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

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

Attitudes of advanced Australian medical oncology trainees to rural practice

Aim: To identify the views of medical oncology trainees regarding rural training posts and rural practice overall, and to identify factors that may improve recruitment. Methods: A questionnaire was posted to all advanced oncology trainees in Australia in June 2006. The trainees were questioned on the perceived advantages and disadvantages of rural practice, their experience during previous rural rotations and potential incentives and barriers in recruiting trainees and specialist oncologists to regional and rural centers. Results: There was a 60% response rate. Of all participants 58% had considered rural practice. Those with a rural family background were more likely to have considered rural practice. Attitudes based on responses to listed disadvantages and advantages of rural practice were heterogenous. Lifestyle factors seemed to be of particular importance. Although there were perceived deficiencies in opportunities for professional education in rural oncology rotations, 94% felt their rotation had been a positive experience overall and 62% were more likely to consider a rural career following their rural rotation. Improving locum cover for leave was seen as a potential incentive by 97% trainees. Conclusion: Despite positive attitudes towards rural practice, many barriers exist preventing recruitment of medical oncology trainees to rural areas, in particular lifestyle factors that are difficult to modify. Factors that can be improved include improving access to clinical trials, enabling access to locum cover. Educational opportunities for current rural trainees need to be improved. Further study into potential incentives to enhance rural recruitment is required

Study protocol: addressing evidence and context to facilitate transfer and uptake of consultation recording use in oncology: a knowledge translation implementation study

Background: The time period from diagnosis to the end of treatment is challenging for newly diagnosed cancer patients. Patients have a substantial need for information, decision aids, and psychosocial support. Recordings of initial oncology consultations improve information recall, reduce anxiety, enhance patient satisfaction with communication, and increase patients' perceptions that the essential aspects of their disease and treatment have been addressed during the consultation. Despite the research evidence supporting the provision of consultation recordings, uptake of this intervention into oncology practice has been slow. The primary aim of this project is to conduct an implementation study to explicate the contextual factors, including use of evidence, that facilitate and impede the transfer and uptake of consultation-recording use in a sample of patients newly diagnosed with breast or prostate cancer. Methods: Sixteen oncologists from cancer centres in three Canadian cities will participate in this three-phase study. The preimplementation phase will be used to identify and address those factors that are fundamental to facilitating the smooth adoption and delivery of the intervention during the implementation phase. During the implementation phase, breast and prostate cancer patients will receive a recording of their initial oncology consultation to take home. Patient interviews will be conducted in the days following the consultation to gather feedback on the benefits of the intervention. Patients will complete the Digital Recording Use Semi-Structured Interview (DRUSSI) and be invited to participate in focus groups in which their experiences with the consultation recording will be explored. Oncologists will receive a summary letter detailing the benefits voiced by their patients. The postimplementation phase includes a conceptual framework development meeting and a seven-point dissemination strategy. Discussion: Consultation recording has been used in oncology, family medicine, and other medicine specialties, and despite affirming evidence and probable applications to a large number of diseases and a variety of clinical contexts, clinical adoption of this intervention has been slow. The proposed study findings will advance our conceptual knowledge of the ways to enhance uptake of consultation recordings in oncology