The Sir Anthony Mamo Oncology Centre

In 2009, the development of a medical brief, effectively detailing the specifications for a purpose-built oncology hospital and including the medical equipment and human resources required, was commenced. Robust engagement by the relevant stakeholders, many of which hailed from the extant Sir Paul Boffa Hospital, ensured a very relevant proposal. The project (ERDF 196), led by the Foundation for Medical Sciences, was subsequently approved for partial funding through European Regional Development Funds. The new Sir Anthony Mamo Oncology Centre, as it came to be named, first opened its doors for service in December 2014 when the Out-patients Department received the first oncology patients. In April 2015, this was extended to include haematology and paediatric oncology patients. Full migration of services, including in-patient care, took place in September 2015. The distribution of services within the new Centre includes five clinical areas for in-patients made up of two oncology wards, one radioisotope unit, one haematology ward and one palliative care ward, with a total of 88 beds, an out-patient unit with 12 clinic rooms, a day area for day-treatment with a total of 21 couches and eight beds, a clinical support services unit and a radiotherapy department.peer-reviewe

Patient/Family Education for Newly Diagnosed Pediatric Oncology Patients

There is a paucity of data to support evidence-based practices in the provision of patient/family education in the context of a new childhood cancer diagnosis. Since the majority of children with cancer are treated on pediatric oncology clinical trials, lack of effective patient/family education has the potential to negatively affect both patient and clinical trial outcomes. The Children’s Oncology Group Nursing Discipline convened an interprofessional expert panel from within and beyond pediatric oncology to review available and emerging evidence and develop expert consensus recommendations regarding harmonization of patient/family education practices for newly diagnosed pediatric oncology patients across institutions. Five broad principles, with associated recommendations, were identified by the panel, including recognition that (1) in pediatric oncology, patient/family education is family-centered; (2) a diagnosis of childhood cancer is overwhelming and the family needs time to process the diagnosis and develop a plan for managing ongoing life demands before they can successfully learn to care for the child; (3) patient/family education should be an interprofessional endeavor with 3 key areas of focus: (a) diagnosis/treatment, (b) psychosocial coping, and (c) care of the child; (4) patient/family education should occur across the continuum of care; and (5) a supportive environment is necessary to optimize learning. Dissemination and implementation of these recommendations will set the stage for future studies that aim to develop evidence to inform best practices, and ultimately to establish the standard of care for effective patient/family education in pediatric oncology

Citation analysis of Canadian psycho-oncology and supportive care researchers

Purpose: The purpose of this study was to conduct a historical review of psycho-oncology and supportive care research in Canada using citation analysis and to review the clinical impact of the research conducted by the most highly cited researchers. Methods: The lifetime journal publication records of 109 psycho-oncology and supportive care researchers in Canada were subject to citation analysis using the Scopus database, based on citations since 1996 of articles deemed relevant to psychosocial oncology and supportive care, excluding selfcitations. Three primary types of analysis were performed for each individual: the number of citations for each journal publication, a summative citation count of all published articles, and the Scopus h-index. Results: The top 20 psycho-oncology/supportive care researchers for each of five citation categories are presented: the number of citations for all publications; the number of citations for first-authored publications; the most highly cited first-authored publications; the Scopus h-index for all publications; and the Scopus h-index for first-authored publications. The three most highly cited Canadian psychooncology researchers are Dr. Kerry Courneya (University of Alberta), Dr. Lesley Degner, (University of Manitoba), and Dr. Harvey Chochinov (University of Manitoba). Conclusions: Citation analysis is useful for examining the research performance of psycho-oncology and supportive care researchers and identifying leaders among the

Treatment-Related Decisional Conflict, Quality of Life, and Comorbid Illness in Older Adults with Cancer

As the aging population in the nation increases, cancer diagnoses in this age group will also increase. The many chronic medical conditions associated with older adults are confounded by a diagnosis of cancer. Older adults with cancer are at risk for physical, psychological, and functional decline as a result of not only the cancer, but also the cancer treatment. In their current research agenda, the Oncology Nursing Society identified the need for research related to multiple comorbidities in older adults with cancer. This study utilized a cross-sectional, descriptive, correlational study design to explore the relationships between and among treatment-related decisional conflict, quality of life, and comorbidity in older adults with cancer. Oncology nurses recruited a sample size of 200 for this study from outpatient medical oncology, radiation oncology, and palliative care practices. Using an anonymous survey method, participants completed three psychometrically-sound instruments, including the Decisional Conflict Scale, Self-Administered Comorbidity Questionnaire, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Bivariate relationships existed between increased levels of decisional conflict and increased quality of life (p = .009) and quality of life and comorbidity (p = .001). All six regression models achieved significance (p \u3c .001). Statistically significant relationships were identified in each of the six regression models. Positive relationships existed between decisional conflict and financial problems, physical function, and global health status/quality of life. Increased emotional function may be predictive of decreased decisional conflict in all of the regression models. Other negative relationships existed between decisional conflict and cognitive function, diarrhea, spiritual support, insomnia, year diagnosed, fatigue, and nausea/vomiting. With their focus on patient-centered care, oncology nurses are a crucial component of the multidisciplinary cancer team that can empower older cancer patients to communicate their values and preferences regarding cancer treatment. Additionally, this study underscores the importance of oncology nurses being prepared to provide high-quality care to geriatric patients with multiple comorbidities. Given the paucity of research on the impact of cancer and its treatment on older adults, there are no published studies that address all of these variables. In light of the regression analyses, further research is needed with regard to emotional function, spiritual support, and symptom management in the setting of decision making in older adults with cancer. Poster presented at: Oncology Nursing Society 42nd Annual Congress in Denver, COhttps://jdc.jefferson.edu/nursingposters/1007/thumbnail.jp

Rapid, ultra low coverage copy number profiling of cell-free DNA as a precision oncology screening strategy.

Current cell-free DNA (cfDNA) next generation sequencing (NGS) precision oncology workflows are typically limited to targeted and/or disease-specific applications. In advanced cancer, disease burden and cfDNA tumor content are often elevated, yielding unique precision oncology opportunities. We sought to demonstrate the utility of a pan-cancer, rapid, inexpensive, whole genome NGS of cfDNA approach (PRINCe) as a precision oncology screening strategy via ultra-low coverage (~0.01x) tumor content determination through genome-wide copy number alteration (CNA) profiling. We applied PRINCe to a retrospective cohort of 124 cfDNA samples from 100 patients with advanced cancers, including 76 men with metastatic castration-resistant prostate cancer (mCRPC), enabling cfDNA tumor content approximation and actionable focal CNA detection, while facilitating concordance analyses between cfDNA and tissue-based NGS profiles and assessment of cfDNA alteration associations with mCRPC treatment outcomes. Therapeutically relevant focal CNAs were present in 42 (34%) cfDNA samples, including 36 of 93 (39%) mCRPC patient samples harboring AR amplification. PRINCe identified pre-treatment cfDNA CNA profiles facilitating disease monitoring. Combining PRINCe with routine targeted NGS of cfDNA enabled mutation and CNA assessment with coverages tuned to cfDNA tumor content. In mCRPC, genome-wide PRINCe cfDNA and matched tissue CNA profiles showed high concordance (median Pearson correlation = 0.87), and PRINCe detectable AR amplifications predicted reduced time on therapy, independent of therapy type (Kaplan-Meier log-rank test, chi-square = 24.9, p < 0.0001). Our screening approach enables robust, broadly applicable cfDNA-based precision oncology for patients with advanced cancer through scalable identification of therapeutically relevant CNAs and pre-/post-treatment genomic profiles, enabling cfDNA- or tissue-based precision oncology workflow optimization

E-survey of current international physiotherapy practice for children with ataxia following surgical resection of posterior fossa tumour.

ObjectiveTo determine current international practice regarding physiotherapy input for children with ataxia following surgery for posterior fossa tumour. Design: An e-survey covering the following domains: participant demographics, treatment/ intervention, virtual training, intensity/timing of treatment, and aims and outcomes of physiotherapy management.ParticipantsPhysiotherapists involved in the management of children with ataxia following surgical resection of posterior fossa tumour. Participants were contacted via 6 key groups; Paediatric Oncology Physiotherapy Network (POPs), Association of Paediatric Chartered Physiotherapists (APCP), European Paediatric Neurology Society (EPNS), International Society of Paediatric Oncology (SIOP)-Europe Brain Tumour Group, Posterior Fossa Society (PFS), and Pediatric Oncology Special Interest Group (SIG) (American Physical Therapy Association).ResultsA total of 96 physiotherapists participated: UK (n =53), rest of Europe (n = 23), USA/ Canada (n = 10), and Australia/NZ (n = 10). The most common physiotherapy interventions used were balance exercises, gait re-education and proximal control activities. The most frequently used adjuncts to treatment were mobility aids and orthotics. Challenges reported regarding physiotherapy treatment were: reduced availability of physiotherapy input following discharge from the acute setting, lack of evidence, impact of adjuvant oncology treatment, and psychosocial impact.ConclusionThis e-survey provides an initial scoping review of international physiotherapy practice in this area. It establishes a foundation for future research on improving rehabilitation of ataxia in this population

Role of noninvasive molecular imaging in determining response

The intersection of immunotherapy and radiation oncology is a rapidly evolving area of preclinical and clinical investigation. The strategy of combining radiation and immunotherapy to enhance local and systemic antitumor immune responses is intriguing yet largely unproven in the clinical setting because the mechanisms of synergy and the determinants of therapeutic response remain undefined. In recent years, several noninvasive molecular imaging approaches have emerged as a platform to interrogate the tumor immune microenvironment. These tools have the potential to serve as robust biomarkers for cancer immunotherapy and may hold several advantages over conventional anatomic imaging modalities and contemporary invasive tissue acquisition techniques. Given the key and expanding role of precision imaging in radiation oncology for patient selection, target delineation, image guided treatment delivery, and response assessment, noninvasive molecular-specific imaging may be uniquely suited to evaluate radiation/immunotherapy combinations. Herein, we describe several experimental imaging-based strategies that are currently being explored to characterize in vivo immune responses, and we review a growing body of preclinical data and nascent clinical experience with immuno-positron emission tomography molecular imaging as a putative biomarker for cancer immunotherapy. Finally, we discuss practical considerations for clinical translation to implement noninvasive molecular imaging of immune checkpoint molecules, immune cells, or associated elements of the antitumor immune response with a specific emphasis on its potential application at the interface of radiation oncology and immuno-oncology

ACR Accreditation for Utah Valley Hospital’s Radiation Oncology Center

Becoming an accredited clinic through the American College of Radiology (ACR) and their Radiation Oncology Practice Accreditation (ROPA) program will provide third-party evaluation of patient care to ensure the best treatment possible for patients. Talk of getting ACR accreditation has occurred in the past for Utah Valley Hospital/American Fork Hospital, but at the time it was seen as something that did not provide sufficient value vs. the cost. The recent One Intermountain restructuring is intended to unify all of the Intermountain Healthcare radiation oncology centers in Utah so the Radiation Oncology Director has set the goal that all Intermountain radiation oncology programs will be accredited. Intermountain Medical Center (IMC) and Dixie Regional Medical Center (DRMC) are currently ACR accredited and can be used as model programs. I started with an in-depth examination of our department’s workflow, documentation, and policies in order to determine where improvements to meet ACR accreditation standards could be made. I followed this up by working on implementing some of these improvements throughout the clinic and made sure they become routine and a standard in the department. An analysis of Dixie Regional Medical Center and Intermountain Medical Center’s ACR documents was performed to provide a baseline of an accredited-ACR program. Finally, a comprehensive checklist of everything that will need to be changed or implemented was presented in order to provide guidance for the future

Applications of the ACGT Master Ontology on Cancer

In this paper we present applications of the ACGT Master Ontology (MO) which is a new terminology resource for a transnational network providing data exchange in oncology, emphasizing the integration of both clinical and molecular data. The development of a new ontology was necessary due to problems with existing biomedical ontologies in oncology. The ACGT MO is a test case for the application of best practices in ontology development. This paper provides an overview of the application of the ontology within the ACGT project thus far

Pan-Canadian Pharmaceutical Alliance (pCPA): Timelines Analysis and Policy Implications

© 2019 Salek, Lussier Hoskyn, Johns, Allen and Sehgal. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).This analysis follows our recent study showing that Canadian public reimbursement delays have lengthened from regulatory approval to listing decisions by public drug plans and delayed public access to innovative medicines, mainly due to processes following the Common Drug Review (CDR) and the pan-Canadian Oncology Drug Review (pCODR). Public drug plans participate in a pan-Canadian Pharmaceutical Alliance (pCPA) joint negotiation process before making decisions about whether or not to reimburse a product reviewed through CDR and pCODR. This research aims to report the findings from a comprehensive analysis of pCPA process times, times to reimbursement by public payers in Canada, and to explore the opportunities to reduce total delays in public reimbursement with a specific focus on the pCPA process. An analysis was conducted of pCPA timelines with respect to making decisions about products and indications reviewed through CDR/pCODR, and focusses on three separate time components: time to begin negotiating, time spent negotiating, and time to implement the negotiation (i.e., time to list) in each of nine jurisdictions (i.e., 10 provinces of Canada, excluding Quebec). This study demonstrates the role of post-CDR/pCODR processes in large and lengthening delays to listing new medicines. Notably, oncology products have experienced the longest increases in time to begin negotiating and to complete negotiations. Trends in listing times post-pCPA across provinces are less clear, however, it appears that consistency in terms of timelines across provinces is not happening quite so smoothly for oncology products compared to non-oncology products. Listing rates also appear to be declining for non-oncology products, although this trend is less conclusive for oncology products. Challenges need to be addressed to improve efficiency, transparency, and ultimately reduce pCPA timelines and total timelines to public reimbursement. Suggested ways to improve and streamline the listing process are: (1) transparent target timelines and associated performance incentives for the pCPA and public plan decisions, (2) parallel HTA-pCPA processes to enable pCPA negotiations to start part-way through the HTA review and allow pCPA negotiation information to be fed back into the HTA review, and (3) innovative agreements that consider patient input and earlier coverage with real-world evidence development.Peer reviewedFinal Published versio