The novel coronavirus disease 2019 (COVID-19) pandemic has been an overwhelming challenge for worldwide health systems. Since the beginning of year 2020, COVID-19 has represented a potential harm for ...cancer patients and has often hindered oncology care. The Collegio Italiano dei Primari Oncologi Medici (CIPOMO) is an Italian association of head physicians in oncology departments, which promotes working and research activities in oncology on a national basis. During the second wave of COVID-19 pandemic, the CIPOMO promoted a national survey aiming to evaluate the impact of COVID-19 on oncologists' clinical activity and what changes have been made compared with the Italian situation during the first wave of the pandemic. Overall, 138 heads of medical oncology departments participated in this survey: 75 (54%) from the North, 24 (17%) from the Centre and 39 (28%) from the South of Italy and islands. This survey provides an overview of Italian oncologists facing the second wave of COVID-19 pandemic. The lesson learned during the first wave of COVID-19 pandemic has led to a better organisation of clinical activities, and regular testing among healthcare practitioners, with better chances to grant patients' protection. However, the lack of standardised informatic platforms results in serious challenges in replacing frontal visits, often making a concrete reduction of patients' hospital accesses unfeasible.
Oncologists need to keep preserving the continuum of care of patients. Standardisation of safety measures, together with the implementation of informatic platforms, can significantly improve oncology pathways during this second wave of COVID-19 pandemic.
•Coronavirus disease 2019 (COVID-19) has revolutionised healthcare worldwide.•The second wave of COVID-19 pandemic is a challenge for cancer care.•Oncologists need to safeguard clinical activity and patients' continuum of care.•Standardised procedures and guidelines should be implemented.•Data are needed on risk categorisation and prioritisation of treatment procedures.
Documented variations in practice compelled the need to establish a network that would facilitate the flow of patients through the care continuum of a provincial health care system in accordance with ...best practices. Therefore, a guideline was developed to provide recommendations for the optimal organization of gynecologic oncology services in this higher resource location to improve access to multidisciplinary care and appropriate treatment.
A systematic review was conducted of Web sites of international guideline developers, relevant cancer agencies, and Medline and EMBASE from 1996 to 2011 using search terms related to gynecologic malignancies, combined with organization of services, patterns of care, and various facility and physician characteristics. The results of the review were combined with expert consensus and stakeholder consultation to develop a gynecologic oncology services organizational guideline.
The evidence review yielded a lower quality evidence base; therefore, recommendations were determined through consensus, including guidance for physician and hospital specialization, and other domains including human and physical resources. Definitive surgical treatment of most invasive cancers by subspecialist gynecologic oncologists is recommended. In addition, it is recommended that these subspecialists provide care within designated gynecologic oncology centers. The recommendations also outline which services, such as radiation therapy, may be provided in other affiliated centers. Multidisciplinary team management is also endorsed.
These recommendations are intended to allow a collaborative community of practice, supported by formal interorganizational processes, to evolve to facilitate adherence to guidelines and best practices at a system-wide level.
In general, patients with a cancer suspicion visit the hospital multiple times before diagnosis is completed. Using various "operations management" techniques a few fast track diagnostic services ...were implemented in the Netherlands Cancer Institute (NKI) in 2006. Growing patient numbers and increasing process complexity, led to diminished service levels. To decrease the amount of patient visits and to extend these services beyond the (obvious) breast cancer services, fast track diagnostics is now implemented for all 18 cancer types that present with a frequency of minimally one per week.
The throughput time (first visit to diagnosis conversation) was measured before, and after implementation of fast track diagnostics. The process was redesigned closely involving the multidisciplinary teams. In an eclectic approach elements from lean management, theory of constraints and mathematical analysis were used to organize slots per tumor type for MRI, CT, PET and echography. A post measurement was performed after 3 and 6 months.
In pre measurement access time was calculated to be 10 to 15 workdays, mean throughput time was 6.0 workdays. It proved possible to design the process of 18 tumors as a fast track, of which 7 as "one stop shop" (diagnosis completed in one visit). Involvement of clinical- and board leadership, massive communication efforts and commitment of physicians to reschedule their work proved decisive. After 3 and 6 months of implementation, the mean access time was 8.2 and 8.7 workdays respectively and mean throughput time was 3.4 and 3.3 workdays respectively.
Throughput- and access time were considerably shortened after implementation of fast track diagnostics for 18 cancer types. The involvement of physicians in reorganizing their work and rapid responding to their needs during the implementation phase were a crucial success factor.
BACKGROUND Nurses who work in hospitals experience a high level of burnout and the relationship between immune variables and burnout syndrome has yet to be elucidated. The aim of the present study ...was to investigate the effects of job burnout on immune function in female oncology nurses in a tertiary oncology hospital in Guangxi, China. The aspects of the human immune system evaluated were humoral and cellular immunity and complement components 3 (C3) and 4 (C4). MATERIAL AND METHODS We administered the Maslach Burnout Inventory-General Survey (MBI-GS), which includes scales for emotional exhaustion, depersonalization (DP), and personal accomplishment (PA), to measure variables related to immune function in 105 female nurses in a tertiary oncology hospital in Guangxi, China. Levels of humoral immunity and C3 and C4 were detected with immune turbidimetry. Cellular immunity was assessed with indirect immunofluorescence. RESULTS A Spearman rank correlation analysis revealed that levels of C3, C4, and CD4- and CD8-positive T cells were significantly associated with burnout symptoms (P<0.05, P<0.01, and P<0.05, respectively). Furthermore, there was a correlation between demographic data and humoral and cellular immunity (both P<0.05). Multivariable linear regression analysis showed that C4 levels were closely related to DP (P<0.05) and that CD4 and CD8 levels were closely related to PA (P<0.01). CONCLUSIONS These results suggest that DP and PA have an impact on immune function, and that timely psychological and behavioral interventions can be used to reduce the degree of job burnout among nurses and regulate their immunity, thus enabling them to better serve patients.
Purpose
Provision of psychosocial care is obligatory in cancer centers certified in accordance with the criteria of the German Cancer Society, but the extent to which it is utilized differs greatly ...between centers. Anomalous utilization percentages are discussed during certification audits. This analysis aims to describe (1) how certified centers explain psychosocial care utilization percentages during audits and (2) the measures they then plan for improving psychosocial care utilization. The aim of the analysis is to help understand patterns of psychosocial care utilization in oncology and reduce potential disparities by describing the challenges that cancer centers face and their strategies for integrating psychosocial care into routine oncological care.
Methods
The content of free‐text comments regarding psychosocial utilization percentages by certified centers during certification audits in 2019 was analyzed. In total, 178 comments were analyzed from 116 prostate, colorectal, and breast cancer centers in Germany, Switzerland, Austria, Italy, and Luxembourg.
Results
The explanations for utilization percentages most often mentioned involved patients' levels of interest and need, outpatient care, staff shortages, inclusion of psychosocial care in other processes in the center, documentation issues, and factors regarding different legal regulations in countries outside Germany. The measures most often planned for improving psychosocial care utilization involved adjusting work processes, increasing staff resources, optimizing documentation, and establishing quality‐assurance groups/task forces.
Conclusion
This exploratory analysis shows that the challenges and strategies involved in incorporating psychosocial care into routine oncological care are diverse. Further research should identify process‐level strategies that can promote the integration of psychosocial care.
Abstract
Advances in cancer care have led to improved survival, which, coupled with demographic trends, have contributed to rapid growth in the number of patients needing cancer care services. ...However, with increasing caseload, care complexity, and administrative burden, the current workforce is ill equipped to meet these burgeoning new demands. These trends have contributed to clinician burnout, compounding a widening workforce shortage. Moreover, family caregivers, who have unique knowledge of patient preferences, symptoms, and goals of care, are infrequently appreciated and supported as integral members of the oncology “careforce.” A crisis is looming, which will hinder access to timely, high-quality cancer care if left unchecked. Stemming from the proceedings of a 2019 workshop convened by the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine, this commentary characterizes the factors contributing to an increasingly strained oncology careforce and presents multilevel strategies to improve its efficiency, effectiveness, and resilience. Together, these will enable today’s oncology careforce to provide high-quality care to more patients while improving the patient, caregiver, and clinician experience.
Introduction: Malnutrition affects an average of 20-80% of cancer patients, leading to an impaired healing process, increased infection rates and hospital costs, and negative impacts on clinical ...results. Oral nutritional supplements (ONS) help to increase the patients caloric and protein supplies, promoting recovery of nutritional status. In order to have good adherence to the ONS, it is necessary that the multidisciplinary team assigned is aligned with regard to the information transferred to the patient. Objectives: This study aimed to assess the technical knowledge about oral nutritional therapy (ONT) among physicians and the nursing staff at a private institution. Materials and Methods: This was a descriptive cross-sectional study. The physicians and residents as well as the nursing staff who work in clinical patient care were invited to answer a semi-structured questionnaire to assess their technical knowledge regarding ONT. Results: This study evaluated 105 professionals. Most physicians and nursing staff stated that ONS is a food supplement. Although they reported not having had technical training on the subject, most of them felt capable of prescribing and providing guidance participants neglected symptoms and conditions relevant to the nutritional status of the patient, such ascites, enteral nutritional therapy and home parenteral nutrition, concomitant chemotherapy/radiotherapy, and emesis. Conclusion: Information about ONS among medical and nursing professionals varies greatly. Interdisciplinary technical training is essential for the success of ONT as a tool for preventing and combating malnutrition.
Increasing effort has been put in the implementation and certification of breast centers in order to establish standardized, quality assured health care for breast cancer patients. The aim of this ...analysis was to investigate whether patients treated in certified breast centers (CBC) have a favorable prognosis as compared to patients treated outside of certified breast treatment units.
The data of 3,940 patients with invasive nonmetastatic breast cancer were analyzed with regard to differences in patient and tumor characteristics and crude overall survival according to diagnosis in or outside CBC in Middle Franconia, Germany. Patient, tumor, and follow-up data were obtained from the clinical cancer registry.
Patients in CBC were younger, and had lower disease stages and lower grading. Independent of the effects of these variables on overall survival, being treated at a CBC added to the prediction of overall survival. Patients treated at a CBC had a hazard ratio of 0.70 (95% confidence interval 0.52-0.93) in the adjusted Cox model.
Independent from common prognostic factors, diagnosis and treatment of breast cancer at a CBC improves the prognosis of patients. It can be hypothesized that this effect is mediated through quality assured health care provided by the certification process.
To improve understanding of the triage process following distress and problem identification and the factors associated with offer and acceptance of supportive care referrals. Review of patient ...records/charts at a metropolitan hospital in Melbourne, Australia. Data were collected on problem identifications from 1/1/13 to 30/6/14, including patient demographics, disease and treatment information, responses to the NCCN Distress Thermometer (DT) and Problem Checklist (PC), whether referrals to supportive care services were offered and accepted/declined. Logistic regressions examined factors associated with referral offer and acceptance. Of patients completing the DT/PC, 50.1% reported a high level of distress. Overall, 61% of patients were offered referral(s), with the majority (71%) being accepted. Referrals were more likely to be offered to patients with a greater number of problems (Odds RatioOR = 1.18, 95%CI = 1.12–1.25) and higher distress (OR = 1.68, 95%CI = 1.07–2.64). Referrals were more likely to be accepted by patients with a greater number of problems (OR = 1.12, 95%CI = 1.06–1.19) and lower distress (OR = 0.58, 95%CI = 0.34–1.00). The type of problem experienced by the patient was strongly related to the type of referral they were offered. At a large metropolitan hospital with in‐house supportive care services, simple problem identification with the DT/PC enabled triage to services that reflected patients’ needs. The findings suggest that clear referral pathways and an organisational emphasis on supportive care may facilitate service use.
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