Original Report

Background Limited access to cancer genetic counselors (GC) may result in the lack of patient identification and/or failure to show due to travel distance and complicated treatment schedules.

Objective We hypothesized that access would improve when a GC collaborated with distant nongenetics health care providers to provide services locally.

Methods Patients at a collaborative site were offered a risk assessment survey that was reviewed remotely by a licensed, boardcertified GC. Patients were triaged such that the onsite registered nurse (RN) provided basic risk assessment and offered genetic testing for straight-forward hereditary breast and ovarian cases. Ongoing training and support was provided by the GC. Followup and complex cases were scheduled with the GC during a monthly outreach visit to the collaborative site.

Results During the 1-year study period, the total number of patients who accessed genetic counseling services from the target region was 4 times greater than the previous year. Ten of 17 patients who were triaged for genetic counseling and testing underwent genetic risk assessment services as a result of this identification and triage protocol.

Conclusion This defines a workable approach for patient identification and triage for hereditary cancer risk assessment and genetic counseling in a community setting. This collaborative approach may be applicable to centers that do not have access to a board-certified GC, especially important in light of the 2012 Commission on Cancer Standards that require cancer risk assessment, genetic counseling and testing services on site or by referral.

Click on the PDF icon at the top of this introduction to read the full article.

Background Limited access to cancer genetic counselors (GC) may result in the lack of patient identification and/or failure to show due to travel distance and complicated treatment schedules.

Objective We hypothesized that access would improve when a GC collaborated with distant nongenetics health care providers to provide services locally.

Methods Patients at a collaborative site were offered a risk assessment survey that was reviewed remotely by a licensed, boardcertified GC. Patients were triaged such that the onsite registered nurse (RN) provided basic risk assessment and offered genetic testing for straight-forward hereditary breast and ovarian cases. Ongoing training and support was provided by the GC. Followup and complex cases were scheduled with the GC during a monthly outreach visit to the collaborative site.

Results During the 1-year study period, the total number of patients who accessed genetic counseling services from the target region was 4 times greater than the previous year. Ten of 17 patients who were triaged for genetic counseling and testing underwent genetic risk assessment services as a result of this identification and triage protocol.

Conclusion This defines a workable approach for patient identification and triage for hereditary cancer risk assessment and genetic counseling in a community setting. This collaborative approach may be applicable to centers that do not have access to a board-certified GC, especially important in light of the 2012 Commission on Cancer Standards that require cancer risk assessment, genetic counseling and testing services on site or by referral.

Click on the PDF icon at the top of this introduction to read the full article.

Background Limited access to cancer genetic counselors (GC) may result in the lack of patient identification and/or failure to show due to travel distance and complicated treatment schedules.

Objective We hypothesized that access would improve when a GC collaborated with distant nongenetics health care providers to provide services locally.

Methods Patients at a collaborative site were offered a risk assessment survey that was reviewed remotely by a licensed, boardcertified GC. Patients were triaged such that the onsite registered nurse (RN) provided basic risk assessment and offered genetic testing for straight-forward hereditary breast and ovarian cases. Ongoing training and support was provided by the GC. Followup and complex cases were scheduled with the GC during a monthly outreach visit to the collaborative site.

Results During the 1-year study period, the total number of patients who accessed genetic counseling services from the target region was 4 times greater than the previous year. Ten of 17 patients who were triaged for genetic counseling and testing underwent genetic risk assessment services as a result of this identification and triage protocol.

Conclusion This defines a workable approach for patient identification and triage for hereditary cancer risk assessment and genetic counseling in a community setting. This collaborative approach may be applicable to centers that do not have access to a board-certified GC, especially important in light of the 2012 Commission on Cancer Standards that require cancer risk assessment, genetic counseling and testing services on site or by referral.

Click on the PDF icon at the top of this introduction to read the full article.

Background Locally advanced pancreatic cancer (LAPC) is associated with poor outcome, and clinical trials are imperative to address this. However, barriers to trial enrollment often exist, particularly in socio-economically challenged populations.

Objective To evaluate the outcome of socio-economically challenged patients who had LAPC, multiple comorbidities, and who were not enrolled on clinical trials, but who were treated with the best standard-of-care.

Methods We retrospectively reviewed the charts of 32 patients diagnosed as having LAPC who were referred to an urban cancer center between 2005 and 2010, analyzing the treatment and outcomes of 19 who underwent treatment at our center.

Results In all 26.3% of the analyzed patients had commercial insurance, 31.6% did not identify English as their preferred language, and 84.2% had 3 or more comorbidities. The median overall survival was 19.1 months, with estimated 1- and 2-year survivals of 60.8% and 36.5%, respectively. The median survival for patients receiving chemotherapy followed by chemoradiation was 26.6 months. Toxicities were controllable. Translation services were required by 26% and social services interventions by 84%. Survival analysis based on insurance coverage did not show a significant association with levels of reimbursement.

Limitations Retrospective study, small sample size, differences in chemotherapy types.

Conclusions These patients, representative of a diverse and socio-economically challenged community, were able to receive standard-of-care therapies with acceptable toxicity and to achieve survivals comparable with clinical trials. This was achieved with intense supportive services.

Click on the PDF icon at the top of this introduction to read the full article.

Background Locally advanced pancreatic cancer (LAPC) is associated with poor outcome, and clinical trials are imperative to address this. However, barriers to trial enrollment often exist, particularly in socio-economically challenged populations.

Objective To evaluate the outcome of socio-economically challenged patients who had LAPC, multiple comorbidities, and who were not enrolled on clinical trials, but who were treated with the best standard-of-care.

Methods We retrospectively reviewed the charts of 32 patients diagnosed as having LAPC who were referred to an urban cancer center between 2005 and 2010, analyzing the treatment and outcomes of 19 who underwent treatment at our center.

Results In all 26.3% of the analyzed patients had commercial insurance, 31.6% did not identify English as their preferred language, and 84.2% had 3 or more comorbidities. The median overall survival was 19.1 months, with estimated 1- and 2-year survivals of 60.8% and 36.5%, respectively. The median survival for patients receiving chemotherapy followed by chemoradiation was 26.6 months. Toxicities were controllable. Translation services were required by 26% and social services interventions by 84%. Survival analysis based on insurance coverage did not show a significant association with levels of reimbursement.

Limitations Retrospective study, small sample size, differences in chemotherapy types.

Conclusions These patients, representative of a diverse and socio-economically challenged community, were able to receive standard-of-care therapies with acceptable toxicity and to achieve survivals comparable with clinical trials. This was achieved with intense supportive services.

Click on the PDF icon at the top of this introduction to read the full article.

Background Locally advanced pancreatic cancer (LAPC) is associated with poor outcome, and clinical trials are imperative to address this. However, barriers to trial enrollment often exist, particularly in socio-economically challenged populations.

Objective To evaluate the outcome of socio-economically challenged patients who had LAPC, multiple comorbidities, and who were not enrolled on clinical trials, but who were treated with the best standard-of-care.

Methods We retrospectively reviewed the charts of 32 patients diagnosed as having LAPC who were referred to an urban cancer center between 2005 and 2010, analyzing the treatment and outcomes of 19 who underwent treatment at our center.

Results In all 26.3% of the analyzed patients had commercial insurance, 31.6% did not identify English as their preferred language, and 84.2% had 3 or more comorbidities. The median overall survival was 19.1 months, with estimated 1- and 2-year survivals of 60.8% and 36.5%, respectively. The median survival for patients receiving chemotherapy followed by chemoradiation was 26.6 months. Toxicities were controllable. Translation services were required by 26% and social services interventions by 84%. Survival analysis based on insurance coverage did not show a significant association with levels of reimbursement.

Limitations Retrospective study, small sample size, differences in chemotherapy types.

Conclusions These patients, representative of a diverse and socio-economically challenged community, were able to receive standard-of-care therapies with acceptable toxicity and to achieve survivals comparable with clinical trials. This was achieved with intense supportive services.

Click on the PDF icon at the top of this introduction to read the full article.

Background and objective The optimal primary intervention for treatment of clinically localized high-grade prostate adenocarcinoma remains to be identified. The present investigation reports disease control and survival outcomes in patients treated with primary radical prostatectomy.

Methods Eligible patients were diagnosed with Gleason score 8-10 at diagnostic biopsy and prostate-specific antigen (PSA) greater than  30 ng/mL, treated with primary radical prostatectomy, without clinical evidence of distant metastatic disease, seminal vesicle invasion, or lymph node involvement. Demographic, treatment, and outcome data were retrospectively collected and analyzed from a clinical database. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints.

Results Fifty patients were eligible for the present analysis, with Gleason 8 and 9 in 32 (64%) and 18 (36%) patients, respectively. Surgical margin, seminal vesicle, and lymph node involvement were noted 32 (64%), 18 (36%), and 6 (12%) patients, respectively; only 4 (8%) received adjuvant radiotherapy. At a median follow-up of 44.9 months (range, 4.2-104.6), 33 patients (66%) had experienced PSA relapse, of whom 7 have been successfully salvaged. Four patients died, all with uncontrolled disease. The estimated 5-year freedom from failure was 17%. Interval from biopsy to prostatectomy, surgical margin status, and seminal vesicle involvement were associated with decreased overall survival.

Conclusions High-risk Gleason score at biopsy is associated with suboptimal PSA control at 5 years following prostatectomy alone; however, in the setting of uninvolved seminal vesicles and lymph nodes, the dominant pattern of failure appears to be local, and early postoperative radiotherapy should be considered.

Click on the PDF icon at the top of this introduction to read the full article.

Background and objective The optimal primary intervention for treatment of clinically localized high-grade prostate adenocarcinoma remains to be identified. The present investigation reports disease control and survival outcomes in patients treated with primary radical prostatectomy.

Methods Eligible patients were diagnosed with Gleason score 8-10 at diagnostic biopsy and prostate-specific antigen (PSA) greater than  30 ng/mL, treated with primary radical prostatectomy, without clinical evidence of distant metastatic disease, seminal vesicle invasion, or lymph node involvement. Demographic, treatment, and outcome data were retrospectively collected and analyzed from a clinical database. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints.

Results Fifty patients were eligible for the present analysis, with Gleason 8 and 9 in 32 (64%) and 18 (36%) patients, respectively. Surgical margin, seminal vesicle, and lymph node involvement were noted 32 (64%), 18 (36%), and 6 (12%) patients, respectively; only 4 (8%) received adjuvant radiotherapy. At a median follow-up of 44.9 months (range, 4.2-104.6), 33 patients (66%) had experienced PSA relapse, of whom 7 have been successfully salvaged. Four patients died, all with uncontrolled disease. The estimated 5-year freedom from failure was 17%. Interval from biopsy to prostatectomy, surgical margin status, and seminal vesicle involvement were associated with decreased overall survival.

Conclusions High-risk Gleason score at biopsy is associated with suboptimal PSA control at 5 years following prostatectomy alone; however, in the setting of uninvolved seminal vesicles and lymph nodes, the dominant pattern of failure appears to be local, and early postoperative radiotherapy should be considered.

Click on the PDF icon at the top of this introduction to read the full article.

Background and objective The optimal primary intervention for treatment of clinically localized high-grade prostate adenocarcinoma remains to be identified. The present investigation reports disease control and survival outcomes in patients treated with primary radical prostatectomy.

Methods Eligible patients were diagnosed with Gleason score 8-10 at diagnostic biopsy and prostate-specific antigen (PSA) greater than  30 ng/mL, treated with primary radical prostatectomy, without clinical evidence of distant metastatic disease, seminal vesicle invasion, or lymph node involvement. Demographic, treatment, and outcome data were retrospectively collected and analyzed from a clinical database. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints.

Results Fifty patients were eligible for the present analysis, with Gleason 8 and 9 in 32 (64%) and 18 (36%) patients, respectively. Surgical margin, seminal vesicle, and lymph node involvement were noted 32 (64%), 18 (36%), and 6 (12%) patients, respectively; only 4 (8%) received adjuvant radiotherapy. At a median follow-up of 44.9 months (range, 4.2-104.6), 33 patients (66%) had experienced PSA relapse, of whom 7 have been successfully salvaged. Four patients died, all with uncontrolled disease. The estimated 5-year freedom from failure was 17%. Interval from biopsy to prostatectomy, surgical margin status, and seminal vesicle involvement were associated with decreased overall survival.

Conclusions High-risk Gleason score at biopsy is associated with suboptimal PSA control at 5 years following prostatectomy alone; however, in the setting of uninvolved seminal vesicles and lymph nodes, the dominant pattern of failure appears to be local, and early postoperative radiotherapy should be considered.

Click on the PDF icon at the top of this introduction to read the full article.

Purpose To assess the feasibility of using a multimedia program to teach caregivers of Veterans with cancer how to offer basic massage for supportive care at home.

Methods Feasibility was assessed according to partner availability, compliance with watching training materials and practicing massage regularly, compliance with data collection; perceived study materials burden; clarity of instructional and other study materials. Pre- and post-massage changes in patients’ symptom scores were measured using a numerical rate scale. A semistructured exit interview was answered by patient and caregiver at the end of the study.

Results A total of 27 dyads were recruited. Veterans were 78% male. Forty-eight percent were diagnosed with hematologic malignancies (85%, advanced stage); 52% were diagnosed with solid tumors (64% advanced stage). Caregivers were 78% female; 81% were spouses. Out of the 27 pairs, 11 completed 8 weeks of data and practiced massage weekly. The majority of attrition (69%) was due to caregivers’ burden. Caregivers reported instructional  materials were clear, high quality, and easy to use. Patients were highly satisfied with receiving touch from their partners regularly. Post-massage  symptom scores showed statistically significant decreases in pain, stress/anxiety, and fatigue. Perceived burden of data collection instruments was high, particularly for patients.

Conclusion It is feasible to use the TCC program to train caregivers of Veterans with cancer to offer massage for supportive
care at home. Future studies should evaluate ways of providing support to caregivers, including offering massage to them, and
easing the burden of data collection for patients.

*For a PDF of the full article, click on the link to the left of this introduction.

Purpose To assess the feasibility of using a multimedia program to teach caregivers of Veterans with cancer how to offer basic massage for supportive care at home.

Methods Feasibility was assessed according to partner availability, compliance with watching training materials and practicing massage regularly, compliance with data collection; perceived study materials burden; clarity of instructional and other study materials. Pre- and post-massage changes in patients’ symptom scores were measured using a numerical rate scale. A semistructured exit interview was answered by patient and caregiver at the end of the study.

Results A total of 27 dyads were recruited. Veterans were 78% male. Forty-eight percent were diagnosed with hematologic malignancies (85%, advanced stage); 52% were diagnosed with solid tumors (64% advanced stage). Caregivers were 78% female; 81% were spouses. Out of the 27 pairs, 11 completed 8 weeks of data and practiced massage weekly. The majority of attrition (69%) was due to caregivers’ burden. Caregivers reported instructional  materials were clear, high quality, and easy to use. Patients were highly satisfied with receiving touch from their partners regularly. Post-massage  symptom scores showed statistically significant decreases in pain, stress/anxiety, and fatigue. Perceived burden of data collection instruments was high, particularly for patients.

Conclusion It is feasible to use the TCC program to train caregivers of Veterans with cancer to offer massage for supportive
care at home. Future studies should evaluate ways of providing support to caregivers, including offering massage to them, and
easing the burden of data collection for patients.

*For a PDF of the full article, click on the link to the left of this introduction.

Purpose To assess the feasibility of using a multimedia program to teach caregivers of Veterans with cancer how to offer basic massage for supportive care at home.

Methods Feasibility was assessed according to partner availability, compliance with watching training materials and practicing massage regularly, compliance with data collection; perceived study materials burden; clarity of instructional and other study materials. Pre- and post-massage changes in patients’ symptom scores were measured using a numerical rate scale. A semistructured exit interview was answered by patient and caregiver at the end of the study.

Results A total of 27 dyads were recruited. Veterans were 78% male. Forty-eight percent were diagnosed with hematologic malignancies (85%, advanced stage); 52% were diagnosed with solid tumors (64% advanced stage). Caregivers were 78% female; 81% were spouses. Out of the 27 pairs, 11 completed 8 weeks of data and practiced massage weekly. The majority of attrition (69%) was due to caregivers’ burden. Caregivers reported instructional  materials were clear, high quality, and easy to use. Patients were highly satisfied with receiving touch from their partners regularly. Post-massage  symptom scores showed statistically significant decreases in pain, stress/anxiety, and fatigue. Perceived burden of data collection instruments was high, particularly for patients.

Conclusion It is feasible to use the TCC program to train caregivers of Veterans with cancer to offer massage for supportive
care at home. Future studies should evaluate ways of providing support to caregivers, including offering massage to them, and
easing the burden of data collection for patients.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Patient understanding of advanced metastatic disease is central to decisions about care near death. Prior studies have focused on gender differences in communication style rather than on illness understanding.

Objectives To evaluate gender differences in terminal illness acknowledgement (TIA), understanding that the disease is incurable and the advanced stage of the disease. To evaluate gender differences in patients’ reports of discussions of life expectancy with oncology providers and its effect on differences in illness understanding.

Methods Coping with Cancer 2 patients (N 68) were interviewed before and after a visit with their oncology providers to discuss scan results.

Results At the prescan interview, there were no statistically significant gender differences in patient measures of illness understanding. At the postscan interview, women were more likely than men to recognize that their illness was incurable (Adjusted Odds Ratio, [AOR] 5.29; P .038), know that their cancer was at an advanced stage (AOR, 6.38; P, .013), and report having had discussions of life expectancy with their oncologist (AOR, 4.77; P, .021). Controlling discussions of life expectancy, women were more likely than men to report that their cancer was at an advanced stage (AOR, 9.53; P .050). Controlling for gender, discussions of life expectancy were associated with higher rates of TIA (AOR, 4.65; P, .036) and higher rates of understanding that the cancer was incurable (AOR, 4.09;  P .085).

Conclusions Due largely to gender differences in communication, women over time have a better understanding of their illness than men. More frequent discussions of life expectancy should enhance illness understanding and reduce gender differences.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Patient understanding of advanced metastatic disease is central to decisions about care near death. Prior studies have focused on gender differences in communication style rather than on illness understanding.

Objectives To evaluate gender differences in terminal illness acknowledgement (TIA), understanding that the disease is incurable and the advanced stage of the disease. To evaluate gender differences in patients’ reports of discussions of life expectancy with oncology providers and its effect on differences in illness understanding.

Methods Coping with Cancer 2 patients (N 68) were interviewed before and after a visit with their oncology providers to discuss scan results.

Results At the prescan interview, there were no statistically significant gender differences in patient measures of illness understanding. At the postscan interview, women were more likely than men to recognize that their illness was incurable (Adjusted Odds Ratio, [AOR] 5.29; P .038), know that their cancer was at an advanced stage (AOR, 6.38; P, .013), and report having had discussions of life expectancy with their oncologist (AOR, 4.77; P, .021). Controlling discussions of life expectancy, women were more likely than men to report that their cancer was at an advanced stage (AOR, 9.53; P .050). Controlling for gender, discussions of life expectancy were associated with higher rates of TIA (AOR, 4.65; P, .036) and higher rates of understanding that the cancer was incurable (AOR, 4.09;  P .085).

Conclusions Due largely to gender differences in communication, women over time have a better understanding of their illness than men. More frequent discussions of life expectancy should enhance illness understanding and reduce gender differences.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Patient understanding of advanced metastatic disease is central to decisions about care near death. Prior studies have focused on gender differences in communication style rather than on illness understanding.

Objectives To evaluate gender differences in terminal illness acknowledgement (TIA), understanding that the disease is incurable and the advanced stage of the disease. To evaluate gender differences in patients’ reports of discussions of life expectancy with oncology providers and its effect on differences in illness understanding.

Methods Coping with Cancer 2 patients (N 68) were interviewed before and after a visit with their oncology providers to discuss scan results.

Results At the prescan interview, there were no statistically significant gender differences in patient measures of illness understanding. At the postscan interview, women were more likely than men to recognize that their illness was incurable (Adjusted Odds Ratio, [AOR] 5.29; P .038), know that their cancer was at an advanced stage (AOR, 6.38; P, .013), and report having had discussions of life expectancy with their oncologist (AOR, 4.77; P, .021). Controlling discussions of life expectancy, women were more likely than men to report that their cancer was at an advanced stage (AOR, 9.53; P .050). Controlling for gender, discussions of life expectancy were associated with higher rates of TIA (AOR, 4.65; P, .036) and higher rates of understanding that the cancer was incurable (AOR, 4.09;  P .085).

Conclusions Due largely to gender differences in communication, women over time have a better understanding of their illness than men. More frequent discussions of life expectancy should enhance illness understanding and reduce gender differences.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Symptom management medications are often compounded into topical gel formulations providing an alternative route of administration for hospice and palliative care patients. Though commonly used, transdermal absorption and bioavailability studies of these gel products are lacking. Chlorpromazine was studied because it is FDA approved for treatment of nausea and vomiting and is used off-label for treatment of agitation and delirium.

Objective The objective of this study is to determine the transdermal absorption of chlorpromazine PLO gel in healthy adults.

Methods Twenty-five milligrams of chlorpromazine in PLO gel was applied to 10 subjects’ wrists and 100 mg was applied to 1 subject’s wrist. Blood draws were completed preapplication and 1, 2, and 4 hours postapplication. This single-center unblinded study recruited healthy adults between 18 and 70 years of age. Participants were not pregnant, did not have an allergy to any component of the study medication, and were not taking a phenothiazine medication.

Results Chlorpromazine was undetected in any of the 11 subjects’ blood samples.

Limitations There is an assumption of equivalent medication absorption in healthy patients and palliative care or hospice patients.

Conclusion Rapid relief of symptoms at end of life is essential. Chlorpromazine in PLO gel may not be an effective treatment option since blood levels were undetectable at 1, 2, and 4 hours after topical application.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Symptom management medications are often compounded into topical gel formulations providing an alternative route of administration for hospice and palliative care patients. Though commonly used, transdermal absorption and bioavailability studies of these gel products are lacking. Chlorpromazine was studied because it is FDA approved for treatment of nausea and vomiting and is used off-label for treatment of agitation and delirium.

Objective The objective of this study is to determine the transdermal absorption of chlorpromazine PLO gel in healthy adults.

Methods Twenty-five milligrams of chlorpromazine in PLO gel was applied to 10 subjects’ wrists and 100 mg was applied to 1 subject’s wrist. Blood draws were completed preapplication and 1, 2, and 4 hours postapplication. This single-center unblinded study recruited healthy adults between 18 and 70 years of age. Participants were not pregnant, did not have an allergy to any component of the study medication, and were not taking a phenothiazine medication.

Results Chlorpromazine was undetected in any of the 11 subjects’ blood samples.

Limitations There is an assumption of equivalent medication absorption in healthy patients and palliative care or hospice patients.

Conclusion Rapid relief of symptoms at end of life is essential. Chlorpromazine in PLO gel may not be an effective treatment option since blood levels were undetectable at 1, 2, and 4 hours after topical application.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Symptom management medications are often compounded into topical gel formulations providing an alternative route of administration for hospice and palliative care patients. Though commonly used, transdermal absorption and bioavailability studies of these gel products are lacking. Chlorpromazine was studied because it is FDA approved for treatment of nausea and vomiting and is used off-label for treatment of agitation and delirium.

Objective The objective of this study is to determine the transdermal absorption of chlorpromazine PLO gel in healthy adults.

Methods Twenty-five milligrams of chlorpromazine in PLO gel was applied to 10 subjects’ wrists and 100 mg was applied to 1 subject’s wrist. Blood draws were completed preapplication and 1, 2, and 4 hours postapplication. This single-center unblinded study recruited healthy adults between 18 and 70 years of age. Participants were not pregnant, did not have an allergy to any component of the study medication, and were not taking a phenothiazine medication.

Results Chlorpromazine was undetected in any of the 11 subjects’ blood samples.

Limitations There is an assumption of equivalent medication absorption in healthy patients and palliative care or hospice patients.

Conclusion Rapid relief of symptoms at end of life is essential. Chlorpromazine in PLO gel may not be an effective treatment option since blood levels were undetectable at 1, 2, and 4 hours after topical application.

*For a PDF of the full article, click on the link to the left of this introduction.

Most patients with esophageal cancer are diagnosed with locoregionally advanced disease at presentation, with an overall 5-year survival rate of 19%.¹ Clinical trials have failed to specify the optimal treatment regimen; however, a multimodal approach to therapy is considered the standard of care for patients with locoregionally advanced disease.² Most often, patients are treated with chemoradiotherapy with or without subsequent esophagectomy. Curative-intent interventions for advanced esophageal cancer are necessarily aggressive and may be associated with significant morbidity and even treatment-related mortality. Appropriate selection of patients for intervention is necessary so that those who are most likely to benefit can initiate curative-intent therapy, whereas those who are unlikely to benefit from intervention may be appropriately initiated on less toxic palliative-intent treatment. The use of positron emission tomography (PET) in esophageal cancer staging has improved the ability to detect distant disease at diagnosis,^3-7 an important factor in determining the appropriate treatment regimen and prognosis…

To read the full article, click on the PDF icon at the top of this introduction.

Most patients with esophageal cancer are diagnosed with locoregionally advanced disease at presentation, with an overall 5-year survival rate of 19%.¹ Clinical trials have failed to specify the optimal treatment regimen; however, a multimodal approach to therapy is considered the standard of care for patients with locoregionally advanced disease.² Most often, patients are treated with chemoradiotherapy with or without subsequent esophagectomy. Curative-intent interventions for advanced esophageal cancer are necessarily aggressive and may be associated with significant morbidity and even treatment-related mortality. Appropriate selection of patients for intervention is necessary so that those who are most likely to benefit can initiate curative-intent therapy, whereas those who are unlikely to benefit from intervention may be appropriately initiated on less toxic palliative-intent treatment. The use of positron emission tomography (PET) in esophageal cancer staging has improved the ability to detect distant disease at diagnosis,^3-7 an important factor in determining the appropriate treatment regimen and prognosis…

To read the full article, click on the PDF icon at the top of this introduction.

Most patients with esophageal cancer are diagnosed with locoregionally advanced disease at presentation, with an overall 5-year survival rate of 19%.¹ Clinical trials have failed to specify the optimal treatment regimen; however, a multimodal approach to therapy is considered the standard of care for patients with locoregionally advanced disease.² Most often, patients are treated with chemoradiotherapy with or without subsequent esophagectomy. Curative-intent interventions for advanced esophageal cancer are necessarily aggressive and may be associated with significant morbidity and even treatment-related mortality. Appropriate selection of patients for intervention is necessary so that those who are most likely to benefit can initiate curative-intent therapy, whereas those who are unlikely to benefit from intervention may be appropriately initiated on less toxic palliative-intent treatment. The use of positron emission tomography (PET) in esophageal cancer staging has improved the ability to detect distant disease at diagnosis,^3-7 an important factor in determining the appropriate treatment regimen and prognosis…

To read the full article, click on the PDF icon at the top of this introduction.

Background The role of radiotherapy in palliation is well recognized. Analyzing referrals from an inpatient palliative care unit to the radiation oncology service may help in planning palliative care services and educational programs.

Objective To determine the pattern and rate of referrals from a PCU to the RO service at a tertiary oncology facility in Saudi Arabia.

Methods Referrals from the PCU to the RO service were prospectively identified over the period beginning November 27, 2007 and ending March 9, 2011. The appropriateness of referrals was determined by 2 radiation oncologists.

Results Of the 635 cancer admissions to the PCU, 25 (3.9%) referrals to RO were made, and 32 sites were irradiated. All patients had a poor performance status (ECOG 3). The most common areas irradiated were vertebrae (40.6%), pelvis (18.7%) and other bony structures (28.1%). Pain control was the most frequent reason for referral (87.5%). Only one referral was regarded by the RO service as inappropriate, indicating that 96% of the referrals were appropriate. The mean time lapse between referral and starting radiation was 4 3.6 days. A total of 75% of the patients died in the PCU within a median of 30 days post radiotherapy.

Conclusion The small minority of patients in the PCU referred for radiotherapy were deemed appropriate referrals by the radiation oncologists despite their poor performance status and limited time remaining. When planning a PCU with similar admission criteria, the availability of a radiotherapy facility in close proximity may not be a priority.

Click on the PDF icon at the top of this introduction to read the full article.

Background The role of radiotherapy in palliation is well recognized. Analyzing referrals from an inpatient palliative care unit to the radiation oncology service may help in planning palliative care services and educational programs.

Objective To determine the pattern and rate of referrals from a PCU to the RO service at a tertiary oncology facility in Saudi Arabia.

Methods Referrals from the PCU to the RO service were prospectively identified over the period beginning November 27, 2007 and ending March 9, 2011. The appropriateness of referrals was determined by 2 radiation oncologists.

Results Of the 635 cancer admissions to the PCU, 25 (3.9%) referrals to RO were made, and 32 sites were irradiated. All patients had a poor performance status (ECOG 3). The most common areas irradiated were vertebrae (40.6%), pelvis (18.7%) and other bony structures (28.1%). Pain control was the most frequent reason for referral (87.5%). Only one referral was regarded by the RO service as inappropriate, indicating that 96% of the referrals were appropriate. The mean time lapse between referral and starting radiation was 4 3.6 days. A total of 75% of the patients died in the PCU within a median of 30 days post radiotherapy.

Conclusion The small minority of patients in the PCU referred for radiotherapy were deemed appropriate referrals by the radiation oncologists despite their poor performance status and limited time remaining. When planning a PCU with similar admission criteria, the availability of a radiotherapy facility in close proximity may not be a priority.

Click on the PDF icon at the top of this introduction to read the full article.

Background The role of radiotherapy in palliation is well recognized. Analyzing referrals from an inpatient palliative care unit to the radiation oncology service may help in planning palliative care services and educational programs.

Objective To determine the pattern and rate of referrals from a PCU to the RO service at a tertiary oncology facility in Saudi Arabia.

Methods Referrals from the PCU to the RO service were prospectively identified over the period beginning November 27, 2007 and ending March 9, 2011. The appropriateness of referrals was determined by 2 radiation oncologists.

Results Of the 635 cancer admissions to the PCU, 25 (3.9%) referrals to RO were made, and 32 sites were irradiated. All patients had a poor performance status (ECOG 3). The most common areas irradiated were vertebrae (40.6%), pelvis (18.7%) and other bony structures (28.1%). Pain control was the most frequent reason for referral (87.5%). Only one referral was regarded by the RO service as inappropriate, indicating that 96% of the referrals were appropriate. The mean time lapse between referral and starting radiation was 4 3.6 days. A total of 75% of the patients died in the PCU within a median of 30 days post radiotherapy.

Conclusion The small minority of patients in the PCU referred for radiotherapy were deemed appropriate referrals by the radiation oncologists despite their poor performance status and limited time remaining. When planning a PCU with similar admission criteria, the availability of a radiotherapy facility in close proximity may not be a priority.

Click on the PDF icon at the top of this introduction to read the full article.

Background Improved measurement of clinically meaningful symptoms is needed in advanced bladder cancer.

Objective This study developed and examined the initial reliability and validity of a new measure of advanced bladder cancer specific symptoms, the NCCN-FACT Bladder Symptom Index-18 (NFBlSI-18), which assesses the symptoms perceived as most important by patients and oncology clinical experts.

Methods A total of 31 individuals with advanced bladder cancer rated the importance of 28 symptoms. In addition, 10 oncology clinical experts rated symptoms as treatment- or disease-related. Patient-rated symptoms were reconciled with published clinicians’ symptom priorities, producing the NFBlSI-18.  Participants completed measures of quality of life (QoL) and performance status to examine initial validity.

Results An 18-item symptom index for advanced bladder cancer included 3 subscales: disease-related symptoms, treatment side effects, and general function/well-being. Lower scores indicate greater symptom burden. Preliminary reliability reveals good internal consistency for the full NFBlSI-18 ( 0.83). The NFBlSI-18 was significantly associated with QOL criteria and performance status, in the expected direction.

Limitations Limitations include the cross-sectional design and the relatively low reliability of the disease-related symptoms subscale.

Conclusion The NFBlSI-18 demonstrates preliminary evidence as a valid brief measure of the most important symptoms of advanced bladder cancer, as rated by both patients and oncology clinical experts. The NFBlSI-18 should have greater acceptability to regulatory authorities than previously developed questionnaires.

*Click on the PDF icon at the top of this introduction to read the full article.

Background Improved measurement of clinically meaningful symptoms is needed in advanced bladder cancer.

Objective This study developed and examined the initial reliability and validity of a new measure of advanced bladder cancer specific symptoms, the NCCN-FACT Bladder Symptom Index-18 (NFBlSI-18), which assesses the symptoms perceived as most important by patients and oncology clinical experts.

Methods A total of 31 individuals with advanced bladder cancer rated the importance of 28 symptoms. In addition, 10 oncology clinical experts rated symptoms as treatment- or disease-related. Patient-rated symptoms were reconciled with published clinicians’ symptom priorities, producing the NFBlSI-18.  Participants completed measures of quality of life (QoL) and performance status to examine initial validity.

Results An 18-item symptom index for advanced bladder cancer included 3 subscales: disease-related symptoms, treatment side effects, and general function/well-being. Lower scores indicate greater symptom burden. Preliminary reliability reveals good internal consistency for the full NFBlSI-18 ( 0.83). The NFBlSI-18 was significantly associated with QOL criteria and performance status, in the expected direction.

Limitations Limitations include the cross-sectional design and the relatively low reliability of the disease-related symptoms subscale.

Conclusion The NFBlSI-18 demonstrates preliminary evidence as a valid brief measure of the most important symptoms of advanced bladder cancer, as rated by both patients and oncology clinical experts. The NFBlSI-18 should have greater acceptability to regulatory authorities than previously developed questionnaires.

*Click on the PDF icon at the top of this introduction to read the full article.

Background Improved measurement of clinically meaningful symptoms is needed in advanced bladder cancer.

Objective This study developed and examined the initial reliability and validity of a new measure of advanced bladder cancer specific symptoms, the NCCN-FACT Bladder Symptom Index-18 (NFBlSI-18), which assesses the symptoms perceived as most important by patients and oncology clinical experts.

Methods A total of 31 individuals with advanced bladder cancer rated the importance of 28 symptoms. In addition, 10 oncology clinical experts rated symptoms as treatment- or disease-related. Patient-rated symptoms were reconciled with published clinicians’ symptom priorities, producing the NFBlSI-18.  Participants completed measures of quality of life (QoL) and performance status to examine initial validity.

Results An 18-item symptom index for advanced bladder cancer included 3 subscales: disease-related symptoms, treatment side effects, and general function/well-being. Lower scores indicate greater symptom burden. Preliminary reliability reveals good internal consistency for the full NFBlSI-18 ( 0.83). The NFBlSI-18 was significantly associated with QOL criteria and performance status, in the expected direction.

Limitations Limitations include the cross-sectional design and the relatively low reliability of the disease-related symptoms subscale.

Conclusion The NFBlSI-18 demonstrates preliminary evidence as a valid brief measure of the most important symptoms of advanced bladder cancer, as rated by both patients and oncology clinical experts. The NFBlSI-18 should have greater acceptability to regulatory authorities than previously developed questionnaires.

*Click on the PDF icon at the top of this introduction to read the full article.

ABSTRACT

Background Burnout among physicians can lead to decreased career satisfaction, physical and emotional exhaustion, and increased medical errors. In oncologists, high exposure to fatal illness is associated with burnout.

Methods The Maslach Burnout Inventory, measuring Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA), was administered to second-year US oncology fellows. Bivariate and multivariate analyses explored associations between burnout and fellow demographics, attitudes, and educational experiences.

Results A total of 254 fellows out of 402 eligible US fellows responded (63.2%) and 24.2% reported high EE, 30.0% reported high DP, and 26.8% reported low PA. Over half of the fellows reported burnout in at least one domain. Lower EE scores were associated with the fellows’ perceptions of having received better teaching, explicit teaching about certain end-of-life topics, and receipt of direct observation of goals-of-care discussions. Fellows who reported better overall teaching quality and more frequent observation of their skills had less depersonalization. Fellows who felt a responsibility to help patients at the end of life to prepare for death had higher PA.

Limitations This survey relies on the fellows’ self-reported perceptions without an objective measure for validation. Factors associated with burnout may not be causal. The number of analyses performed raises the concern for Type I errors; therefore, a stringent P value (.01) was used.

Conclusions Burnout is prevalent during oncology training. Higher-quality teaching is associated with less burnout among fellows. Fellowship programs should recognize the prevalence of burnout among oncology fellows as well as components of training that may protect against burnout.

*For a PDF of the full article, click on the link to the left of this introduction.

ABSTRACT

Background Burnout among physicians can lead to decreased career satisfaction, physical and emotional exhaustion, and increased medical errors. In oncologists, high exposure to fatal illness is associated with burnout.

Methods The Maslach Burnout Inventory, measuring Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA), was administered to second-year US oncology fellows. Bivariate and multivariate analyses explored associations between burnout and fellow demographics, attitudes, and educational experiences.

Results A total of 254 fellows out of 402 eligible US fellows responded (63.2%) and 24.2% reported high EE, 30.0% reported high DP, and 26.8% reported low PA. Over half of the fellows reported burnout in at least one domain. Lower EE scores were associated with the fellows’ perceptions of having received better teaching, explicit teaching about certain end-of-life topics, and receipt of direct observation of goals-of-care discussions. Fellows who reported better overall teaching quality and more frequent observation of their skills had less depersonalization. Fellows who felt a responsibility to help patients at the end of life to prepare for death had higher PA.

Limitations This survey relies on the fellows’ self-reported perceptions without an objective measure for validation. Factors associated with burnout may not be causal. The number of analyses performed raises the concern for Type I errors; therefore, a stringent P value (.01) was used.

Conclusions Burnout is prevalent during oncology training. Higher-quality teaching is associated with less burnout among fellows. Fellowship programs should recognize the prevalence of burnout among oncology fellows as well as components of training that may protect against burnout.

*For a PDF of the full article, click on the link to the left of this introduction.

ABSTRACT

Background Burnout among physicians can lead to decreased career satisfaction, physical and emotional exhaustion, and increased medical errors. In oncologists, high exposure to fatal illness is associated with burnout.

Methods The Maslach Burnout Inventory, measuring Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA), was administered to second-year US oncology fellows. Bivariate and multivariate analyses explored associations between burnout and fellow demographics, attitudes, and educational experiences.

Results A total of 254 fellows out of 402 eligible US fellows responded (63.2%) and 24.2% reported high EE, 30.0% reported high DP, and 26.8% reported low PA. Over half of the fellows reported burnout in at least one domain. Lower EE scores were associated with the fellows’ perceptions of having received better teaching, explicit teaching about certain end-of-life topics, and receipt of direct observation of goals-of-care discussions. Fellows who reported better overall teaching quality and more frequent observation of their skills had less depersonalization. Fellows who felt a responsibility to help patients at the end of life to prepare for death had higher PA.

Limitations This survey relies on the fellows’ self-reported perceptions without an objective measure for validation. Factors associated with burnout may not be causal. The number of analyses performed raises the concern for Type I errors; therefore, a stringent P value (.01) was used.

Conclusions Burnout is prevalent during oncology training. Higher-quality teaching is associated with less burnout among fellows. Fellowship programs should recognize the prevalence of burnout among oncology fellows as well as components of training that may protect against burnout.

*For a PDF of the full article, click on the link to the left of this introduction.