by a very complex and comprehensive system of interdisciplinary collaboration among GPs and specialists as well as by establishment of interdisciplinary oncology expert groups and cooperation with cancer centres and hospitals. The anticipated medical and epidemiologic development requires further optimisation and expansion of quality assurance and qualification tools to guarantee reliable outpatient structures of the highest standard.     

Where your data is going and where it's been

Collecting data is time-consuming and expensive. Electronic transactions, including electronic medical records and the unification of many billing procedures, have transformed the rate at which data are able to be extracted. Although obstacles remain, the rate at which data are de-identified, collected, and aggregated will help improve safety and standards of care for oncology patients. Everyone participating in the care of oncology patients must understand how important data are as the quality initiatives and performance metrics are numerous and growing; these initiatives cannot be successful without timely, accurate, and quantifiable data that address the continuum of oncology care.     

Aufbau klinischer Krebsregister

The establishment of epidemiological and clinical cancer registries has substantially increased in recent years and one of the aims is to collate regional differences in the incidence of cancerous diseases. It is also hoped that a stable database for the quality of care of tumor patients can be achieved by the documentation of different forms of treatment and their results. However, several additional prerequisites are essential in order that these aims can also be reached by the introduction of clinical cancer registries. The compilation of data must occur in the treatment process and the quality data must represent the basis for a structured dialogue. The financial aspects of these quality assurance measures must be secure. Everybody wants to know what they achieve by the treatment of their own patients and what the quality of the treatment is. This is a long-awaited dream of all professional groups participating in the medical care of oncology patients. However, these registries will only be a success if the problems not dealt with during the planning phase can be discussed in a transparent way and the available instruments can be developed further.     

The value of acupuncture in cancer care

Clinical research on acupuncture in cancer care is a new and challenging field in oncology. The results of clinical research will continue to provide clinically relevant answers for patients and oncologists. The evidence currently available has suggested that acupuncture is a safe and effective therapy to manage cancer and treatment related symptoms, while giving patients the ability to actively participate in their own care plan. The article explains the potential benefits of acupuncture and describes the difficulties in studying its effectiveness.     

Utility and use of palliative care screening tools in routine oncology practice

Palliative care, which seeks to alleviate suffering and optimize quality of life, is an increasingly recognized and valued medical subspecialty. With its focus on identifying and managing symptoms and problems encountered in expected functional decline, the domain of palliative care overlaps significantly with that of oncology, where patients typically experience a host of disease- and treatment-related effects. Assessment instruments have been developed and validated in the context of both disciplines, but oncology may benefit from the inclusion of palliative care screening instruments specifically developed for patients with advanced, life-limiting illnesses. New methods of screening, particularly technology-based ones such as electronic data capture, allow greater flexibility across care settings and longitudinal data capture for ongoing evaluation. This article reviews frequently used and available screening instruments for common palliative needs in cancer patients and provides an example of a novel technology-based screening approach to quickly identify and address a critical patient concern.     

La dépression en oncologie

The purpose of this paper was to make a brief review of the main problematics raised by depression in oncology in terms of prevalence, semiology, screening, risk, prognosis factors and treatment. This reflection was based on recent literature data obtained through a PubMed search. Depressive disorders have frequently been encountered in cancer patients. During routine oncology daily care, depression screening, assessment and treatment are of paramount importance regarding psychosocial management. Depressive elements have a tremendous impact on the quality of life, tolerance and compliance with anticancer treatment. Moreover, depression morbidity and its possible influence on prognosis represent an important challenge in terms of prevention. A specific semiology for depressive disorders in the oncologic field might be more relevant with practical clinical implications. Optimal care of these mood disorders have to be implemented as soon as possible and be supported by the association of pharmacological treatment and psychotherapy.     

Palliative care in orthopaedic surgical oncology

Hundreds of thousands of Americans are affected every year by skeletal complications of oncologic disease. Recent developments in medical oncology, radiation oncology and radiology, particularly with respect to the use of bisphosphonate medication and radiofrequency techniques, have served to greatly lessen the morbidity associated with metastatic skeletal disease. Similarly, there has been significant advancement in the field of orthopaedic oncology in the areas of internal fixation, endoprosthetic implant design, and minimally invasive kyphoplasty technology. Given the palliative intent of intervention in this patient population, the goal of treatment of skeletal metastases must be optimization of limb function and ultimately, quality of life.     

Status of oncologic specialties: global survey of physicians treating cancer

Background

In the United States, medical oncologists play a central role in the management of systemic therapy for cancer patients. Medical oncology as a specialty is not as established in Japan and several other European nations according to recent surveys, and little is known about this specialty in developing nations. We aimed to identify global differences in the roles of physicians treating cancer; specifically, how the management of advanced disease differs among nations.

Methods

In March 2016, a self-administered internet survey was conducted with degreed physicians who prescribed systemic agents for adult cancer treatment within the past 5 years. Physicians were identified from the American Society of Clinical Oncology active member online directory.

Results

Among 3907 members in 55 nations, 376 (9.6%) responded to the survey. The 310 respondents who provided an answer to the recognition of medical oncology were dominated by male MDs that have practiced for more than 5 years at academic centers, and ~60% were medical oncologists. A majority of the respondents in all four regions reported that medical oncology was established in their corresponding nations. However, there are several outlying nations where oncologic specialties play a minimal role in the management of systemic therapy.

Conclusion

Despite general recognition of medical oncology, the role is not globally established as the primary point of care for delivery of systemic therapy. Nations lacking this specialty should be assisted by the international community to develop medical oncology.