Oncology Course Research Articles

A Survey of Clinicians Evaluating an Online Prelicensure Oncology Nursing Elective.

Despite a growing population of individuals with cancer, there is limited oncology content in prelicensure nursing curricula. A distance learning oncology nursing elective course creates an option for integration into nursing programs. The purpose of this article is to describe curriculum development for an online oncology elective course using feedback and expertise from oncology nurses. An online oncology course curriculum was developed and then shared with 70 oncology nurse experts to elicit feedback on course objectives, content, teaching strategies, and evaluation methods using a survey and open-ended questions. Experts agreed course objectives, content, teaching strategies, and evaluation methods were clear and comprehensive. Curriculum revisions were made based on recommendations from expert clinicians. A curriculum table for this proposed course is presented. There is a need for oncology nursing curriculum in prelicensure programs. Educators should consider innovative ways of increasing academic-practice partnerships in curriculum development.

Aggressive Neuroblastoma in a Pediatric Patient with Severe Hemophilia A

Despite the extensive information regarding hemophilia’s hemorrhagic complications, the literature on cancer in hemophilia is scarce, especially in pediatric patients. Many uncertainties remain concerning diagnosis and workup. We report a rare case of two severe diseases (neuroblastoma and hemophilia A (HA)) concomitantly present in the same pediatric patient. We highlight that the diagnosis of severe HA did not have a negative impact on the patient’s oncologic course. This case also illustrates the significance of the cooperation among different specialties and hospitals when caring for the same patient.

Building a precision oncology workforce by multidisciplinary and case-based learning

BackgroundParticipants in two recent National Academy of Medicine workshops identified a need for more multi-disciplinary professionals on teams to assist oncology clinicians in precision oncology.MethodsWe developed a graduate school course to prepare biomedical students and pharmacy students to work within a multidisciplinary team of oncology clinicians, pathologists, radiologists, clinical pharmacists, and genetic counselors. Students learned precision oncology skills via case-based learning, hands-on data analyses, and presentations to peers. After the course, a focus group session was conducted to gain an in-depth student perspective on their interprofessional training experience, achievement of the course learning outcomes, ways to improve the course design in future offerings, and how the course could improve future career outcomes. A convenience sampling strategy was used for recruitment into the focus group session. A thematic content analysis was then conducted using the constant comparative method.ResultsMajor themes arising from student feedback were (1) appreciation of a customized patient case-based teaching approach, (2) more emphasis on using data analysis tools, (3) valuing interdisciplinary inclusion, and (4) request for more student discussion with advanced preparation materials.ConclusionsFeedback was generally positive and supports the continuation and expansion of the precision oncology course to include more hands-on instruction on the use of clinical bioinformatic tools.

Knowledge and attitudes of pharmacists towards colorectal cancer health education in Jordan: A cross-sectional study.

The purpose of this study was to assess pharmacists' knowledge and attitude towards early detection of colorectal cancer (CRC) in Jordan and to explore potential predictor variables of such knowledge and attitude. An electronic, self-reported questionnaire was used to collect data about demographics, knowledge and attitude regarding early detection of CRC. Both content and face validity were tested in a panel of experts. The participants' responses were analysed using descriptive statistics and multiple linear regressions. The 352 pharmacists (78% females, 94% Jordanian) had a median age of 28years and graduated mostly (83%) from public universities. Surprisingly, 90% were not able to identify carcinoembryonic antigen (CEA) as a non-accurate diagnostic method and almost one-third did not identify the correct screening tests. On a scale of 5, the majority of participants (59%) had moderate knowledge scores (3 or 4) in case scenarios. The median knowledge Percent of Maximum Possible (POMP) score was 67% and higher scores were associated with more years since graduation, pharmacists with MSc degree and higher, working in urban areas, studying oncology course and received oncology training (P<.05). Most participants showed a positive attitude towards early detection of CRC (median attitude POMP score was 78%). However, none of the analysed variables predicted their level of attitude. Although the majority of pharmacists demonstrated a positive attitude towards early detection of CRC, their knowledge was inadequate. The study highlighted the importance of optimising the education programmes to improve the pharmacists' knowledge about CRC early detection and preparing the pharmacists for participating in future national screening initiatives.

ENFERMAGEM ONCOLÓGICA: INTEGRAÇÃO UNIVERSIDADE-COMUNIDADE NO PROCESSO DE ENSINO-APRENDIZAGEM

Objetivo: descrever os aspectos operacionais e as vivências de discentes do curso de Enfermagem em um projeto de extensão universitária em Enfermagem Oncológica. Método: estudo descritivo, tipo relato de experiência relacionado a um projeto de extensão em Enfermagem. Resultados: dividiu-se o projeto em três etapas, incluindo a oferta de curso livre na área de oncologia, atividades extensionistas na comunidade e pesquisa em oncologia. Compôs-se a equipe por oito discentes, cinco docentes e quatro enfermeiras. Revela-se que, nas atividades de ensino e extensão, participaram 103 estudantes e 120 pessoas da comunidade, entre profissionais de saúde e outros residentes do município. Produziram-se 12 trabalhos científicos apresentados em eventos com abrangências local, regional e nacional. Permitiu-se, pela vivência dos discentes no projeto, a aproximação com a prática de Enfermagem Oncológica, consolidando os princípios de integralidade das ações de saúde na formação universitária. Conclusão: demonstrou-se, pelo estudo, a aplicação de um modelo de ensino-aprendizagem na Enfermagem que busca integrar universidade e comunidade, contribuindo para a abordagem de temas ainda pouco trabalhados na formação profissional e suscitando possibilidades de práticas interdisciplinares, com a reflexão crítica do ser “enfermeiro” nesse campo de atuação.

ESO-ESSO-ESTRO Multidisciplinary Course in Oncology for Medical Students: 4 Years of Experience (2016-2019).

The ESO-ESSO-ESTRO Multidisciplinary Course in Oncology is intended to fill the gap of the undergraduate fragmented oncology education, to provide insight into all theoretical and practical aspects of oncology, and to encourage future professional choices towards an oncology discipline. Students are exposed to (a) preclinical cancer topics; (b) natural history of the disease; (c) laboratory diagnostic tests; (d) medical, radiation, surgical, and palliative treatment; and (e) direct or through multidisciplinary patients' approach. Students are obliged to attend (i) all theoretical lectures, (ii) clinical case presentations, (iii) laboratories and ward visits, and (iv) to prepare and present a specific project under supervision. Participation is limited to 24 medical students who are selected through a competitive application process. Between 2016 and 2019, 96 students from 29 countries have attended. Data analysis derived from a given questionnaire demonstrates that most of the participants have declared that (1) they have achieved their expectations and objectives, (2) they have highly rated both clinical and non-clinical teaching oncological topics, and (3) they have been stimulated in developing a professional career in the field of oncology.

PO-1947: ARIA 15 Visual care Path for quality assurance of radiation oncology course

PO-1947: ARIA 15 Visual care Path for quality assurance of radiation oncology course

University of South Alabama College of Medicine.

University of South Alabama College of Medicine.

Pull-through resection without free-flap reconstruction for lateral wall oropharyngeal cancer.

While transoral robotic surgery (TORS) is widely used for the management of lateral wall oropharyngeal carcinomas (OPC), open surgical techniques are still used in some cases. A pull-through method for open surgical resections of OPC has recently been introduced. We improved on this method by eliminating the need for subsequent free-flap reconstruction. 16 patients with lateral wall OPC underwent pull-through resections. After resection, we used the digastric muscle, stylohyoid muscles, submandibular gland and the surrounding tissues to block the neck and oral cavity and to avoid reconstruction. This novel technique was performed without major complications or morbidities. The average post-operative hospital stay was 14.6±6.1days, and the average duration until initiation of oral intake post-operation was 6.5±2.9days. Oncological outcomes, post-operative course and function were acceptable. Our novel method provides an efficient and less invasive surgical technique than conventional open approaches.

Development, implementation and evaluation of a management specialization course in oncology using blended learning

BackgroundIdentifying effective methods for safeguarding the efficient functioning of the healthcare system contributes significantly towards establishing a successful healthcare organization. Consequently, quality management programs are currently being implemented in healthcare as a vital strategy for patient care. Quality management encompasses protocols and guidelines in decision-making and in the evaluation of processes and treatment flowcharts, data analysis and health indicators, and addresses improvement in the interaction between different health professionals. Qualifying health professionals to perform quality management has represented a barrier to implementing a well-structured management system. Indeed, the pathway to qualifying health managers is often poorly outlined, with clear gaps in the definition of their competencies, training and career plans. Therefore, studies and education-related actions aimed at qualifying health professionals in management are vital if health services of excellence are to be established. The present study aimed to plan, develop, implement and evaluate a management specialization course in oncology using blended learning.MethodsFollowing approval by the institution’s internal review board, the study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). The Analysis, Design, Development, Implementation and Evaluation (ADDIE) model was used to plan, develop, implement and evaluate the course. Data were collected as the course participants who had concluded all the modules evaluated the program.ResultsA management course in oncology, consisting of ten sequential modules, was developed and implemented between March 2018 and February 2019. The course consisted of monthly face-to-face encounters, each with 12 h of activities, and distance education using a virtual learning environment. Each module was presented by a specialist on the subject in question. After the end-of-course conclusion work had already been handed in and evaluated by the tutors, the participants completed a form to assess the course using Kirkpatrick’s training evaluation model.ConclusionsA management course in oncology was developed using the ADDIE model. A high degree of satisfaction was found among the participants regarding improvements in their management skills and their professional behavior. The expectation is that this initiative will ultimately improve healthcare and reduce costs, as well as encourage further innovative educational actions for health professionals.

Practice and evaluation of integrated course in clinical oncology

Because clinical oncology course for undergraduates is related to many clinical specialties, traditional teaching of this course is likely to lead to repetition and contradiction of knowledge. Clinical medical college carried out integrated curriculum in clinical oncology for three years during the implementation of teaching reform to overcome the above-mentioned disadvantages. Teaching and research sections related to clinical oncology were horizontally integrated under the guidance of teaching affairs office; On the premise of meeting the requirements of teaching outlines, the clinical oncology in internal medicine, surgery and gynecology was systematically improved in accordance with cognitive laws. Following the previous year, PBL teaching program in clinical oncology still focused on the integration of theoretical course and probation course. After integration, the sub-specialty teacher team was gradually shaped, the teaching quality was significantly improved and the clinical thinking of medical students was enhanced. Key words: Clinical oncology; Curriculum integration; Teaching reform; Teaching evaluation; Teaching management

The outcome-based iCAN! / theyCAN! feedback paradigm differentiates strong and weak learning outcomes, learner diversity, and the learning outcomes of each learner: A shift to metacognitive assessment

Abstract Background Can learning outcomes be transformed in useful tools revealing strong and weak learning outcomes, learners, teachers; reporting student self-assessment overestimation; informing formative feedback and summative examinations? Methods Based on the ESMO / ASCO global curriculum, 66 level-two learning outcomes were identified and transformed in the iCAN!-Oncology and theyCAN!-Oncology questionnaires, anonymously completed online, before and after teaching, by trainees and trainers respectively, in a five-day fulltime undergraduate oncology course. Results In total, students assessed themselves (iCAN!) with 55% before and 70% after the course (27% improvement); teachers assessed students (theyCAN!) with 43% before and 69% after (60% improvement). Twenty level-two learning outcomes (30%) were scored below the pass / fail cut-point by students while 46 (70%) by teachers, before the course; none after the course. Students assessed themselves the highest in “TNM system” before (81%) and after (82%), while the teachers assessed students so in “Normal cell biology” before (72%) and “Moral / ethical issues in clinical research” after (83%). The lowest assessed outcome was the “Research protocol” by students (28%) and teachers (18%) before, and the “Anticancer agents” after (54% by both). Individual students self-assessed themselves from 31% to 88% before, and from 54% to 88% after; individual teachers assessed students from 29% to 66% before, and from 55% to 94% after. The iCAN! / theyCAN! provided detailed individual student or teacher profile, tightfisted or generous. Conclusions The iCAN! / theyCAN! differentiate strong and weak learning outcomes, learners, teachers; reveal no student self-assessment overestimation; inform formative feedback and summative exams at a metacognitive level; generalize to any course and assessor; support evidence-based teaching and learning SWOT policy.

Evaluation of a new e-learning framework for teaching nuclear medicine and radiology to undergraduate medical students.

BackgroundRadiology and nuclear medicine have traditionally been taught in a series of lectures and seminars concluded by an examination testing knowledge rather than skills.PurposeTo emphasize skills in the students’ learning process, we developed and evaluated a new e-learning framework for teaching medical imaging.Material and MethodsThe framework consists of electronic lectures, a learning management system (LMS), and a diagnostic viewing system. Students were to review positron emission tomography/computed tomography (PET/CT) examinations of five cases of lung cancer. The framework was evaluated in an objective structured clinical examination (OSCE) taken by 139 undergraduate students at the end of their third year, and in a comparative survey of two groups of 85 and 84 students in the fifth and sixth year who were taught the same oncology course with and without mandatory PET/CT exercises, respectively.ResultsOf the 139 third-year students, 134 (96%) passed the OSCE PET/CT station according to the predefined criteria. While 85/85 (100%) of the fifth-year students had taken exercises when they were mandatory, only 2/84 (2%) of the sixth-year students had reviewed the cases on a voluntary basis (P < 0.001). Of the 25 survey responders in the fifth year, 24 (96%) agreed that the mandatory PET/CT exercises had promoted their learning while the sixth-year students, whose course concluded with a multiple-choice examination, emphasized the utility of online lectures.ConclusionThe new e-learning framework teaches students basic competency in PET/CT navigation and interpretation and is associated with a high degree of student satisfaction.

Flipping the medical classroom: Effect on workload, interactivity, motivation and retention of knowledge

Engagement with homework assignments is important to be able to actively process content during in-class activities in flipped classroom education. Active engagement with the content is assumed to promote deeper understanding and to improve retention of knowledge. This comparative case study aims to explore student workload during homework activities and examines in-class activities next to student motivation and their retention of knowledge in both traditional education and flipped classrooms.This quasi-experimental study was conducted in a Hematology and Oncology course, which is scheduled in the second year of medical education, in Utrecht, the Netherlands. Students’ self-reported study time in traditional classrooms (2014) and flipped classrooms (2015) were measured during one course with a daily online questionnaire and in-class activities were explored using an observation scheme and audio recordings. Cognitive evaluation theory was used to investigate student motivation by measuring perceived autonomy and competence (self-efficacy) of students at the end of the course. Knowledge retention and self-efficacy were (again) measured after 10 months.The in-class observations suggested more interactivity in flipped classrooms. All participating students reported similar workload during the course, whereas exam preparation after flipped classrooms was significantly less time consuming. Students in flipped classrooms reported higher scores for self-efficacy, whereas perceived autonomy was comparable to students learning in traditional classrooms. Ten months after the course, retention of knowledge and self-efficacy scores showed no difference.This study indicated that flipped classroom education required less time investment when preparing for the end-of-course exam and students perceived higher self-efficacy, which is relevant in the light of student stress and burn-out. However, comparison of long-term measurements (retention of knowledge and self-efficacy) showed similar outcomes for students in traditional classrooms and flipped classrooms. It would be interesting to learn whether students trained in flipped classroom education turn out to be better problem solvers in their future careers. For example, if the students in this study are better able to handle patient cases during their clinical rotations.

Propensity-Matched Survival Analysis of Upper Urinary Tract Urothelial Carcinomas between End-Stage Renal Disease with and without Kidney Transplantation.

Urothelial carcinoma is the most common cancer following kidney transplantation (KT) in Taiwan. Unusual presentation of upper urinary tract urothelial carcinoma (UTUC) is noted in Taiwan and China. As the post-KT-UTUC oncological course is not fully understood, the aim of this study is to identify postulated significant differences for the clinical cancer course of UTUC among end-stage renal disease (ESRD) patients with and without KT. From 2005 January to 2016 March, 194 ESRD patients underwent radical nephroureterectomy due to UTUC in our hospital. The parameters were obtained from the chart record and pathology report. SPSS version 21 software was used for all statistical analyses. Unequal matching created study groups wherein a 0.2 caliper width was performed for adjusting these confounding pathological factors. Propensity score-matching cohort was performed for each population first, and then for all the study patients. We observed that the average age of UTUC in ESRD patients after KT was younger than in those without KT. The pathological factors such as stage, bladder cancer history, papillary structure, lymphovascular invasion, and variant histology were equal in these two groups. However, younger onset (p<0.001), more multifocal tumors, and carcinomas in situ were observed in post-KT UTUC (p<0.001 and 0.006, respectively). After adjustment of pathological factors by propensity score-matched analysis, the 5-year systemic UTUC recurrence was significantly more in ESRD after KT compared with ESRD without KT (p=0.03). No obvious difference in 5-year cancer related death could be observed between these two groups (p=0.314). Post-kidney transplantation upper urinary tract urothelial carcinoma in Taiwan is relatively common, has younger onset, and is associated with aggressive pathological features. The oncologic outcome of UTUC after KT is poor in our observation, even after propensity scored-matched analysis. It indicates the immunosuppression status is still associated with more malignant UTUC behavior.

Revision of an undergraduate nursing oncology course using the Taylor Curriculum Review Process.

Patients diagnosed with cancer require intensive nursing care and support across all healthcare settings (Canadian Association of Nurses in Oncology [CANO], 2015). Advances in this nursing specialty and the resulting changes to practice add to the complexity of the nursing role. Clinical improvements impact the preparation of nursing students transitioning into this area of practice. The inclusion of an oncology curriculum in undergraduate programs can help to develop fundamental competencies for undergraduates in this specialty (Lockhart et al., 2013). A fourth-year undergraduate nursing oncology course was recently evaluated at the University of Calgary to ensure content was congruent with current practice. Since the course was initially developed in 2011, there have only been minor updates, potentially resulting in out-of-date content. A curriculum review process outlined by the Taylor Institute of Teaching and Learning was used to complete this course revision (Dyjur & Kalu, 2016). The findings of this course revision indicate the need to provide more student-centred learning, to discuss the implementation of recent treatments, and to provide more clinically centered literature on recent developments in oncology.

Revision of an undergraduate nursing oncology course using the Taylor Curriculum Review Process

Apres un diagnostic de cancer, les patients ont besoin d’un grand soutien et de soins infirmiers intensifs, et ce, peu importe le milieu de soins (Association canadienne des infirmieres en oncologie [ACIO], 2015). Les avancees accomplies dans cette branche specialisee des soins et leurs effets sur la pratique complexifient le role de l’infirmiere. En outre, les progres cliniques influencent la preparation des etudiants qui se dirigent vers ce domaine. L’inclusion d’un cours d’oncologie aux programmes de premier cycle permettrait l’acquisition de competences fondamentales necessaires a l’exercice de cette specialite (Lockhart et al., 2013). A l’Universite de Calgary, un cours de soins infirmiers en oncologie offert aux etudiants en quatrieme annee du premier cycle a recemment fait l’objet d’une evaluation pour verifier que le contenu correspondait bel et bien aux realites actuelles de la pratique. Depuis sa mise en place en 2011, le cours n’a subi que quelques mises a jour mineures; son contenu risquait donc d’etre depasse. La revision a ete effectuee selon les criteres d’evaluation de programme du Taylor Institute of Teaching and Learning (Dyjur et Kalu, 2016). Ses conclusions : il faut mettre davantage l’etudiant au centre de l’apprentissage, discuter de l’application des traitements recents et aborder les derniers developpements en oncologie en mettant l’accent sur la pratique clinique.

Impact of postoperative complications on long-term survival following surgery for T4 colorectal cancer

BackgroundPostoperative complications (POCs) after the resection of locally advanced colorectal cancer (CRC) may influence adjuvant treatment timing, outcomes, and survival. This study aimed to evaluate the impact of POCs on long-term outcomes in patients surgically treated for T4 CRC.MethodsAll consecutive patients who underwent the resection of T4 CRC at a single centre from 2004 to 2013 were retrospectively analysed from a prospectively maintained database. POCs were assessed using the Clavien-Dindo classification. Patients who developed POCs were compared with those who did not in terms of recurrence-free survival (RFS) and overall survival (OS).ResultsThe study population comprised 106 patients, including 79 (74.5%) with synchronous distant metastases. Overall, 46 patients (43%) developed at least one POC during the hospital stay, and of those patients, 9 (20%) had severe complications (Clavien-Dindo ≥ grade III). POCs were not associated with OS (65% with POCs vs. 69% without POCs; p = 0.72) or RFS (58% with POCs vs. 70% without POCs; p = 0.37). Similarly, POCs did not affect OS or RFS in patients who had synchronous metastases at diagnosis compared with those who did not.ConclusionsPOCs do not affect the oncological course of patients subjected to the resection of T4 CRC, even in cases of synchronous metastases.

SJS-1 - All oncologists are geriatric oncologists

More than 60% of cancers will be soon diagnosed after 70 years, sparing no country, no culture, but even more importantly no single physician if (s)he is involved in the management of cancer. Geriatric oncology cannot be considered anymore as a dawning topic or a confidential practice. Defined as the development of adjusted strategies for the older cancer patients, it requires specific approaches, from bench to bedside, nailing down the unmet clinical needs which cannot be answered simplistically by the usual extrapolation from results in younger patients. It fosters a strong collaboration between both medical worlds of oncology and geriatrics to channel the scaremonger epidemiological tsunami. However, given the challenges faced to implement geriatric oncology in daily practice, one needs a single voice. Since its creation in 2000, the International Society of Geriatric Oncology (SIOG) has consistently worked on actions for this underserved population to support cares organization, information to a wide audience including patients and caregivers, education of professionals, and research. This has been used on several occasions for national initiatives, with education and research, both mattering very much to oncology, often selected as priority actions. All these goals cannot be achieved without international assistance, increased awareness and strong public, politic and state support. They need an efficient network across borders, as advocated by SIOG in joint efforts with other key professional societies as ESMO or JSMO. They also require global education actions as the SIOG international advanced course in geriatric oncology developed with the Universita Cattolica del Sacro Cuore. Only through this continuous action, one will be able to step up to the challenge of our moving society, catering for all, not leaving the frailer ones behind. Oncologists must spearhead this action to be able to arbitrate fairly innovation. The onus is on them.

Integration of Palliative Care into the Comprehensive Cancer Center of Germany - Consultation Hours and Fellowship Rotations of the Specialized Palliative Care

Comprehensive Cancer Centers are characterized by interdisciplinary exchange for meeting increasingly complex care needs during the course of the disease. Tumor consultations hours and fellowship rotations build hereby bridges between the subjects and disciplines. In order to be able to provide support in the Comprehensive Cancer Center Network for the further integration of specialized palliative medicine, it was highlighted to what extent consultation hours and fellowship rotations for the palliative care are integrated into the centers. Information about the spS and fellowship rotation of the Comprehensive Cancer Center (n = 16), which had previously been funded by the Cancer Aid, was paper-based collected with a survey questionnaire. For this purpose, the heads of the palliative care departments of the centers were interviewed from July to August 2017. The evaluation was performed by SPSS (frequency, mean value, median, range). 15 from 16 centers responded to the survey (93.75 %). Nine centers (60 %) have a consultation hour for palliative care. Four from nine centers can submit this offer for ≥ 4 hours (44.4 %). Fellowship rotations in the palliative care occur primarily in all centers from oncology / hematology (n = 11, 73.3 %) and anaesthesia (n = 6) and often for a twelve months (n = 11) period of time. Outpatient structures of the palliative care have been insufficiently implemented to a consultation hour within Comprehensive Cancer Centers. The existing effort to integrate palliative care into the oncological course of disease requires further structuring in order to increase the visibility of palliative care services. Fellowship rotations in the palliative care department are regularly implemented in the network even if only for some of the subjects in order to raise awareness of the possibilities of the palliative care.