National Oncology Societies Research Articles

The national COVID-19 vaccination campaign targeting the extremely vulnerable: the Florence Medical Oncology Unit experience in patients with cancer

BackgroundInternational and national oncology societies had released recommendations in favor of COVID-19 vaccination in cancer patients. In the context of the national vaccination campaign targeting the so called extremely vulnerable, we aimed to assess the safety and efficacy of the mRNA vaccines in a cohort of 623 patients. MethodsBetween March 26 and April 04, 2021, the Pfizer and BioNTech BNT162b2 mRNA and the Moderna mRNA-1273 vaccines were given as a two-dose prime-boost regimen. Starting on September 25th 2021 a third dose was offered to patients in whom a suboptimal immunogenicity with COVID-19 vaccination could be expected. Safety assessments were performed by phone call 7 days after each dose. Electronic health records were accessed to review demographic information, disease history, treatment detail, and outcome events of participants patients’. FindingsNo toxicities were reported in 63.7%, 54%, and in 48.7% patients with cancer after each dose. Mild-to-moderate pain at the injection site was the most commonly adverse event. After the second dose, 46% of the 610 patients reported toxicity, with more systemic side-effects observed. Fever was reported in 45% of patients, with a temperature ≥ 38 °C in 21.4% of them. Of the 335 patients receiving a third vaccine dose, 51% reported toxicity, with 13% of patients reporting more than one effect. Logistic regression analysis reported mixed results, with limited variables or categories reporting a significant odd ratio. The type of vaccine reported a significant value at first dose (OR = 0.12; CI 0.52, 0.26; p = 0.00). Thirty-four cases of COVID-19 infection were reported with only one patient requiring a short-term hospitalization for monitoring. InterpretationThe safety profile of the mRNA vaccines does not raise any specific concerns and support prioritization of vaccination for cancer patients.

Burnout Syndrome among Doctors in Greek Oncology Departments.

Objective: Economic crisis and austerity has dramatic consequences for health care professionals’ mental health. This study aimed to investigate the prevalence of burnout syndrome among doctors working in public or private oncology departments in Greece and its association with factors determined by economic crisis. Method : Medical or radiation oncologists who are members of the National Oncology Societies and practicing oncology at least for one year were enrolled in this study. An On-Line questionnaire consisting of the Maslach Burnout Inventory and an informative questionnaire was utilized. Results: Eighty-six On-Line questionnaires waere analyzed. Radiation oncologists had significantly higher Depersonalization (DP), whereas medical oncologists had significantly higher Emotional Exhaustion (EE) scores. Registrars had higher scores compared to consultants in all subscales of the burnout syndrome. Factors such as ‘‘hospitals are not safe due to the lack or reductions in medical supplies and personnel shortage’’ and ‘‘receiving less than 50% of annual leave’’ were associated with significantly higher levels of EE. Factors such as ‘‘not afraid of moving abroad’’ and ‘‘receiving 100% of annual leave’’ were associated with significantly higher levels of low Personal Accomplishments (PA). The principal component analysis yielded three principal components: ‘future insecurity’, ‘feeling secure while working’ and ‘working conditions associated with burnout syndrome. Conclusion: Several factors associated with austerity resulting from economic crisis significantly influenced prevalence of burnout syndrome among oncologists in Greece. Further studies need to be conducted to mobilize policy makers to develop and implement policies to improve oncologists' mental health.

1742P Outcomes of the reorganisation of a medical oncology department during the COVID-19 pandemic: Real-word experience

The coronavirus disease 2019 (COVID-19) pandemic has transformed health care delivery in the world, forcing clinicians to make challenging triage decisions. COVID-19 represents a significant harm for cancer patients, who are at high risk of infections due to their immunosuppressed status and serious COVID-19-related events. Portuguese oncologists joined forces to ensure safety of clinical practice without compromising cancer patients care, as the benefit of ensuring an anti-cancer treatment outweighs the risks of COVID-19. Description and outcomes analysis of structural organization measures adopted by a Portuguese Medical Oncology Department during the COVID-19 pandemic. A proactive approach to the actual emergency panorama was promptly implemented: use of individual protection equipment, triage of patients accessing the hospital, use of telemedicine in selected patients with no need for on-site assessment, customising treatment delivery, regularly test patients under immunosuppressive treatments, test all patients prior to admission in oncology wards, limited access for visitors and caregivers, health professionals worked in “mirror teams” and most multidisciplinary boards have been converted in telematic meetings. Despite all the constraints in the activity, the number of consultations (including tele-consultations) increased compared to the same period of the previous year (3245 consultations from 1/03 to 15/05/2020 versus 3305 in the same period of 2019), the number of first consultations remained similar comparatively (15%) and were carried out in a timely manner, indicative that the cancer patient circuit was not compromised. 368 fewer treatments were performed in the same period, compared to 2019. Until May 15th, 288 tests have been carried out. Four patients were positive for COVID-19 without severity criteria, two of them with a diagnosis of cure, currently being under antineoplastic treatment without related complications. Practice recommendations from European and national oncology societies were applied, which translated into a safe continuum of cancer care delivery. In the middle-term, will be a priority to assess the real impact on cancer mortality.

Medical Oncology Workload in Europe: One Continent, Several Worlds

AimsThe workload pressure on medical oncologists will increase in the near future. There are no comprehensive data available about the current workload of medical oncologists in Europe. Here we report the European results of a global survey of the workload of medical oncologists. Materials and methodsAn online survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 21 European countries. We compared the workload of medical oncologists in Eastern European countries (EECs) and Western European countries (WECs). The primary measure of workload was the annual number of new cancer patient consults seen per oncologist. ResultsIn total, 495 oncologists from 16 European countries completed our survey: 100 from seven EECs and 395 from nine WECs. The median number of annual consults per medical oncologist was 225 in EECs compared with 175 in WECs (P < 0.001). The proportion of medical oncologists seeing more than 300 consults/year was 35% (35/100) in EECs compared with 18% (68/395) in WECs. The median number of patients seen in a full day clinic was 25 in EECs and 15 in WECs (P < 0.001). Eastern European medical oncologists reported spending a median of 25 min per new consultation compared with 45 min in WECs (P < 0.001). The top two reported barriers in both EECs and WECs to patient care were high clinical volumes and insufficient time for reading. ConclusionThe clinical workload of medical oncologists in EECs was substantially higher than in WECs. European health policymakers and educators need to address existing disparities in the workload of medical oncologist, undertake plans for future workforce supply and consider alternative models of care.

Cancer care workforce in Africa: perspectives from a global survey

BackgroundWhile the burden of cancer in Africa is rapidly rising, there is a lack of investment in healthcare professionals to deliver care. Here we report the results of a survey of systemic therapy workload of oncologists in Africa in comparison to oncologists in other countries.MethodsAn online survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 65 countries. The survey was distributed within Africa through a network of physicians associated with the African Organisation for Research and Training in Cancer (AORTIC). Workload was measured as the annual number of new cancer patient consults seen per oncologist. Job satisfaction was ranked on a 10-point Likert scale; scores of 9–10 were considered to represent high job satisfaction.ResultsThirty-six oncologists from 18 countries in Africa and 1079 oncologists from 47 other countries completed the survey. Compared to oncologists from other countries, African oncologists were older (median age 51 vs 44 years, p = 0.007), more likely to prescribe chemotherapy and radiation [61% (22/36) vs 10% (108/1079), p < 0.001], less likely to have completed training in their home country [50% (18/36) vs 91% (979/1079), p < 0.001], and more likely to work in the private sector [47% (17/36) vs 34% (364/1079), p = 0.037]. The median number of annual consults per oncologist was 325 in Africa compared to175 in other countries. The proportion of oncologists seeing > 500 consults/year was 31% (11/36) in Africa compared to 12% (129/1079) in other countries (p = 0.001). African oncologists were more likely than global colleagues to see all cancer sites [72% (26/26) vs 24% (261/1079), p < 0.001]. Oncologists in Africa were less likely than other oncologists to have high job satisfaction [17% (6/36) vs 30% (314/1079), p = 0.013].ConclusionAfrican oncologists within the AORTIC network have a substantially higher clinical workload and lower job satisfaction than oncologists elsewhere in the world. There is an urgent need for governments and health systems to improve the oncologist-to-patient ratio and develop new models of capacity building, retention and skills enhancement to strengthen the wide variety of cancer care systems across continental Africa.

Training of oncologists: Results of a global survey.

10526 Background: While several studies have highlighted the global shortages of oncologists and their workload, few have studied the characteristics of current oncology training. Methods: An online survey was distributed through a snowball method via national oncology societies and a pre-existing network of contacts to cancer care providing physicians in 57 countries. Countries were classified into low- or lower-middle-income countries (LMICs), upper-middle-income countries (UMICs), and high-income countries (HICs) based on World Bank criteria. Results: 273 physicians who trained in 57 different countries responded to the survey; 33% (90/273), 32% (87/273), and 35% (96/273) in LMICs, UMICs and HICs respectively. 60% of respondents were practicing physicians and 40% were in training. The proportion of trainees was higher in LMICs (51%; 45/89) and UMICs (42%; 37/84), than HICs (19%; 28/96; P = 0.013). A higher proportion of respondents from LMICs (37%; 27/73) self-fund their core oncology training compared to UMICs (13%; 10/77) and HICs (11%; 10/89; P &lt; 0.001). Respondents from HICs were more likely to complete an accepted abstract, poster and publication from their research activities compared to respondents from UMICs and LMICs (abstract: 37/72 (51%) from HICs, 18/66 (27%) from UMICs, 24/65 (37%) from LMICs, P = 0.014; poster: (42/72 (58%) from HICs, 28/66 (42%) from UMICs, 13/65 (20%) from LMICs, P &lt; 0.001; publication: 43/72 (60%) from HICs, 32/66 (49%) from UMICs, 24/65 (37%) from LMICs, P = 0.029). Respondents identified several barriers to effective training including skewed service to education ratio and burnout. With regards to preparedness for practice, mean scores on a 5-point Likert scale were low for professional tasks like supervision and mentoring of trainees, leadership and effective management of an oncology practice, and understanding of healthcare systems irrespective of country grouping. Conclusions: Investment in training by the public sector would be vital to decreasing the prevalence of self-funding in LMIC. Gaps in research training and enhancement of competencies in research dissemination in LMIC require attention. Instruction on cancer care systems and leadership need to be incorporated in training curricula in both LMICs and HICs.

Medical oncology job satisfaction: Results of a global survey

BackgroundWhile physician burnout is increasingly recognized, little is known about medical oncologist job satisfaction, and the factors associated with low satisfaction. Here, we report the results of an international survey of medical oncologists. MethodsAn online survey was distributed using a modified snowball methodology via national oncology societies to chemotherapy-prescribing physicians in 65 countries. Oncologist job satisfaction was assessed by asking, “On a scale of 1-10, how would you rate your satisfaction as an oncologist? 1 = unsatisfying, 10 = satisfying.” Low, moderate and high job satisfaction was defined as scores of 1-6, 7-8, and 9-10, respectively. Results1,115 physicians from 42 countries completed the survey. Overall job satisfaction rates were 20% (222/1,115), 51% (573/1,115), and 29% (320/1,115) for low-, moderate-, and high-satisfaction, respectively. Respondents with low job satisfaction were younger (P = 0.001) and had fewer years in clinical practice (P = 0.013) compared to those with high satisfaction. Increasing hours worked by per week (p = 0.042), decreasing annual weeks of paid vacation (P = 0.007), being on-call every night (P = 0.016), higher clinic volumes (P = 0.004) and lack of access to on-site radiotherapy (P = 0.049), palliative care (P = 0.005), and chemotherapy pharmacists (P = 0.033) were associated with low-job satisfaction. Respondents with low-job satisfaction were less likely to discuss prognosis with their patients compared to those with moderate or high job satisfaction (median 45% of patients v 65% v 75%, P < 0.001). ConclusionsGlobally, 1 in 5 medical oncologists report low job satisfaction. The main correlates of job satisfaction are related to system-level pressures resulting in less time for quality patient care and personal resilience. Improving oncologist job satisfaction will require new approaches to models of care delivery.

Medical oncology in India: Workload, infrastructure, and delivery of care

Abstract Background: The growing burden of cancer within India has implications across the health system including operational delivery of cancer care and planning for human health resources. Here, we report the Indian results of a global survey of medical oncology (MO) workload in comparison to medical oncologists (MOs) in other low-middle- income countries (LMICs). Methods: An online survey was distributed through a snowball method through national oncology societies to chemotherapy-prescribing physicians in 22 LMICs. The survey was distributed to Indian MOs by the Indian Society of Medical and Pediatric Oncology and the National Cancer Grid of India. The workload was measured as the annual number of new cancer patient consults seen per oncologist. Results: One hundred and forty-seven oncologists from LMICs completed the survey; 82 from India and 65 from other LMICs. About 59% (48/82) of Indian MOs reported working exclusively in the private health system compared to 23% (15/65) of MOs in other LMICs (P &lt; 0.001). The median number of annual consults per MO was 475 in India compared with 350 in other LMICs. The proportion of MOs seeing &gt;1000 new consults/year was 24% (20/82) in India and 20% (13/65) in other LMICs (P = 0.530). The median number of patients seen in a full-day clinic was 35 in India and 25 in other LMCs (P = 0.003); 26% of Indian MO reported seeing &gt;50 patients per day. Compared to other LMICs, Indian MOs worked more days/week (median 6 vs. 5, P &lt; 0.001) and hours/week (median 51–60 vs. 41–50, P = 0.004) and had less annual leave for vacation (3 weeks vs. 4, P = 0.017). Conclusion: Indian MOs have higher clinical volumes and workload than MOs in other LMICs and substantially higher workload than MOs in high-income countries. Indian health policymakers should consider alternative models of care and increasing MO workforce supply to address the growing burden of cancer.

Report on the status of women occupying leadership roles in oncology

BackgroundWhile the global workforce is approaching gender parity, women occupy a small number of management level positions across most professions, including healthcare. Although the inclusion of women into the membership of many oncology societies has increased, the under-representation of women in leadership roles within international and national oncology societies remains relatively consistent. Moreover, the exact status of women participating as board members or presidents of oncology societies or as speakers at oncology congresses was undocumented to date.MethodsThe database used in this analysis was derived from data collection performed by the European Society for Medical Oncology for the years 2015–2016 and data analyses performed using the Statistical Analysis Software V.9.3 and R language for statistical computing V.3.4.0 by Frontier Science Foundation-Hellas. The literature search was performed by the authors.ResultsWe report the presence of a gender gap within oncology. Results regarding the under-representation of women occupying leadership roles in oncology show female participation as members of the board or presidents of national and international oncology societies and as invited speakers at oncology congresses remains below 50% in the majority of societies included in this analysis. Women in leadership positions of societies was associated with a higher percentage of female invited speakers at these societies’ congresses (p=0.006).ConclusionThe full contribution that can be attained from using the potential of women in leadership roles is currently under-realised. Examples of how gender and minority participation in organisations improves outcomes and creativity are provided from science, clinical practice and industry that show outcomes are greatly improved by collective participation of both men and women. Although there are programmes in place in many oncology organisations to improve this disparity, the gender gap is still there. Ongoing discussion may help to create more awareness in the effort to accelerate the advancement of women within oncology.

Medical oncology workload in Canada: infrastructure, supports, and delivery of clinical care.

In 2000, a Canadian task force recommended that medical oncologists (mos) meet a target of 160-175 new patient consultations per year. Here, we report the Canadian results of a global survey of mo workload compared with mo workload in other high-income countries (hics). Using a snowball method, an online survey was distributed by national oncology societies to chemotherapy-prescribing physicians in 22 hics (World Bank criteria). The survey was distributed within Canada to all members of the Canadian Association of Medical Oncologists. Workload was measured as the annual number of new cancer patient consults per oncologist. The survey was completed by 782 oncologists from hics, including 58 from Canada. Median annual consults per mo were 175 in Canada compared with 125 in other hics. The proportions of mos having 100 or fewer consults or more than 300 consults per year were 3% (2/58) and 5% (3/58) in Canada compared with 31% (222/724) and 16% (116/724) in other hics (p < 0.001 and p = 0.023 respectively). The median number of patients seen in a full-day clinic was 15 in Canada and 25 in other hics (p = 0.220). Canadian mos reported spending a median of 55 minutes per new consultation; new consultations of 35 minutes were reported in other hics (p < 0.001). Median hours worked per week was 55 in Canada and 45 in other hics (p = 0.200). Although the median annual clinical volume for Canadian mos aligns with recommended targets, half the respondents exceeded that level of activity. Health policymakers and educators have to consider mo workforce supply and alternative models of care in preparation for the anticipated surge in cancer incidence in the coming decade.

Delivery of Global Cancer Care: An International Study of Medical Oncology Workload.

BackgroundTo our knowledge, there is no literature that has described medical oncology (MO) workload in the global context. Here, we report results of an international study of global MO workload.MethodsAn online survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 65 countries. Countries were classified into low- or low-middle–income countries (LMICs), upper-middle–income countries (UMICs), and high-income countries (HICs) on the basis of World Bank criteria. Workload was measured as the annual number of new consultations provided to patients with cancer per oncologist.ResultsA total of 1,115 physicians completed the survey: 13% (147 of 1,115) from LMICs, 17% (186 of 1,115) from UMICs, and 70% (782 of 1,115) from HICs. Eighty percent (897 of 1,115) of respondents were medical oncologists, 10% (109 of 1,115) were clinical oncologists, and 10% (109 of 1,115) were other. The median number of annual consults per oncologist was 175 (interquartile range, 75 to 275); 13% (140 of 1,103) saw ≥ 500 new patients in a year. Annual case volume in LMICs (median consults, 425; 40% of respondents seeing > 500 consults) was substantially higher than in UMICs (median consults, 175; 14% > 500) and HICs (median consults, 175; 7% > 500; P < .001). Among LMICs, UMICs, and HICs, median working days per week were 6, 5, and 5, respectively (P < .001). The highest annual case volumes per oncologist were in Pakistan (median consults, 950; 73% > 500 consults), India (median consults, 475; 43% > 500), and Turkey (median consults, 475; 27% > 500).ConclusionThere is substantial global variation in medical oncology case volumes and clinical workload; this is most striking among LMICs, where huge deficits exist. Additional work is needed, particularly detailed country-level mapping, to quantify activity-based global MO practice and workload to inform training needs and the design of new pathways and models of care.

Delivering global cancer care: An international study of medical oncology workload.

e18080 Background: With a disproportionate global burden of cancer, access to care in low-middle income countries (LMICs) is a pressing issue. To our knowledge there is no literature that has described medical oncology (MO) workload in the global context. Here, we report the first results of an international study of global MO training, infrastructure and workload. Methods: A multinational panel of oncologists from diverse practice settings designed a 51 item online survey. The survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 50 countries. Countries were classified into low or low-middle (LMIC), upper-middle (UMIC) and high-income countries (HIC) based on World Bank criteria. Due to small numbers, African nations were reported as a region. The primary objective of this study was to describe the annual number of new cancer patient consults seen per oncologist. Results: 708 physicians completed the survey; 14% (96/708) from LMICs, 21% (152/708) UMICs, and 65% (460/708) HICs. 85% (604/708) of respondents were MOs, 9% (65/708) clinical oncologists, 6% (39/708) other. Respondents worked a median 5 days/week and had 4 weeks of annual paid vacation. The median number of annual consults per oncologist was 175 (IQR 125-375); 16% (114/708) of respondents saw 500+ new patients in a year. Annual case volume in LMICs (median consults 425, 46% respondents seeing &gt; 500 consults) was substantially higher than UMICs (175, 15% &gt; 500) and HICs (175, 10% &gt; 500) (p &lt; 0.001). Among LMICs, UMICs, and HICs, median days worked per week were 6, 5, 5 respectively (p &lt; 0.001); annual weeks of paid vacation were 3, 3, 5 respectively (p &lt; 0.001). Among countries/regions with 10+ responses, the highest annual case volumes per oncologist were Pakistan (median consults 950, 73% &gt; 500 consults), India (475, 47% &gt; 500), Turkey (475, 25% &gt; 500), Africa (400, 42% &gt; 500) and China (325, 31% &gt; 500). Conclusions: There is substantial global variation in oncology case volumes and clinical workload; this is most striking among LMICs. Further work is needed to quantify activity-based global MO practice and workload to inform training needs and the design of new pathways and models of care.

Factors influencing treatment recommendations in early-stage Hodgkin’s disease: a survey of physicians

The aim of this study was to explore variation in practice patterns and identify factors associated with physicians' treatment decisions for early-stage Hodgkin's disease. We conducted a one-time mail survey of oncologists randomly selected from directories of national oncology societies (n = 207) and Hodgkin's disease experts (n = 147). The survey included questions on (i) physician factors, (ii) preferred treatment choices for six case scenarios of early-stage Hodgkin's disease that varied by patient factors, and (iii) thresholds for changing treatment recommendations. The response rate was 50%. For non-bulky Hodgkin's disease, 69% of respondents chose combined modality therapy (CMT). On multivariate analysis, physician factors that independently predicted for choice of CMT included a high Hodgkin's disease case load (P = 0.02) and a high percentage of patients enrolled in clinical trials (P = 0.05). Radiation oncologists had a lower threshold for adding radiation therapy (P = 0.02). More experience with second malignancy cases and longer time in practice were associated with a higher threshold for adding radiation therapy (P = 0.04 and P = 0.008, respectively). In stratified analyses, treatment decisions of non-experts were significantly influenced by physician factors, but not by patient factors. Conversely, choices of Hodgkin's disease experts were insensitive to all physician factors, but experts were significantly more likely to select chemotherapy alone in young women and CMT in older patients. Our results indicate that physician factors including practice type and experience may in part explain variation in practice pattern for Hodgkin's disease therapy. Hodgkin's disease experts are more likely to tailor therapy according to individual patient factors.