Changes In Cancer Care Research Articles

A New Model: Physician-Patient Collaboration in Online Communities and the Clinical Practice of Oncology

The practice of medicine is in the midst of a fundamental transformation based on the new availability of health information through the Internet and other sources accessible by the broad lay public, as well as on the easy sharing of experiences and content through social media. This is occurring at a time when the volume of new information required for optimal medical care is exceeding that which an individual physician can feasibly follow and master. The changes in cancer care are especially acute as we experience an ongoing reclassification of many disease entities to reflect divisions by molecular variables, often with new clinical options now optimized for very limited patient subsets. The increasing complexity of the field, combined with the high stakes of optimizing treatment decisions and the growing availability of a wide range of information in the public domain, make oncology an area in which patients and caregivers are most motivated to become active seekers of medical information and participants in their care decisions. The credibility of the available online information in such a situation has emerged as a critical issue, but physicians have historically been reluctant to create content or interact with the lay public in online patient communities. Here we will highlight several examples of collaborative engagement between health care professionals and motivated patients in an online environment that illustrate how a new bidirectional or even networked model that is a product of the Internet age can accelerate clinical research and improve delivery of cancer care.

Changes in global patterns of care for first-line advanced nonsquamous (NS) non-small cell lung cancer (NSCLC): 2007-2010.

e16639 Background: Few reports have focused on global changes in cancer care. The objective of this study is to assess changes in first line therapy of NS NSCLC following publication of phase 3 data in Sept 2007 (IASLC 2007), May 2008 (Scagliotti JCO 2008) and May 2009 (ASCO 2009, 8045). Methods: Chemotherapy use in first line NS NSCLC was collected via Synovate’s Tandem Oncology Monitor, a commercial system in which oncologists in US (500), EU (783), Korea (125) and Japan (350) enter de-identified data on patterns of care for cancer patients from their practice monthly. Results: See table. Conclusions: While Plat/ Pac and Plat/ Gem use gradually declined, use of Plat/ Pem and EGFR inhibitors increased. Although results were first presented in 2007 (IASLC), increase in Plat/ Pem use in the US and EU followed publication of the manuscript (JCO, 2008) and Pem approval. The increase occurred in ’09-’10 in Asia following the Asian subgroup analysis (ASCO, 2009) and Pem approval. Jan-Jun 07 Jul-Dec 07 Jan-Jun 08 Jul-Dec 08 Jan-Jun 09 Jul-Dec 09 Jan-Jun 10 Jul-Sept 10 US (N)* 527 586 536 1,222 1,414 1,274 1,217 548 Carbo/Pac ± Bev** 40 42 43 27 28 24 24 28 Plat/Pem ± Bev 0 0 1 5 13 20 18 24 Plat/Gem ± Bev 13 13 13 11 6 6 4 4 Plat/Doc ± Bev 9 9 9 9 6 8 12 8 Single agent 15 20 15 18 18 17 15 14 Erl ± Bev 9 9 10 19 21 17 17 16 Other 8 8 6 4 5 4 5 3 Europe (N)+ 706 803 725 819 911 881 991 485 Plat/ Pac ± Bev 11 9 10 9 10 8 11 13 Plat/ Pem ± Bev 0 0 1 8 10 16 24 26 Plat/ Gem ± Bev 37 35 37 34 26 27 22 18 Plat/Doc 5 7 9 6 5 6 5 4 Plat/Vin 15 17 13 13 16 13 9 7 Single Agent 19 16 16 15 17 13 12 9 EGFR Inhibitor 4 6 6 6 8 11 11 16 Other 7 5 7 6 4 5 3 4 Japan (N) 439 378 403 354 410 362 303 174 Carbo/Pac ± Bev 31 25 33 32 28 27 16 19 Plat/Pem 0 0 0 0 0 10 21 25 Plat/Gem 15 10 14 15 14 12 10 8 Plat/Doc 7 11 6 9 7 5 7 6 Plat/Vin 9 10 6 9 6 6 6 3 Single agent 6 8 11 9 10 7 9 9 EGFR Inhibitor 19 21 20 18 25 28 27 26 Other 12 14 13 10 9 5 4 4 Korea (N) 74 82 97 102 75 98 76 36 Plat/Pac 23 32 24 20 14 23 42 16 Plat/Pem ± Bev 0 0 0 1 0 0 12 14 Plat/Gem ± Bev 37 27 31 17 45 26 28 25 Plat/Doc 17 24 26 33 12 21 7 19 Single agent 8 4 4 7 8 12 5 11 EGFR inhibitor 3 1 2 10 9 2 5 8 Other 11 12 12 13 9 15 2 6 Abbreviations: Plat: Carboplatin or cisplatin; Bev: Bevacizumab; Single agent: docetaxel/gemcitabine/pemetrexed/vinorelbine; EGFR inhibitor: erlotinib/gefitinib. * N: Unique treatments. ** All data are% use. + EU: France, Italy, Germany, UK and Spain

Job stress and job satisfaction of physicians, radiographers, nurses and physicists working in radiotherapy: a multicenter analysis by the DEGRO Quality of Life Work Group.

BackgroundOngoing changes in cancer care cause an increase in the complexity of cases which is characterized by modern treatment techniques and a higher demand for patient information about the underlying disease and therapeutic options. At the same time, the restructuring of health services and reduced funding have led to the downsizing of hospital care services. These trends strongly influence the workplace environment and are a potential source of stress and burnout among professionals working in radiotherapy.Methods and patientsA postal survey was sent to members of the workgroup "Quality of Life" which is part of DEGRO (German Society for Radiooncology). Thus far, 11 departments have answered the survey. 406 (76.1%) out of 534 cancer care workers (23% physicians, 35% radiographers, 31% nurses, 11% physicists) from 8 university hospitals and 3 general hospitals completed the FBAS form (Stress Questionnaire of Physicians and Nurses; 42 items, 7 scales), and a self-designed questionnaire regarding work situation and one question on global job satisfaction. Furthermore, the participants could make voluntary suggestions about how to improve their situation.ResultsNurses and physicians showed the highest level of job stress (total score 2.2 and 2.1). The greatest source of job stress (physicians, nurses and radiographers) stemmed from structural conditions (e.g. underpayment, ringing of the telephone) a "stress by compassion" (e.g. "long suffering of patients", "patients will be kept alive using all available resources against the conviction of staff"). In multivariate analyses professional group (p < 0.001), working night shifts (p = 0.001), age group (p = 0.012) and free time compensation (p = 0.024) gained significance for total FBAS score. Global job satisfaction was 4.1 on a 9-point scale (from 1 – very satisfied to 9 – not satisfied). Comparing the total stress scores of the hospitals and job groups we found significant differences in nurses (p = 0.005) and physicists (p = 0.042) and a borderline significance in physicians (p = 0.052).In multivariate analyses "professional group" (p = 0.006) and "vocational experience" (p = 0.036) were associated with job satisfaction (cancer care workers with < 2 years of vocational experience having a higher global job satisfaction). The total FBAS score correlated with job satisfaction (Spearman-Rho = 0.40; p < 0.001).ConclusionCurrent workplace environments have a negative impact on stress levels and the satisfaction of radiotherapy staff. Identification and removal of the above-mentioned critical points requires various changes which should lead to the reduction of stress.

Multidisciplinary teamwork in urological oncology

The cancer pathway, from primary-care referral to specialist consultation, diagnostic test(s), decision to treat, treatment itself and, invariably, life-long follow-up, has the main aim of curing a patient with minimal morbidity, while maintaining their physical and psychological wellbeing. Recently, in the UK it was recommended that improvements in cancer outcome can be achieved through major organizational changes in cancer care by reorganizing cancer services into ‘cancer networks’ and adopting significant changes in professional practice through the promotion of specialization by individual consultants, a multidisciplinary approach and shared clinical protocols [101]. In urological oncology, it was recommended that all cancer patients should be managed by a multidisciplinary urological cancer team [102]. Taking this mandate forward, patterns of clinical practice have changed and at the heart of modern urological cancer care is the multidisciplinary team (MDT). The MDT consists of: • Consultant urologists; • Clinical and medical oncologists; • Radiologists with expertise in urological cancers to perform imaging investigations in accordance with the Royal College of Radiologists’ Guidelines [1]; • A specialist uropathologist who reports on all the information required by the current Royal College of Pathologists’ minimum dataset for the relevant cancer [103]; • Clinical nurse specialists who have a high level of skill in communication. Patient advocacy and provision of information and support for patients and carers are crucial aspects of this role; • An MDT coordinator, who organizes the weekly meeting and ensures that all required documentation is available at each meeting (e.g., patient lists and case notes); • A designated lead clinician (normally a consultant urologist) who will take overall responsibility for the service. According to the Guidance on Cancer Services: Improving Outcomes in Urological Cancers paper, the main roles of the MDT are: Provision of a rapid diagnostic and assessment service, including satisfying the 2-week-wait criterion [104];

Editorial

Cancer nurses have such a busy time. They are expected to act as advocates and advisors for the individual with a cancer diagnosis and for the people who care for them. This role is particularly problematic because of the many changes in cancer care, new treatments, new ideas and changing views promoted by the media as new causes of the disease are reported almost daily. regarding their own risks and possible prevention strategies.

The economics of reimbursement and technological change in cancer care.

INTRODUCTION THE RECENT evolution towards prospective financing systems may be an important mechanism for cost-containment in healthcare, but the potential interactions with technological innovations in healthcare have, up to now, largely been ignored. Prospective reimbursement is likely to be more conducive to cost-reducing rather than to quality-improving medical innovations. Furthermore, it may slow down the overall pace of technological innovations since funding clinical research, especially phase III projects, may become increasingly difficult. This article concludes with some suggestions to cope with these problems.