Physician attitudes and treatment patterns for pancreatic cancer

BACKGROUND: Surgery appears to be an underutilized treatment option for pancreatic cancer. Nihilistic physician attitudes may be partly responsible. The study objectives were to analyze physician attitudes towards this disease and determine treatment patterns and outcomes including rates of surgical referral. METHODS: A survey was administered to 420 physicians in Manitoba to document general knowledge and attitudes. Population based administrative data was accessed for all patients diagnosed with pancreatic cancer between 2004 and 2006 to examine treatment patterns and outcomes. RESULTS: 181 physicians responded to the survey. Most (73%) believed that surgical resection was worthwhile. Of the 413 Manitobans diagnosed with pancreatic cancer, only 11% underwent an attempt at surgical resection. There were 124 patients with stage I or II disease (i.e. potentially resectable), 85 of these patients received no treatment and 39% were not referred to a surgeon. These patients were older than those referred, but did not have more comorbidities. CONCLUSION: Most physicians were insightfully aware of both the survival benefit and potential risks of surgical resection. However, some did overestimate the surgical mortality and underestimate the associated survival benefit. Although advanced age may justly account for some of the patients not receiving a referral, it is reasonable to assume that nihilistic physician attitudes is contributing to the apparent underutilization of surgery for pancreatic cancer. Efforts should be made to ensure that eligible patients are at least offered surgery as a potential treatment option

COVID-19 and the Homelessness Support Sector: Perspectives on a Small Community’s Early Response to a Public Health Crisis

This exploratory study sought to uncover service provider perspectives on the early response to COVID-19 in a small community in an advanced industrialized country - the homelessness support sector of the Central Okanagan, British Columbia. Following a case study approach, snowball sampling was utilized in May and June 2020 to achieve a sample size of 30 through a mix of one-on-one interviews and open-ended surveys. Qualitative thematic analysis was used to uncover commonalities among interview responses. Common themes are discussed in relation to three areas of questioning including challenges, successes, and mitigations/areas for future support. While the community came together to support the response, there were challenges and concerns regarding safety and personal protective equipment supplies, social distancing and knowledge transmission within the homeless community, access to food and water, and lack of space for isolating positive cases. The findings illustrate possible research, practice, public health policy, and emergency planning considerations within smaller communities