Oncology Healthcare Professionals Research Articles

Exploring Herbal Medicine Use during Palliative Cancer Care: The Integrative Physician as a Facilitator of Pharmacist-Patient-Oncologist Communication.

Oncology patients frequently use herbal and other forms of complementary medicine, often without the knowledge of oncologists, pharmacists, and other healthcare professionals responsible for their care. Oncology healthcare professionals may lack the knowledge needed to guide their patients on the safe and effective use of herbal medicinal products, a number of which have potentially harmful effects, which include direct toxicity and negative herb–drug interactions. The current review addresses the prevalence and expectations of oncology patients from herbal medicine, as well as evidence for the beneficial or harmful effects of this practice (potential and actual), especially when the herbal products are used in conjunction with anticancer agents. Models of integrative oncology care are described, in which open and effective communication among oncologists, pharmacists, and integrative physicians on the use of herbal medicine by their patients occurs. This collaboration provides patients with a nonjudgmental and multidisciplinary approach to integrative medicine, echoing their own health-belief models of care during conventional cancer treatments. The role of the integrative physician is to facilitate this process, working with oncologists and pharmacists in the fostering of patient-centered palliative care, while ensuring a safe and effective treatment environment. Case scenario: W. is a 56 year old female artist who was recently diagnosed with localized hormone receptor-positive breast cancer. Following lumpectomy and sentinel node dissection, she is scheduled to begin adjuvant chemotherapy with a regimen which will include adriamycin, cyclophosphamide, and paclitaxel (AC-T protocol). She is worried about developing peripheral neuropathy and its impact on her ability to paint, and she asks about a number of dietary supplements which she heard could prevent this from happening: omega-3, vitamin E, alpha-lipoic acid, and acetyl-l-carnithine. She is concerned, however, that the supplements may negatively interact with her chemotherapy regimen.

Burn-out of the Medical Oncology Health Care Professionals and Associated Factors in Tunisia

Introduction: Burn-out is defined as a syndrome of emotional exhaustion, depersonalization and diminished self-achievement that affects individuals exposed to chronic occupational stress. Physicians and caregivers faced with the death of their patients, such as oncology, are particularly vulnerable to this syndrome.Objectives: To evaluate the burn-out of medical professionals in medical oncology, to research the predisposing factors and to analyze the functional complaints and the behavior of the staff associated with this syndrome.Methods: A descriptive and analytical cross-sectional study among medical oncology professionals practicing in public hospitals in the Tunisian territory who exercise more than two years in oncology; with the Maslach Burnout Inventory (MBI).Results: Our study population was predominantly female (81%). 53% are doctors and 47% are paramedical health care professionals. A high degree of emotional exhaustion, depersonalization and personal achievement were found in 63%, 53% and 59% in our population, respectively. With 21% global high burn-out. The female sex was associated with high emotional exhaustion and low personal accomplishment as well as global burn-out. This burn-out was attributed to factors associated with working conditions and professional climate, mainly: overwork, poor organization of service, lack of resources and time, lack of recognition, lack of communication, lack of respect, conflicts with colleagues, report unsatisfactory salary effort and aggressions by patients and their families. Functional complaints and health care professional’s behavior associated with burn-out were: feelings of sadness, blockage, and irritability, sleep disorders, unexplained pain, epigastralgia, addictive behaviors, psychotropic consumption, suicidal thoughts, decreased performance and desire for a job transfer.Conclusions: By its impact on professionals, burn-out in medical oncology represents a major threat to the quality of health care. Its etiologies, although complex and intricate, are well known. Its prevention and its support are possible, but involve mobilization at all levels.

Virtual Conferences: Optimizing Oncology Nurses' Experience.

One casualty of the COVID-19 pandemic was in-person professional conferences. Organizations, including the American Society of Clinical Oncology, American Association for Cancer Research, and Oncology Nursing Society, had to quickly pivot and radically transform the delivery of the traditional in-person conference to a virtual offering accessible to thousands of oncology healthcare professionals. However, what may have felt catastrophic has revealed unique opportunities to engage individuals in professional offerings, including those who, because of cost or travel, may not have previously participated. In this article, the authors present insights into how to optimize virtual learning experiences during the COVID-19 pandemic and beyond.

Seroconversion in patients with cancer and oncology health care workers infected by SARS-CoV-2

BackgroundPatients with cancer have high risk for severe complications and poor outcome to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease [coronavirus disease 2019 (COVID-19)]. Almost all subjects with COVID-19 develop anti-SARS-CoV-2 immunoglobulin G (IgG) within 3 weeks after infection. No data are available on the seroconversion rates of cancer patients and COVID-19.Patients and methodsWe conducted a multicenter, observational, prospective study that enrolled (i) patients and oncology health professionals with SARS-CoV-2 infection confirmed by real-time RT-PCR assays on nasal/pharyngeal swab specimens; (ii) patients and oncology health professionals with clinical or radiological suspicious of infection by SARS-CoV-2; and (iii) patients with cancer who are considered at high risk for infection and eligible for active therapy and/or major surgery. All enrolled subjects were tested with the 2019-nCoV IgG/IgM Rapid Test Cassette, which is a qualitative membrane-based immunoassay for the detection of IgG and IgM antibodies to SARS-CoV-2. The aim of the study was to evaluate anti-SARS-CoV-2 seroconversion rate in patients with cancer and oncology health care professionals with confirmed or clinically suspected COVID-19.ResultsFrom 30 March 2020 to 11 May 2020, 166 subjects were enrolled in the study. Among them, cancer patients and health workers were 61 (36.7%) and 105 (63.3%), respectively. Overall, 86 subjects (51.8%) had confirmed SARS-CoV-2 diagnosis by RT-PCR testing on nasopharyngeal swab specimen, and 60 (36.2%) had a clinical suspicious of COVID-19. Median time from symptom onset (for cases not confirmed by RT-PCR) or RT-PCR confirmation to serum antibody test was 17 days (interquartile range 26). In the population with confirmed RT-PCR, 83.8% of cases were IgG positive. No difference in IgG positivity was observed between cancer patients and health workers (87.9% versus 80.5%; P = 0.39).ConclusionsOur data indicate that SARS-CoV-2-specific IgG antibody detection do not differ between cancer patients and healthy subjects.

Health Care Professionals' Knowledge and Attitudes Toward Physical Activity in Cancer Patients: A Systematic Review.

The purpose of this study was to, combine current available literature across health professionals to determine commonalities and differences between knowledge and attitudes of physical activity (PA) and its importance within the cancer population. It aimed to identify any gaps in the literature to inform future study directions to enhance PA participation and improve health outcomes and quality of life. Design: systematic review. Google Scholar, EBSCO, PubMed, Scopus, Web of Science. survey-based studies specifically reporting PA levels for both cancer patients and survivors from the perspective of oncology health care professionals. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to guide this review. The initial search highlighted 15,342 articles and returned 190 articles with relevant titles, of which 20 met the eligibility criteria; 15.8% of cancer patients reported to meeting PA guidelines during treatment and 36.5% after treatment. On average 58.1% of health care professionals self-reported discussing PA with their cancer patients, with the average referral rate to an exercise specialist or rehabilitation program being 18.3%. Only a limited number of health care professionals are initiating a discussion about PA with their cancer patients. Some health care professionals reported limited knowledge of PA guidelines for cancer patients. Their own personal PA levels do not seem to be associated with whether they discuss PA with their patients. Common barriers to providing PA advice were experienced across all health care professions such as time, limited referral pathways, and patient interest. Future research should be carried out to substantiate these barriers and discover which strategies could be implemented to improve the levels of PA discussions and referrals within clinical practice. Given the position nurses hold within the health care system, it would be beneficial to upskill and improve their understanding of PA and exercise as medicine for the cancer population. This has enormous potential that could enhance PA advice and boost referrals to exercise professionals improving the health and quality of life of the cancer population.

Abstract PO-072: Doctors and nurses during COVID19 pandemic: A different perception of cancer care

Abstract Background: The spread of coronavirus disease brought the need to reorganize clinical activity in oncology. Cancer patients are very vulnerable, and it is well known that their treatment has to be strictly planned. The most critical considerations still relate to the entry of the virus into hospitals, the heart of health care, where cancer patients are protected. Instead, during the COVID19 pandemic the oncologic department had to limit access to care to protect patients from a more dangerous disease for them, witnessing a paradox of health care. This brought with it worries in oncologic health care professionals in replanning activities in order to guarantee therapeutic continuity and quality of care. It is well known that physicians and nurses have different role concepts and role expectations. The purpose of our study was to investigate doctors’ and nurses' perception of cancer patient reorganization during the COVID19 pandemic in a sample of Italian health care professionals in oncology. Methods: We submitted a survey to oncologic health care workers (physicians and nurses) of Italian National Health Care System during the pandemic to investigate clinical activity reorganization and cancer patient management through 12 closed questions. The survey promoted by Clinica Oncologica, AOU Riuniti di Ancona-Università Politecnica delle Marche was electronic and anonymous. Results: A total of 383 oncology health workers completed the survey, 60 nurses (15%) and 323 physicians (85%). 60% of interviewed physicians perceived qualitatively lower than usual the therapeutic path of patients taken in charge in this historical moment, while 45% of nurses declared it was the same (P<0.01). The continuity of the multidisciplinary team was defined as guaranteed for 68% of oncologists, while almost 40% of nurses declared to not know it. Almost all physicians (95%) answered that their clinical activity was reorganized, compared to a lower portion of nurses (80%) who replanned their care role (p<0.01). Deferring treatments caused fear and anxiety in 62% of physicians and 46% of nurses (P=0.027). Conclusion: The survey underlined the need to integrate skills and involve all professional figures in planning cancer patients’ treatment to guarantee optimal therapeutic strategies and a global take in charge in all its details, even during emergencies. Citation Format: Lucia Bastianelli, Filippo Merloni, Nicoletta Ranallo, Luca Cantini, Lorenzo Mariotti, Alessandra Lucarelli, Zelmira Ballatore, Rossana Berardi. Doctors and nurses during COVID19 pandemic: A different perception of cancer care [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-072.

Abstract PO-027: Multi-institutional survey of COVID-19 impact in cancer care in patients and health care providers

Abstract Background: The COVID-19 pandemic has altered the priorities and capacities of health care systems worldwide, including how oncologic care is managed. Unprecedented changes to cancer care are being implemented to reduce rates of infection and conserve health care resources, while providing optimal cancer care. To this date, no comprehensive study has been conducted to assess the attitudes of both oncology patients and providers surrounding these changes. Methods: A multi-institutional survey was provided to patients and oncology health care professionals. Demographics and clinical data were collected. Questions concerning treatment, safety, communication, and emotional stress before and after the pandemic outbreak was measured on a 5-point Likert scale. Open-ended responses were collected, scored in a blinded fashion by three providers, and evaluated using Nominal Group Technique. Wilcoxon signed-rank test and Wilcoxon rank-sum test were used to compare provider and patient answers where appropriate. Results: Patient concerns regarding susceptibility to infection [z=2.536, p=0.011] and their cancer outcome [z=4.572, p<0.001] were significantly increased during the COVID-19 period. Factors associated with increased concern were colorectal cancer, white race, stage 3 and 4, active treatment, and <1 year since diagnosis. However, providers were more concerned regarding outcome than patients, believing that cancer care is overall more poorly planned [z=-3.857, p=<0.001]. While patients were comparatively more worried about contracting COVID-19 than providers, providers felt less safe in clinic. Nonetheless, providers had more concern about patients contracting infection than patients themselves, felt facilities were less sanitary, and had less confidence in the hospital overall. Among providers, strong concerns regarding availability of protective personal equipment [z=-4.082, p<0.001] and infecting providers’ families [z=4.965, p<0.001] were identified. Further, providers (significantly more than patients) felt that cancer care planning and communication were worse than before COVID-19. Conclusion: To our knowledge, this is the first multi-institutional survey to assess the impact of the COVID-19 pandemic on patients and providers. Patients had more difficulty coping during the pandemic, suggesting an increased need for emotional support. Nonetheless, patients did not perceive significant differences in their cancer treatment. This is in stark contrast to providers, who had major concerns regarding their ability to provide optimal cancer care, felt unprepared to handle the outbreak independent of the practice setting, and had personal safety concerns. This study suggests that more emotional support infrastructure for patients is required. Further, the bleak assessment of providers regarding effectiveness of their treatment and concerns for their personal safety raises concern for an increased risk of provider burnout, suggesting the need for novel targeted interventions. Citation Format: Sylvia V. Alarcon, Omid Salehi, Eduardo A. Vega, Vera Kazakova, Claudius Conrad. Multi-institutional survey of COVID-19 impact in cancer care in patients and health care providers [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-027.

The perceived effect of parental cancer on children still living at home: According to oncology health professionals.

How children are affected by their parent's diagnosis is limited in the literature, and children are typically not considered in current clinical practice. Despite suggestion that the patient's oncology team are well placed to support their children, this is yet to be sufficiently explored. This study aimed to explore how oncology healthcare professionals (HPs) perceive children are affected by a parent's diagnosis of cancer. This qualitative study was informed by principles of grounded theory and embedded within a social constructivist framework. 15 health professionals working in oncology were interviewed using a semi-structured format. Data were analysed using methods of constant comparison. From the perspective of HPs, when a parent is diagnosed with cancer, their dependent children are rendered invisible. Factors within the (a) clinical healthcare system and (b) the families' psychosocial context were identified, which contribute to the invisibility of children. HPs are well-placed to facilitate an entry point into the healthcare system for patients' children; however, this is not occurring due to children's lack of visibility. Clinical and psychosocial barriers need to be addressed to ensure HPs are visibly aware of all children and thus able to appropriately support, intervene or refer on.

Learning Outcomes of Diverse Oncology Professionals After the TEAM Cultural Competency Training

Racial, ethnic, sexual, and gender minorities are more likely to report challenges with oncology provider communication and quality of care. The Together-Equitable-Accessible-Meaningful (TEAM) training was developed to improve health equity across cancer care organizations by guiding teams of interprofessional learners through planning and implementation of quality improvements to advance equitable, accessible, and patient-centered cancer care. This study compared changes to self-reported cultural competence as measured by the Cultural Competency Assessment (CCA); Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS); and Interprofessional Socialization and Valuing Scale (ISVS). The primary aim of the study was to assess changes to self-reported cultural competence; the secondary aim was to examine changes to interprofessional valuation from baseline to post-intervention. Results indicated statistically significant improvements in self-reported Cultural Competency Behaviors (p = .055), a subscale of the CCA, and Attitudinal Awareness toward sexual and gender minorities (p = .046), a subscale of the LGBT-DOCSS, using p < .10 as statistically significant. These subscale results drove statistically significant improvements for their respective composite scales. No other statistically significant results were found. This study suggests that cultural competency training among interprofessional oncology health care professionals can be effective. Given the growing diversity within the USA, additional opportunities for cultural competency training are needed.

Patient and Medical Oncologists' Perspectives on Prescribed Lifestyle Intervention-Experiences of Women with Breast Cancer and Providers.

This study explored the perspectives and experiences of breast cancer patients and medical oncologists with regards to participation in a lifestyle intervention at a tertiary cancer treatment center. A thematic approach was used to understand the context within which a lifestyle intervention was recommended and experienced, to inform future lifestyle programming and promote uptake. Twelve women with breast cancer receiving adjuvant chemotherapy and eight medical oncologists completed interviews. Findings suggest receiving a prescription for a lifestyle intervention from a trusted health professional was influential to women with breast cancer. The intervention offered physical, psychological, emotional, social, and informational benefits to the women and oncologists perceived both physiological and relational benefit to prescribing the intervention. Challenges focused on program access and tailored interventions. Lifestyle prescriptions are perceived by women with breast cancer to have numerous benefits and may promote lifestyle interventions and build rapport between oncologists and women. Oncology healthcare professionals play a pivotal role in motivating women’s participation in lifestyle interventions during breast cancer treatment. Maintenance programs that transition patients into community settings and provide on-going information and follow-up are needed.

Abstract LB-254: The effectiveness of healthcare professional training on the legal issues impacting individuals diagnosed with cancer to improve patient quality of life

Abstract A cancer diagnosis may carry with it a variety of legal issues, including insurance coverage, government benefits, and consumer rights. These legal issues can cause people unnecessary worry, confusion, and stress, and can be overwhelming. The Insurance and Finance Intensive is focused on providing healthcare professionals tools to proactively identify the presence of cancer-related legal, health insurance, and financial issues facing their patients. Additionally, the training helps health care professionals to offer referrals to appropriate legal and related resources, once those issues are identified. Oncology healthcare professionals participated in an eight-hour comprehensive training. Attendees were provided with substantive information about cancer-related legal issues, such as identifying health insurance options, navigating disability insurance and appeals, and managing finances. A follow-up survey was sent to all past intensive attendees to measure the effectiveness of the training and to address any lingering questions and difficult case studies. Ninety-four percent of survey respondents strongly agreed or agreed that the information provided by the training helped them reduce the stress and anxiety of their patients and their families. Ninety-two percent of survey respondents strongly agreed or agreed that the information provided by the training improved the quality of life of their patients and their families. The Insurance &amp; Finance Intensive successfully provided health care professionals with valuable information on the practical and legal issues that impact individuals diagnosed with cancer. It is recommended that more healthcare professionals participate in this training to improve the quality of life of their patients beyond diagnosis. Citation Format: Joanna Morales, Monica Bryant. The effectiveness of healthcare professional training on the legal issues impacting individuals diagnosed with cancer to improve patient quality of life [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-254.

Prevalence and risk factors for suicidality in cancer patients and oncology healthcare professionals strategies in identifying suicide risk in cancer patients.

The aim of this study was to summarize the literature on prevalence and risk factors for suicidality in cancer patients and to document the research on oncology healthcare professionals' strategies in identifying this risk. Cancer patients exhibit increased risk of suicidality compared with the general population. Various risk factors have been identified including sociodemographic factors such as poverty, being male and elderly as well as disease-related attributes such as cancer type and stage. The literature on how healthcare professionals identify suicide risk is sparse. Ten articles were found that focused on two main themes. These included information on systematic strategies in identifying suicide risk and factors that affect healthcare professionals' ability to identify risk in their patients. Although there is an immense amount of literature documenting the problem of suicidality among patients, the research on how healthcare professionals identify and respond to these indications in patients is nearly nonexistent. Cancer centres should implement standardized and systematic screening of cancer patients for suicidality and research on this patient population should collect and report these data. Ongoing training and education for healthcare professionals who work in the oncology setting on how to identify and respond to suicide risk among cancer patients is urgently needed.

An Overview of Treating People with Comorbid Dementia: Implications for Cancer Care

With increasing prevalence of both cancer and dementia in the UK, due to an ageing population, oncology healthcare professionals will experience higher numbers of people with both conditions. As dementia is highly heterogeneous and symptoms vary from individual to individual, it presents specific challenges for healthcare professionals, people with dementia and caregivers alike. This overview will describe current theories that explain the association between cancer and dementia, report prevalence rates and highlight the evidence on the impact of having a diagnosis of dementia on outcomes along the cancer pathway from cancer symptom detection to cancer treatment outcomes. It suggests that although prevalence rates of cancer and dementia are typically lower than other comorbidities, people with cancer and dementia have poorer cancer-related outcomes. This includes later stage cancer diagnoses, fewer cancer treatment options and an increased risk of death compared with people who have cancer alone or other comorbid conditions. Considerations for cancer treatment decision making and management are proposed to improve patient experience for this group.

Palliative Care's Role Managing Cancer Pain During the Opioid Crisis: A Qualitative Study of Patients, Caregivers, and Clinicians

ContextPatients with cancer face symptoms because of disease and treatment, and pain is common and complex. The opioid crisis may complicate patients' and clinicians' experiences of managing pain in cancer care. ObjectivesIn our study of perceptions and experiences with palliative care (PC) at an outpatient cancer center, we examined communication around symptom management throughout cancer care, and pain and its management emerged as particularly salient. The objective of this article is to describe, from the perspectives of patients, caregivers, and oncology health care professionals, the role of PC in navigating the complicated dynamics of pain management amidst the opioid crisis. MethodsA qualitative descriptive study with grounded theory components was designed to investigate experiences with and perceptions of specialist PC and symptom management, including pain. Interviews were audiorecorded and transcribed, and focused coding identified themes related to pain and pain management from all three perspectives. ResultsAbout 44 patients, caregivers, and non-PC health care professionals completed interviews. Patients with cancer and their caregivers had many concerns about pain management and were specifically concerned about opioid use and stigma. For patients, PC improved pain management and helped to destigmatize appropriate pain management. Oncology clinicians reported that partnering with PC facilitated complex pain management and also provided moral support around difficult opioid recommendations for patients. ConclusionPC offers the potential to uniquely support both patients and other oncology professionals in optimally navigating the complexity around pain management for cancer care in the midst of the opioid crisis.

Exercise Is Medicine: Need To Improve Exercise Prescriptions In Pediatric Oncology To Help Female Survivors

PURPOSE: About 65% of childhood survivors who were exposed to chemotherapeutic agents during treatment suffer from multiple late adverse effects. Even though both males and females were treated with chemotherapy during their cancer, the distinction between them is not always taken into consideration in an exercise oncology context. This study aims to assess cardiorespiratory fitness and moderate to vigorous physical activity (MVPA) of survivors in comparison to healthy participants. Genetic associations with cardiorespiratory fitness levels were reported to provide a better understanding of how physiological parameters differ in both males and females, and to find out whether gender and genetic parameters have an impact on their cardiorespiratory fitness. METHODS: Germline variants in a selected set of genes were analyzed for an association with cardiorespiratory fitness. Whole-exome sequencing in survivors (N=239) was performed. Cardiorespiratory fitness and MVPA data were compared between childhood ALL survivors (N=221) and healthy participants (N=825). Additional analyses were performed to study the physiological differences between males and females. RESULTS: We found that female survivors (27.7±6.7mL·kg-1·min-1) were more affected than males (36.8±7.1mL·kg-1·min-1) by low cardiorespiratory fitness. For a clinically equivalent level of MVPA, cardiorespiratory fitness was significantly lower in female survivors (27.7±6.7mL·kg-1·min-1), compared to healthy females (37.0±7.6mL·kg-1·min-1). Female survivors' physical deconditioning seems to increase with age. Female survivors have significant genetic associations between their cardiorespiratory fitness and their trainability genes (LEPR, IGFBPI and ENO3 genes) that play an important role in the functioning of their skeletal and cardiac muscles. CONCLUSIONS: Female survivors are at higher risk than males to have an impairment in their cardiorespiratory fitness and represent at-risk patients in regard to their genetic dispositions. The promotion of physical activity needs to be encouraged through the care system with the involvement of health care professionals in pediatric oncology. An evidence-based medicine approach is essential to help females to improve their cardiorespiratory fitness through physical activity.

Feasibility, Acceptability, and Clinical Implementation of an Immersive Virtual Reality Intervention to Address Psychological Well-Being in Children and Adolescents With Cancer.

Objective: Virtual reality (VR), a novel and highly immersive technology, offers promise in addressing potential psychological impacts of cancer treatments and hospitalization. The primary aim of this study was to examine multiple key user perspectives on the acceptability and feasibility of an Immersive VR therapeutic intervention for use with hospitalized patients with cancer. Secondary aims were to identify issues and opportunities related to the adoption and clinical implementation of VR in pediatric oncology settings. Method: The study was conducted at The Royal Children's Hospital (RCH), Melbourne, Australia. Thirty multidisciplinary oncology health care professionals participated in an initial test of VR intervention usability (Stage 1). Ninety oncology inpatients (7-19 years) and their parent caregivers participated in a pilot randomized controlled study to examine the effectiveness of an Immersive VR therapeutic intervention (Stage 2). This mixed methods study reports Stages 1 and 2 quantitative and qualitative data related to VR feasibility and acceptability. Results: Results indicate favorable perceptions from health care professionals with respect to ease of use and usefulness of VR, and had positive intentions to use it in the future. Parent caregivers reported high acceptability of VR for their hospitalized child. Patients reported high satisfaction of the VR intervention within minimal adverse effects. Barriers and facilitators to VR use with seriously ill children and specific recommendations for content development were elicited. Conclusion: This study shows that there are several potential clinical uses for Immersive VR intervention, beyond medical procedural distraction, to support psychological adjustment to hospitalization and patient quality of life.

The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients

BackgroundBRCA1/2 mutation status has increasing relevance for ovarian cancer treatments, making traditional coordination of genetic testing by genetic services unsustainable. Consequently alternative models of genetic testing have been developed to improve testing at the initial diagnosis for all eligible women. MethodsA training module to enable mainstreamed genetic testing by oncology healthcare professionals was developed by genetic health professionals. Oncology healthcare professionals completed questionnaires before and 12 months post-training to assess perceived skills, competence and barriers to their coordinating genetic testing for women with high-grade non-mucinous epithelial ovarian cancer. Genetic health professionals were surveyed 12 months post-training to assess perceived barriers to implementation of mainstreaming. Results185 oncology healthcare professionals were trained in 42 workshops at 35 Australasian hospitals. Of the 273 tests ordered by oncology healthcare professionals post-training, 241 (93.1%) met national testing guidelines. The number of tests ordered by genetic health professionals reduced significantly (z = 45.0, p = 0.008). Oncology healthcare professionals' perceived barriers to mainstreamed testing decreased from baseline to follow-up (t = 2.39, p = 0.023), particularly perceived skills, knowledge and attitudes. However, only 58% reported either ‘always’ or ‘nearly always’ having ordered BRCA testing for eligible patients at 12 months, suggesting oncology healthcare professionals' perceived barriers were not systematically addressed through training. ConclusionsOncology healthcare professionals have demonstrated a willingness to be involved in the provision of genetic testing in a mainstreaming model. If oncology services are to hold responsibility for coordinating genetic testing, their readiness will require understanding of barriers not addressed by training alone to inform future intervention design.

Oncology team perception and patient experience discordances in triple-negative breast cancer (TNBC) care.

e19176 Background: In TNBC, ensuring patients understand their treatment options and engaging them in shared decision-making (SDM) is vital to patient centered care; however, system-, team-, and individual-level barriers may challenge optimal SDM. As part of a quality improvement, accredited initiative, we identified areas of discordance between oncology healthcare professionals (HCP) perception and actual patient reported experiences. Methods: From 02/2019 – 10/2019, we administered surveys to assess challenges, barriers, attitudes, and experiences of HCP who care for patients with TNBC (N = 77) and their patients with TNBC (N = 65) at 6 community oncology practices. Results: Despite indications of high levels of SDM – 86% of patients indicated that they are always or mostly involved with treatment decisions – survey responses highlight discordances. For example, when asked to identify the most influential factors to patient treatment choice, HCP most commonly indicated side effects (94%), while patients most commonly indicated quality of life (48%). Additionally, when asked to identify the side effect of greatest concern to patients, 61% of patients indicated alopecia, while 45% of HCP indicated gastrointestinal (GI) distress. While both HCP and their patients indicate that the oncology team is the most useful source of patient education, HCP underestimated the extent to which patients rely on their primary care providers (PCPs). Patients and HCP each identified limited time as a barrier to SDM, but patients indicated not knowing what to ask, while HCP indicated that low health literacy was the top barrier to SDM. 31% of patients and their care team identified that improvements in discussions about realistic prognosis were vital to improved care. Conclusions: These survey findings reveal discordances between oncology HCP’s perceptions and patient reported experiences when receiving treatment for TNBC. These findings may highlight areas for improvement in co-productive patient-centered care. [Table: see text]

Risk of burnout in a sample of oncology healthcare professionals working in a hospital oncology unit with hospice and relationship with dysfunctional metacognitive beliefs

Risk of burnout in a sample of oncology healthcare professionals working in a hospital oncology unit with hospice and relationship with dysfunctional metacognitive beliefs

Addressing Cancer Treatment Shortages in Saudi Arabia: Results of a National Survey and Expert Panel Recommendations.

PURPOSECancer treatment shortages are complex and a persistent problem worldwide. Patients with cancer are most vulnerable to drug shortages, which provides opportunities to examine the extent of the challenge(s) facing Saudi Arabia and to provide recommendations toward mitigating the impact of cancer treatment shortages on patient outcomes.MATERIALS AND METHODSA qualitative methodologic approach was conducted in April 2019 using a validated questionnaire and structured panel discussion for data generation.RESULTSOverall, 55 responses were received from practicing oncology health care professionals (26 pharmacists and 29 physicians). The annual average number of treated patients with cancer per institution was 640 (adults [n = 400] and pediatric [n = 240]). All respondents (100%) reported that cancer treatment shortages constitute a current problem in their center, with an average of 5 (range, 1-9) per month. The panelists recognized 2 fundamental points. First, the definition of cancer drug shortages should be standardized and recognized at the national level. Second, the current system must be improved to ensure proper and efficient use of the current resources. On that basis, the panelists developed 9 recommendations for action.CONCLUSIONCancer drug shortage is a significant problem in all health centers in Saudi Arabia. This study presents challenges that should be addressed at the national level and essential consensus recommendations for a coordinated action developed by a panel of experts to tackle the current national problem of cancer treatment shortages. Implementing these recommendations will provide a blueprint for management of national drug shortages in general and cancer treatment shortages in particular.