Survey Of Oncologists Research Articles

PC-FACS

PC-FACS

Quantitative Radiology Reporting in Oncology: Survey of Oncologists and Radiologists.

Tumor quantification is essential for determining the clinical efficacy and response to established and evolving therapeutic agents in cancer trials. The purpose of this study was to seek the opinions of oncologists and radiologists about quantitative interactive and multimedia reporting. Questionnaires were distributed to 253 oncologists and registrars and to 35 radiologists at our institution through an online survey application. Questions were asked about current reporting methods, methods for Response Evaluation Criteria in Solid Tumors (RECIST) tumor measurement, and preferred reporting format. The overall response rates were 43.1% (109/253) for oncologists and 80.0% (28/35) for radiologists. The oncologists treated more than 40 tumor types. Most of the oncologists (65.7% [67/102]) and many radiologists (44.4% [12/27]) (p = 0.020) deemed the current traditional qualitative radiology reports insufficient for reporting tumor burden and communicating measurements. Most of the radiologists (77.8% [21/27]) and oncologists (85.5% [71/83]) (p = 0.95) agreed that key images with measurement annotations helped in finding previously measured tumors; however, only 43% of radiologists regularly saved key images. Both oncologists (64.2% [70/109]) and radiologists (67.9% [19/28]) (p = 0.83) preferred the ability to hyperlink measurements from reports to images of lesions as opposed to text-only reports. Approximately 60% of oncologists indicated that they handwrote tumor measurements on RECIST forms, and 40% used various digital formats. Most of the oncologists (93%) indicated that managing tumor measurements within a PACS would be superior to handwritten data entry and retyping of data into a cancer database. Oncologists and radiologists agree that quantitative interactive reporting would be superior to traditional text-only qualitative reporting for assessing tumor burden in cancer trials. A PACS reporting system that enhances and promotes collaboration between radiologists and oncologists improves quantitative reporting of tumors.

Unmet clinical needs in the management of advanced melanoma: findings from a survey of oncologists.

Advanced melanoma is a life‐threatening cancer with limited life expectancy. The recent introduction of new targeted systemic therapies has provided clinicians with the means to potentially extend survival for the first time. However, the chance of cure remains very low and treatment‐induced toxicity is well described. This qualitative study was undertaken to evaluate clinicians’ assessment regarding the key concerns in managing advanced melanoma following the introduction of these new treatments. Three hundred and forty‐three oncologists were surveyed online between August and November 2012 (in 11 countries) and March and April 2013 (in an additional country). Analysis of free‐text responses identified 23 clinical issues of concern across all countries. Of these, the most common clinical concerns were drug toxicity and tolerability, followed by limited treatment effectiveness and limited treatment options. These results suggest that despite the promise of the two new agents in the field, clinicians are still concerned about the limitations of current treatment options, recognising that there remains a significant unmet need in the treatment of advanced melanoma.

АНАЛІЗ ПРОБЛЕМ ТА РОЗРОБКА ЗАХОДІВ ЩОДО ПІДВИЩЕННЯ ЕФЕКТИВНОСТІ ФАРМАЦЕВТИЧНОГО ЗАБЕЗПЕЧЕННЯ ХВОРИХ НА ЛЕЙКОЗИ В УКРАЇНІ

<p align="center"><strong>ANALYSIS OF PROBLEMS AND DEVELOPING MEASURES TO IMPROVE THE EFFECTIVE OF THE PHARMACEUTICAL PROVIDING PATIENTS WITH </strong><strong>LEUKOSIS</strong><strong> IN UKRAINE</strong><strong></strong></p><p class="tecst" align="center"><strong>G. L. Panfilova, </strong><strong>О</strong><strong>. V. Tsurikova</strong></p><p align="center">NationalPharmaceuticalUniversity,Kharkov</p><p><strong>Summary:</strong> The article presents the results of the survey of physicians of oncology and hematology at a range of issues relating to the organization of medical and pharmaceutical care to patients with leukosis in Ukraine. Evaluation of all the physicians who participated in the survey, problem-solving in the organization of effective medical and pharmaceutical care must be realized in the plane the introduction of compulsory health insurance in the healthcare practice.</p><p><strong>Keywords:</strong> expert survey, leucosis, pharmaceutical care, pharmaceutical providing</p><p><strong>Introduction.</strong> According to the National Cancer Registry leukosis steadily occupy the first position in the structure of morbidity and mortality from malignant neoplasm’s among the age group from 0 to 17 years. Important role in determining the direction of overcoming the problem of low efficiency of medical and pharmaceutical care to patients with leukosis is opinion analysis oncologists and hematologists. These groups of physicians are an essential element that connects patients and pharmacists in the pharmaceutical provision of hematological patients.</p><p><strong>Methods.</strong> The study used a logical, comparative, graphic and statistical method of analysis and of scientific search. The objects of research were selected results of the expert survey of oncologists and hematologists physicians, conducted during the years 2012-2014 in various regions of Ukraine.</p><p><strong>Results and discussion</strong>. According to the results of data processing survey found that in rating the importance of factors that influence prescription, took the leading position of clinical and economic factors and regulatory and legal content. According to physicians, unimportant factors are those associated with traditional application of different chemotherapy regimens. By unimportant factors physicians classified as one that is due to the possibility of the use of a name of the drug under conditions of absence of more effective drug. It is proved that the vast majority of experts only partially satisfied with the level of organization and financing of health care and pharmaceutical providing patients with leukosis. The main directions of solving this problem 100% believe the introduction of compulsory medical insurance in Ukraine. Almost every second expert noted a low level of satisfaction of needs of drugs. More than half the respondents consider it inexpedient to give preference domestically produced drugs at the budget procurement of drugs. Installed contradictory attitude of experts to assess the frequency of prescriptions drugs procured by the state. More than half of physicians believe that they have sufficient information on new drugs and chemotherapy leukosis. Physicians believe the most appropriate use of the work such sources of information as «analytical and brief overview», «annotations in monographs magazine articles, etc.». More than three-quarters of physicians indicated that their hospitals are absent pharmacies of state (municipal) ownership. The 56 of experts consider it appropriate opening in their hospital pharmacies of state (municipal) ownership. More than half of physicians assessed the level cooperation of pharmacies and the hospital where they work as «satisfactory». Physicians believe that the main factor that affects the level of cooperation between the pharmacy and the hospital are «affordability of drugs». According to the opinion the overwhelming number of physicians, the main problems in pharmaceutical providing of leukosis patients are «low income of the population» and «insufficient budget financing program «Oncology»». Great importance, according to the majority experts, is a lack systematic and clear state policy in the pharmaceutical sector of Ukraine. The results of our studies developed measures to improve pharmaceutical providing patients with leucosis in Ukraine. Offered by us are measures should be implemented at the macroeconomic and microeconomic level.</p><p><strong>Conclusion.</strong> The results of the research, a list of measures to improve the efficiency of pharmaceutical providing of leukosis patients in Ukraine. These measures should be implemented at two levels (macroeconomic and health facility level).</p>

A Quantitative Study of Triggered Palliative Care Consultation for Hospitalized Patients With Advanced Cancer

ContextUnplanned cancer-related hospital admissions often herald entry into the final phase of life. Hospitalized patients with advanced cancer have a high symptom burden and a short life expectancy, which may warrant palliative care intervention. ObjectivesTo identify the impact of implementing triggered palliative care consultation (TPCC) as part of standard care for patients admitted to the solid-tumor oncology service with advanced cancer. MethodsWe conducted a prospective, sequential, three-cohort study to evaluate TPCC feasibility and impact using patient-reported outcomes, electronic medical records to identify resource utilization, and surveys of oncologists' perspectives on TPCC. ResultsSixty-five patients were evaluated before TPCC implementation (Cohort 1). Seventy patients (Cohort 2) were evaluated after initiation of TPCC, and 68 patients (Cohort 3) were evaluated after modifications based on implementation barriers identified in Cohort 2. The percentage of patients correctly identifying their cancer as incurable increased from 65% in Cohort 1 to 94% in Cohorts 2 and 3. TPCC had minimal impact on hospice utilization, cost of care, survival, patient-reported symptoms, and patient satisfaction, likely because of the limited nature of the intervention. Implementation was challenging, with only 60% of patients in Cohort 2 and 62% in Cohort 3 receiving TPCC. Overall, the intervention was viewed favorably by 74% of oncologists. ConclusionAlthough TPCC was viewed favorably, implementation was logistically challenging because of short stays, high-acuity symptoms, and individual provider resistance. TPCC improved patients' understanding of their cancer. This population demonstrates high palliative care needs, warranting further research into how best to deliver care.

PCN167 - Perception of value of New Cancer Drugs: a survey of Oncologists in the United States (US)

PCN167 - Perception of value of New Cancer Drugs: a survey of Oncologists in the United States (US)

Treatment of metastatic breast cancer with 𝑛𝑎𝑏-paclitaxel in the community practice setting: a US Oncology survey.

Different dosages-schedules of nab-paclitaxel have been assessed in trials of metastatic breast cancer (MBC). However, there is limited information on nab-paclitaxel dosing-scheduling in the community setting. To report on experience with nab-paclitaxel for human epidermal growth factor receptor 2 (HER2)-negative MBC and identify patient characteristics affecting nab-paclitaxel treatment patterns in the community practice setting. From September 6-October 21, 2013, a 35-question, web-based survey on nab-paclitaxel dosing, toxicities leading to dose modifications, management, and treatment duration was sent to US Oncology network oncologists. Respondents were categorized by percentage of their patients with HER2-negative MBC who received nab-paclitaxel. 104 of 428 oncologists responded; 84% were from large practices (≥16 oncologists), and 56% had a high level of experience using nab-paclitaxel. For first- and second-line treatment, 100 mg/m² weekly was the most common starting dosage-schedule, followed by 125 mg/m² weekly and 260 mg/m² every 3 weeks (q3w); 150 mg/m² weekly was used least frequently. Several factors, including select aggressive disease characteristics, were found to affect nab-paclitaxel dose selection. Weekly dosing was preferred in patients with select aggressive disease characteristics, whereas q3w dosing was commonly used in patients aged ≤50 years and those with good performance status. Differences in management styles among oncologists with high compared with infrequent nab-paclitaxel experience were also observed. Peripheral neuropathy and neutropenia were common dose-limiting toxicities. Recall and response bias may be limitations of this study. In the community setting, nab-paclitaxel 100 mg/m² weekly was the most commonly used starting dose for patients with HER2-negative MBC, including those with aggressive disease characteristics.

Regional variation in physicians’ awareness, understanding, and use of personalized medicine in the treatment of cancer and perception of patient (pt) education.

574 Background: A multinational survey of oncologists was conducted to assess the awareness and use of biomarkers in clinical practice (Ciardiello et al, ESMO 2014). These data explore regional variations as well as perceived level of “cancer literacy” among pts. Methods: Ten-minute online interviews were conducted with practicing oncology specialists (3 to 35 years of experience, treating > 15 pts/month) from 12 representative countries in Europe, South America, and Asia. Results: In total, 895 interviews were completed; numerous regional differences were observed. While most physicians use biomarkers (90%), there were marked regional variations. KRAS was the most frequent test. Among the 10% of physicians not using biomarkers, local availability of testing, speed of obtaining results, and cost were cited as the main reasons. The majority of Chinese doctors indicated that physician training (82%) and better biomarker information for pts (83%) would enable them to use biomarkers more often (global averages: 38% and 34%, respectively). Striking variation was seen in physicians’ assessment of pts’ knowledge of cancer biology, treatment options, use of biomarkers, and involvement in their own treatment plans. Only 38% of German physicians believed their pts know that tumors can be tested to help decide which treatment to give (global average: 73%). Only 21% of Saudi Arabian physicians believed the treatment decision process is shared between the doctor and/or multidisciplinary team and pt (global average: 82%). While physicians felt specialist nurses were the best source of information for pts, only 45% globally believed pts had access to these nurses (ranging from 19% in Russia to 83% in the UK). Conclusions: These data demonstrate wide global use of biomarkers but with regional variations reflecting cultural and local practice. Perception of pt cancer literacy and pt access to information also differs widely. Most physicians agree, however, that pts require more information to understand their disease better and become involved in treatment decisions.

An International Survey of Health Care Providers Involved in the Management of Cancer Patients Exposed to Cardiotoxic Therapy.

Cardiotoxicity is the second leading cause of morbidity and mortality in cancer survivors. The objective of this international cardiac oncology survey was to gain a better understanding of current knowledge and practice patterns among HCPs involved in the management of cancer patients exposed to potentially cardiotoxic drugs. Between 2012 and 2013, we conducted an email-based survey of HCPs involved in the management of cardiac disease in cancer patients. 393 survey responses were received, of which 77 were from Canadian respondents. The majority of respondents were cardiologists (47%), followed closely by medical oncologists. The majority of respondents agreed that cardiac issues are important to cancer patients (97%). However, only 36% of total respondents agreed with an accepted definition of cardiotoxicity. While 78% of respondents felt that cardiac medications are protective during active cancer treatment, only 51% would consider prescribing these medications up-front in cancer patients. Although results confirm a high level of concern for cardiac safety, there continues to be a lack of consensus on the definition of cardiotoxicity and a discrepancy in clinical practice between cardiologists and oncologists. These differences in opinion require resolution through more effective research collaboration and formulation of evidence-based guidelines.

Understanding potential communication gaps between oncologists and patients with advanced breast cancer: A survey of oncologists.

124 Background: About 232,670 cases of breast cancer will be diagnosed in the US in 2014, of which 86,088 (37%) will be metastatic advanced breast cancer (ABC). The 2013 Global Count Us, Know Us, Join Us survey found that 53% of US women with ABC wanted more time to discuss their needs during clinic visits, and 60% believe their cancer treatment options are limited. To better understand unmet patient needs and potential communication gaps with physicians, surveys were developed for women with ABC, their caregivers, and oncologists. The oncologists’ survey results are presented. Methods: The Make Your Dialogue Count survey for oncologists has 32 items. Responses are single or multiple response numeric text or rated on a 4-point Likert scale. Harris Poll conducted this online survey from June through July 2014 among randomly selected, licensed US medical oncologists who treat ≥ 5 women with ABC per month. Responses for geographic region and number of years in practice by sex were weighted to match actual proportions in the population. Results: By July 15, 2014, 228 oncologists responded. At initial diagnosis, showing care and compassion was very important to 79% of oncologists; helping patients cope with diagnosis (62%) and manage cancer symptoms (56%) and discussing expected treatment response (57%) and side effects (51%) were also very important. Most oncologists (88%) revealed that treating women with ABC has a negative emotional toll. Although 81% of oncologists believe it to be unprofessional to let their emotion affect treatment recommendations, 26% reported that their emotions kept them from providing some information. Notably, 31% of oncologists reported that in certain situations, they have not discussed with patients that ABC is incurable. Conclusions: Caring for terminally ill patients has an emotional impact on oncologists. For some, their emotions have influenced what treatments they recommend and what information they impart. Our findings show that oncologists are compassionate and share disease- and treatment-related information and highlight the need to develop communication strategies that facilitate exchange between oncologists and their patients with ABC.

CHEMOTHERAPY AND TOXICITY ASSESSMENT

Cancer is a disease associated with aging, and the majority of cancer diagnoses and deaths occur in patients age 65 and older.1 Older age is a risk factor for chemotherapy toxicity,2 and older adults are less likely to be offered chemotherapy because of concerns regarding their ability to tolerate the treatment. [3] Hurria A. Hurria F.L. Villaluna D. et al. Role of age and health in treatment recommendations for older adults with breast cancer: the perspective of oncologists and primary care providers. J Clin Oncol. 2008; 26: 5386-5392 Crossref PubMed Scopus (85) Google Scholar [4] Kornblith A.B. Kemeny M. Peterson B.L. et al. Survey of oncologists' perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials. Cancer. 2002; 95: 989-996 Crossref PubMed Scopus (150) Google Scholar However, older adults derive benefit from chemotherapy similar to that derived by younger adults. [5] Muss H.B. Woolf S. Berry D. et al. Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA. 2005; 293: 1073-1081 Crossref PubMed Scopus (346) Google Scholar [6] Sargent D.J. Goldberg R.M. Jacobson S.D. et al. A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med. 2001; 345: 1091-1097 Crossref PubMed Scopus (823) Google Scholar As a result, there is a need to characterize the “functional age” of older patients with cancer in order to tailor treatment decisions based on factors other than chronologic age alone. The aging process is heterogeneous, making chronological age a relatively poor marker of overall physiologic and health status and ability to tolerate treatment.

Treatment ofpatients (pts) with HER2- metastatic breast cancer (MBC) with nab-paclitaxel (nab-P) in the clinical practice setting—Results of a US Oncology survey.

e12008 Background: Different dosages/schedules of nab-P (ie, 260 mg/m2 q3w, 100 mg/m2 qw, and 150 mg/m2 qw) have been assessed in phase 2/3 trials of MBC. However, limited information exists on the use of nab-P in the community setting. Here we report on experience with nab-P for the treatment of HER2− MBC and pt characteristics that impact nab-P treatment patterns in the community practice setting. Methods: From 9/6 to 10/21, 2013, US Oncology network physicians completed 30-question, web-based surveys on nab-P utilization, toxicity frequency, management, and duration. Responses were analyzed categorically by pt characteristics and proportional nab-P utilization. High (H) nab-P users were defined as those with ≥ 33% of HER2− pts who received nab-P. Results: 104/428 responded; 84% were from large practices (≥ 16 oncologists) and 56% were H nab-P users. For first- and second-line treatment, 100 mg/m2 qw (51% and 58%) was the most common starting dosage/schedule followed by 125 mg/m2 qw (22% and 14%), while...

Current Practices in the Management of Adverse Events Associated With Targeted Therapies for Advanced Renal Cell Carcinoma: A National Survey of Oncologists

BackgroundOncologists treating patients with targeted therapies encounter adverse events (AEs) that pose management challenges, lead to dosing inconsistencies, and impact patient quality of life. Oncologists' practices and attitudes in the management of targeted therapy–related AEs in patients with renal cell carcinoma (RCC) are poorly understood. We sought to identify unmet needs associated with AE management and understand oncologists' treatment optimization strategies. MethodsA 24-item online survey was administered in August 2012 to 119 US oncologists treating patients with advanced RCC. The survey solicited responses regarding demographics, practice settings, AE management practice patterns and beliefs, treatment barriers, and patient education. ResultsRespondents indicated that between 25% and 50% of patients require dose modification/discontinuation because of AEs. The greatest barrier to optimizing treatment for RCC is the unpredictability of patient responses to treatment (43%). Most respondents (78%) discuss AE management with patients, but only a minority of them proactively reach out to patients (46%). Most practitioners (70%) refer patients to nononcology specialists when faced with unfamiliar AEs, although finding interested physicians (43%) and time constraints (40%) were the most commonly cited barriers to consulting with other specialties. ConclusionResults suggest that many patients require dose modification/discontinuation because of AEs and that nononcologists are a frequently utilized resource to manage these events. There is a need for predictive drug toxicity markers to establish counseling and prevention, along with opportunities for increased education on supportive care techniques to maintain health-related quality of life and consistent dosing.

Provision and discussion of survivorship care plans among cancer survivors: results of a nationally representative survey of oncologists and primary care physicians.

Survivorship care planning should involve discussions between providers and cancer survivors to address survivors' needs and optimize adherence. We examined the frequency and factors associated with oncologists' and primary care physicians' (PCPs) reports of provision of written survivorship care plans (SCPs) and discussion of survivorship care recommendations with survivors. A nationally representative sample of 1,130 oncologists and 1,020 PCPs was surveyed about survivorship care practices with survivors. Logistic regression models predicted multilevel factors associated with providing SCPs or discussing recommendations with survivors. Although a majority of oncologists (64%) reported always/almost always discussing survivorship care recommendations with survivors, fewer also discussed who survivors should see for cancer-related and other follow-up care (32%); fewer still also provided a written SCP to the survivor (< 5%). Survivorship care recommendations and provider responsibility were not regularly discussed by PCPs and survivors (12%). Oncologists who reported detailed training about late and long-term effects of cancer were more likely to provide written SCPs (odds ratio [OR], 1.73; 95% CI, 1.22 to 2.44) and discuss survivorship care planning with survivors (OR, 2.02; 95% CI, 1.51 to 2.70). PCPs who received SCPs from oncologists were 9× more likely (95% CI, 5.74 to 14.82) to report survivorship discussions with survivors. A minority of both PCPs and oncologists reported consistently discussing and providing SCPs to cancer survivors. Training and knowledge specific to survivorship care and coordinated care between PCPs and oncologists were associated with increased survivorship discussions with survivors. These nationally representative data provide a useful benchmark to assess implementation of new efforts to improve the follow-up care of survivors.

Current Opinions on Medical Radiation: A Survey of Oncologists Regarding Radiation Exposure and Dose Reduction in Oncology Patients

The aim of this study was to evaluate oncologists' opinions about the use of ionizing radiation in medical imaging of oncology patients. An electronic survey was e-mailed to 2,725 oncologists at the top 50 National Cancer Institute-funded cancer centers. The survey focused on opinions on CT dose reduction in oncology patients and current philosophies behind long-term imaging in these patients. The response rate was 15% (415 of 2,725). Eighty-two percent of respondents stated that their patients or families have expressed anxiety regarding radiation dose from medical imaging. Although fewer than half of oncologists (48%) did not know whether CT dose reduction techniques were used at their institutions, only 25% were concerned that small lesions may be missed with low-dose CT techniques. The majority of oncologists (63%) follow National Comprehensive Cancer Network guidelines for imaging follow-up, while the remainder follow other national guidelines such as those of the Children's Oncology Group, the American Society of Clinical Oncology, or clinical trials. Ninety percent of respondents believe that long-term surveillance in oncology patients is warranted, particularly in patients with breast cancer, melanoma, sarcoma, and pediatric malignancies. The majority of oncologists would consider the use of low-dose CT imaging in specific patient populations: (1) children and young women, (2) those with malignancies that do not routinely metastasize to the liver, and (3) patients undergoing surveillance imaging. Cumulative radiation exposure is a concern for patients and oncologists. Among oncologists, there is support for long-term imaging surveillance despite lack of national guidelines.

Perspectives on Psychosocial and Spiritual Cancer Support Services in New Zealand

In New Zealand, support services have been developed in response to patient need but are variable. The benefits of psycho-social-spiritual care in reducing distress and enhancing quality of life for people with cancer and their families are well established yet unmet needs continue to feature. This project aimed to examine how health care professionals assessed for psycho-social-spiritual distress and unmet need, decisions on appropriate support, and identification of barriers in the referral process. A mixed-methods approach was used for this research. The qualitative phase entailed semistructured interviews with health care professionals working in cancer care. The quantitative phase was an online survey of oncologists and nurses. Thematic analysis was carried out by performing a side-by-side analysis of both sets of data. Nurses were most likely to assess for psycho-social-spiritual need and to refer to support services. Despite a clear mandate to provide regular psycho-social-spiritual assessment, there is no consistency of assessment and referral across New Zealand. There are clearly unmet psycho-social-spiritual needs among people affected by cancer in New Zealand, with health care professionals in this study noting structural impediments to adequate supportive care. There is a mismatch between the importance placed on such care and the capacity that is currently available. The results of this study provide evidence that can be used to argue for improvements in the infrastructure, funding allocation and policy that would allow for better psycho-social-spiritual care within the challenging context of increasing numbers of those affected by cancer.

PCN179 - Perception of Country-Specific Health Care Reform and Consideration of Real World Evidence in Routine Practice: Survey of Oncologists in European Union, United States, China and Brazil

PCN179 - Perception of Country-Specific Health Care Reform and Consideration of Real World Evidence in Routine Practice: Survey of Oncologists in European Union, United States, China and Brazil

Faculty of Radiation Oncology 2012 trainee survey

This paper reports the key findings of the first Faculty of Radiation Oncology survey of trainees dealing with experiences and perceptions on work practices and choice of specialty. The survey was conducted in mid 2012 using a 37-question instrument. This was distributed by email to 159 current trainees and advertised through the Radiation Oncology Trainees Committee and other channels. There were six email reminders. Respondents were reassured that their responses were anonymous. The overall response rate was 82.8%. Gender was balanced among respondents with 67 (51.5%) being male and 63 (48.5%) being female. The most common age bracket was the 31 to 35 years range. There were similar proportions of trainee responders in each of the five years of training. A substantial number of trainees held other degrees besides medical degrees. The large majority were satisfied with radiation oncology as a career choice and with the Training Network within which they were training. Interest in oncology patients, lifestyle after training and work hours were given as the major reasons for choosing radiation oncology as a career. Nearly half of trainees were interested in undertaking some of their training in a part-time capacity and working part time as a radiation oncologist in the future. Over 70% of trainees stated they were working 36-55 clinical hours per week with additional non-clinical tasks, after-hours work and on-call duties. Nearly half of all trainees reported having one or less hours of protected time per week. Nonetheless, 40% of respondents indicated they had enough time to pursue outside interests. Radiation treatment planning and maintaining currency in general medicine were considered the most difficult aspects of training in radiation oncology. Most respondents were keen on the concept of fostering a research mentor. In terms of views on practice after completion of training, the majority were interested in pursuing a fellowship, and nearly all expressed an interest in maintaining an element of academic practice. The large majority of respondents preferred to work in an urban department as a component of their practice after training and nearly all wanted a component of public sector practice. There were only four per cent who preferred to work only within the private sector. Job availability was a concern for 94% of trainees, which far outweighed any other concerns. Trainees in radiation oncology are generally satisfied with their choice of specialty and their training. Most trainees are interested in fellowship positions, links with academia and largely public sector work in the future. Job availability for the future is their major concern.

Impact of sociodemographic factors on the radiotherapeutic management of lung cancer: Results of a Quality Research in Radiation Oncology Survey

Purpose: The objective of this study is to describe the impact of sociodemographic (SOC) factors on the management of lung cancer patients treated at radiation therapy facilities participating in the Quality Research in Radiation Oncology survey.Methods and materials: A 2-stage stratified random sample of lung cancer patients treated in 2006 to 2007 at 45 facilities yielded 340 stage I-III non-small cell lung cancer (NSCLC) and 144 limited-stage small cell lung cancer (LS-SCLC) cases. Five SOC variables based on data from the 2000 US Census were analyzed for association with the following clinical factors: patients living in urban versus rural settings (U/R); median household income (AHI); % below poverty level (PPV); % unemployed (PUE); and % with college education (PCE).Results: The 340 NSCLC patients were stage I, 16%; stage II, 11%; stage III, 62%; stage unknown, 11%. Histologic subtypes were adenocarcinoma, 31.8%; squamous cell carcinoma, 35.3%; large cell carcinoma, 3.2%; and NSCLC NOS, 27.7%. The median age was 66 years. Median Karnofsky performance status (KPS) was 80. The 144 LS-SCLC had a median age of 63; 73 were male (50.7%). Median KPS was 80. Stereotactic body radiation therapy (SBRT) and modern imaging utilization was associated with treatment at facilities located in higher SOC regions. SBRT was employed in 46.8% stage I NSCLC patients treated in centers where %PUE was below median versus 14.8% in centers where %PUE was above median (P = .02). Four-dimensional computed tomography was utilized in 14.2% of patients treated in centers located in regions with %PPV below median versus 3.7% in centers located in regions with %PPV above median (P < .01). SCLC patients were more likely to receive all of their planned RT when treated at centers located in regions with lower PPV (95.0% vs 79.1%; P = .04).Conclusions: SOC factors may impact use of modern treatment planning and delivery and multidisciplinary management of NSCLC and SCLC. These results may suggest an impact of these SOC factors on access to health care.

Comment on ‘Fertility preservation in cancer survivors: a national survey of oncologists’ current knowledge, practice and attitudes’ – Oncologists must not allow personal attitudes to influence discussions on fertility preservation for cancer survivors

Comment on ‘Fertility preservation in cancer survivors: a national survey of oncologists’ current knowledge, practice and attitudes’ – Oncologists must not allow personal attitudes to influence discussions on fertility preservation for cancer survivors