中国六家肿瘤中心与欧美肿瘤中心放疗医师培养工作比较

目的:对比国内外优秀放疗中心肿瘤放疗专科医师培养经验,为中国肿瘤专科医院放疗基地医师培养体制提供改进的依据。方法:通过电子问卷邮件和在线调查,收取中国6家省级肿瘤专科医院和欧美5家肿瘤专科中心的住院医师及教师反馈,描述和比较培养模式。结果:中国26位住院医师和23位教师参与调查。国外20位住院医师和1位教师回答问卷,并...     

Cancer genetics in rural primary care: a pilot nurse-led service using a new mobile IT system

Somerset has a relatively high incidence of cancer. The county is very rural with pockets of deprivation and sizeable areas of poor access to services. The Cancer Plan advocates early identification of cancer and identified the genetic revolution as having the potential to predict risk, and detect and diagnose cancer early. This innovative Public Health led pilot takes specialist cancer genetics services into primary care. It explores a new service model that is patient focused, provides services close to home and reduces hospital visits and pressure on genetics departments. People who believe they are at increased risk of developing cancer, due to family history, are assessed by nurse specialists at their local surgery and triaged into population, medium and high risk groups. Patient pathways have been streamlined for breast, ovarian and colorectal cancers, which are known to have a genetic link and there may be advantage in increased surveillance and/or genetic testing. People are given the opportunity to understand their personal level of risk and make choices about lifestyles and interventions. To support the delivery of cancer genetics services in primary care a bespoke software package has been developed building on a commercial programme already established in many genetics departments. Electronic transmission of pedigrees from primary to tertiary care assists the lean pathways and the incorporation of a new risk calculator based on NICE guidelines for familial breast cancer is being assessed.     

Neurocognitive training in patients with high-grade glioma: a pilot study

Although their neurocognitive performance is one of the major concerns of patients with high-grade gliomas (HGG) and although neurocognitive deficits have been described to be associated with negative outcome, neurocognitive rehabilitation is usually not integrated into the routine care of patients with malignant gliomas. In this pilot trial, a weekly group training session for attention, verbal, and memory skills was offered to patients with HGG with pre and post-training evaluation. Eleven patients, six with glioblastoma multiforme and five with WHO grade III gliomas, median age 50 years, with a Karnofsky performance score of 80–100 participated in ten group training sessions of 90 min. For evaluation at baseline and after the training by a neuropsychologist not involved in care or training of the patients, Trail Making Tests A and B (TMTA and TMTB), Hopkins Verbal Learning Test (HVLT), and the Controlled Oral Word Association Test (COWA) were used. Comparison of mean group differences between baseline and at post-training evaluation after 12 weeks revealed improvement across all neurocognitive variables. The patients showed a great diversity in their performances, with worsening, improvement, and stabilization. However, a significant group difference was detected only for the HVLT (score 19.6 ± 8.9 at baseline, 23.6 ± 8.8 after 12 weeks, P = 0.04). This pilot study shows that neurocognitive training in patients with HGG is feasible as group training with weekly sessions and might be able to induce improvements in attention and memory skills.     

A curriculum in palliative care for internal medicine housestaff: a pilot project

Despite dramatic growth in the number of hospice programs over the past 15 years, palliative care skills and principles receive minimal attention in medical schools and residency training programs. Northwestern University Medical School and Northwestern Memorial Hospital have developed a program in palliative care education for internal medicine housestaff. Residents, working with a multidisciplinary team of hospice staff, have primary responsibility for the care of terminally ill patients in the home. An inpatient unit is available for acute care when needed. A formal lecture series on symptom management, accompanied by a bibliography and defined learning objectives, provides a guide to the clinical experience. Participating residents also attend seminars focusing on physicians' coping skills and attitudes toward death and dying. Evaluation of the program in its first year shows a definite perception of educational benefit by residents, and enthusiasm for continued involvement in palliative care.     

Cancer survivorship: a new challenge in comprehensive cancer control

Cancer survivors are a growing population in the United States because of earlier cancer diagnosis, the aging of society, and more effective risk reduction and treatment. Concerns about the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families are increasingly being recognized and addressed by public, private, and non-profit organizations. The purpose of this paper is to discuss how survivorship fits within the framework of comprehensive cancer control. We summarize three national reports on cancer survivorship and highlight how various organizations and programs are striving to address the needs of cancer survivors through public health planning, including the challenges these groups face and the gaps in knowledge and available services. As cancer survivorship issues are being recognized, many organizations have objectives and programs to address concerns of those diagnosed with cancer. However, better coordination and dissemination may decrease overlap and increase the reach of efforts and there is limited evidence for the effectiveness and impact of these efforts.     

Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists

Purpose

New strategies for delivering cancer follow-up care are needed. We surveyed primary care providers (PCPs) and oncologists to assess how physician attitudes toward and self-efficacy with cancer follow-up affect preferences for different cancer survivorship models.

Methods

The survey of physician attitudes regarding the care of cancer survivors was mailed to a randomly selected national sample of PCPs and oncologists to evaluate their perspectives regarding physician roles, knowledge about survivorship care processes, and views on cancer surveillance. Multinomial logistic regression models were constructed to examine how physician attitudes towards, and self-efficacy with, their own skills affected preferences for different cancer survivorship care models.

Results

Of 3,434 physicians identified, a total of 2,026 participants provided eligible responses: 938 PCPs and 1,088 oncologists. Most PCPs (51 %) supported a PCP/shared care model; whereas, the majority of specialists (59 %) strongly endorsed an oncologist-based model (p?<?0.001). Less than a quarter of PCPs and oncologists preferred specialized survivor clinics. A significant proportion of oncologists (87 %) did not feel that PCPs should take on the primary role of cancer follow-up. Most PCPs believed that they were better able to perform breast and colorectal cancer follow-up (57 %), detect recurrent cancers (74 %), and offer psychosocial support (50 %), but only a minority (32 %) was willing to assume primary responsibility. PCPs already involved with cancer surveillance (43 %) were more likely to prefer a PCP/shared care than oncologist-based survivorship model (OR, 2.08; 95 % CI, 1.34–3.23).

Conclusions and Implications for Cancer Survivors

PCPs and oncologists have different preferences for models of cancer survivorship care. Prior involvement with cancer surveillance was one of the strongest predictors of PCPs’ willingness to assume this responsibility.

     

Fostering partnerships in survivorship care: report of the 2011 Canadian genitourinary cancers survivorship conference

Purpose  

New models of survivorship care are required to address the needs of genitourinary (GU) cancer survivors. Current approaches do not effectively engage cancer survivors or advocacy groups. A group of clinicians in collaboration with the Canadian Urologic Association held a forum for GU cancer survivors, advocacy groups, and health professionals to explore ways to collaboratively enhance survivorship care.     

Cancer diagnostic assessment programs: standards for the organization of care in Ontario

Background

Improving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a high-quality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap.

Methods

As a quality initiative of Cancer Care Ontario’s Program in Evidence-Based Care, the Diagnostic Assessment Standards Panel, with representation from clinical oncology experts, institutional and clinical administrative leaders, health service researchers, and methodologists, conducted a systematic review and a targeted environmental scan of the unpublished literature. Standards were developed based on expert consensus opinion informed by the identified evidence. Through external review, clinicians and administrators across Ontario were given the opportunity to provide feedback.

Results

The body of evidence consists of thirty-five published studies and fifteen unpublished guidance documents. The evidence and consensus opinion consistently favoured an organized, centralized system with multidisciplinary team membership as the optimal approach for the delivery of diagnostic cancer assessment services. Independent external stakeholders agreed (with higher mean values, maximum 5, indicating stronger agreement) that dap standards are needed (mean: 4.6), that standards should be formally approved (mean: 4.3), and importantly, that standards reflect an effective approach that will lead to quality improvements in the cancer system (mean: 4.5) and in patient care (mean: 4.3).

Interpretation

Based on the best available evidence, standards for the organization of daps are offered. There is clear need to integrate formal and comprehensive evaluation strategies with the implementation of the standards to advance this field.     

Education and training programs at the National Cancer Institute: 1938-1982

The National Cancer Institute (NCI) has supported cancer research training and clinical cancer education since 1938, the latter in a variety of forms. These include direct clinical fellowships, followed by institutional grants designed to improve the education of students concerning cancer in medical and dental schools, and subsequently in teaching hospitals. The institutional grants went through three stages between 1948 and 1982, and have recently entered a fourth. Undergraduate Cancer Training Grants supported cancer teaching for medical and dental students. Clinical Cancer Training Grants expanded teaching activities to include post-resident trainees and medical and dental practitioners. Clinical Cancer Education Grants further extended cancer education and emphasized goals, objectives and evaluation, and focused on areas of weakness in cancer teaching such as epidemiology and cancer, cancer prevention and the role of radiation therapy. The various pressures within and without NCI that have influenced the development of these grant programs are discussed. Some cancer education activities supported by Cancer Control programs, both at NCI and another agency of the Public Health Service, are briefly mentioned. Aspects of the grant review process, program monitoring, and the impact of a professional organization developed in direct response to the first institutional cancer education grant program are described.