bluuebunny/crossref_metadata_2025 huggingface dataset:
A multifaceted approach to wellness in a hematology/oncology fellowship program.
Authors: Srikumar Thejal , Ansari Norin , Fanucci Kristina , Goldberg Sarah B. , Hurwitz Michael E. , Podoltsev Nikolai Alexandrovich , Lee Alfred Ian , Sanft Tara B.
Published: June 2023

11006

Background: Burnout is widespread among physician trainees and is a growing problem despite increasing awareness. We describe multiple efforts in a single institution’s Hematology/Oncology (HO) fellowship program to help support trainees’ wellness. Methods: A needs assessment was conducted to identify wellness topics and programming important to fellows. Anonymous surveys were distributed to all fellows in Yale’s HO fellowship program at the start of the academic year. Three senior fellows reviewed the results and, with the support of core faculty, designed initiatives to address top priorities. The interventions included off-campus debrief sessions for fellows only, Schwartz Rounds-style discussions during weekday didactic slots, faculty-led didactics on Imposter Syndrome and Perfectionism, and several off-campus, after-hours social activities. A follow-up survey was conducted six months after the initial survey (mid-academic year) to garner feedback. Results: Of the 23 fellows who were sent the initial survey, 17 responded (73.9%). The most requested discussion topics were Perfectionism Traps, Imposter Syndrome, Achieving Happiness/Defining Success at Work, and Myths About Work/Life Balance. Most fellows (76.5%) responded that they would attend off-site debrief sessions if offered. In response to the initial survey, several initiatives were undertaken as described in Methods. The mid-year survey was completed by 16 of 23 fellows (69.6%). Of these 16 respondents, attendance was as follows: 31.3% for after-hours debrief sessions, 75% for Schwartz Rounds-style discussion, 75% for Imposter Syndrome and Perfectionism lecture, and 75% for at least one social activity. The majority of fellows who attended these events reported them to be helpful (range 75-100%). Themes identified from written comments included universal appreciation for wellness programming efforts and a desire for more sessions for group reflection. One fellow noted these activities were “helpful for wellness and fostering a pleasant work environment.” Other fellows noted the Imposter Syndrome discussion “should be mandatory” and “would be helpful earlier in the year.” Several fellows expressed their wellness was linked to clinical workload, and one fellow noted sessions outside of regular work hours are difficult to attend. Conclusions: Structured needs assessment and implementation of wellness programming in a HO training program appeared to be beneficial to the majority of fellows. To our knowledge, this is the first description of comprehensive fellow-directed wellness initiatives in HO training. Continued efforts must be made to better support fellows, including options in location, timing, faculty presence, and optimizing work responsibilities and expectations. Further study is necessary to quantify the impact of these initiatives and to tailor the most effective approach to fellows’ wellness.
Tumor board tuesday and awareness of novel therapies and toxicities in solid tumor oncology.
Authors: Ebben Johnathan , Rothbaum Alison , Pishvaian Michael J.
Published: June 2023

11008

Background: Social media platforms, including Twitter, offer novel tools to accelerate discussion and learning that crosses national borders, flattens hierarchies, and enables collaborations not previously possible. Here, we report on a new initiative, Tumor Board Tuesday (TBT), which facilitates the presentation of cases with active discussion from thousands of stakeholders across the oncology community, highlighting new practice changes and precision oncology strategies. Herein, we sought to evaluate 1) the nature of participation by individuals and groups, as well as their scope of participation in TBT; 2) the impact of participation in TBT, including new collaborations forged, practice changes, increased knowledge of the use of novel agents, and their associate toxicities, as well as emerging clinical trials available to patients. Methods: TBT performed a survey designed to assess the demographics, experience, and opinions of platform users. This survey was collated with voluntary pre/post TBT presentation knowledge checks to assess knowledge acquisition. Results: Based on the survey of TBT participants (n = 38), participant gender is roughly balanced (48.4% women, 48.4% men; 3.2% prefer not to answer). 83.6% of respondents reside in the United States, 8% in Brazil, 5.4% in India, and 3% in Ireland. Interestingly, the majority of respondents identified Twitter as their primary source for oncologic and practice changing updates. Among self-identified oncologists, 12.9% identified as senior members of the field, 51.6% as mid-career, 16.1% as early career, and 12.9% as fellows/trainees. Despite the wide variation in career stage, 81.1% of respondents noted that they had become aware of a new treatment option or modality through TBT participation, which caused 78.4% to change or re-think their treatment approach. In addition, 75.7% of respondents noted that TBT had helped them to become more aware of novel agent toxicities, and 78.4% became aware of a clinical trial option because of TBT participation. Finally, 78.4% of respondents identified TBT as a tool that had helped grow professional connections and networks. On average, there were 56 respondents to knowledge-based questions within each TBT presentation. Analysis of responses to pre and post TBT questions focused on breast, GU, and pulmonary malignancies revealed a 12%, 13%, and 6% respective increase in correct answer choices. Conclusions: Social media, specifically, the use of the TBT platform engages oncology professionals across the career spectrum, enhances learning about novel therapies and corresponding toxicities, and broadens professional connections.
Quality and accessibility of liquid biopsy information: An analysis of online content.
Authors: Litt Henry Kazunaru , Greenstreet Akman Emma , Trejo Evelin , Florez Narjust , Velazquez Manana Ana I.
Published: June 2023

11010

Background: Circulating tumor DNA assays, also known as liquid biopsies, are increasingly used by oncologists to evaluate residual disease, cancer genomic composition, resistance mechanisms, and guide therapy selection. Since patients often use the internet as a source of medical information, we evaluated the quality, accessibility, and understandability of publicly available online information on liquid biopsies. Methods: We performed a cross-sectional study of 100 videos and 100 webpages that resulted from the search of “liquid biopsy” on a commonly used search engine (Google) and social network (YouTube). Videos over 5 min, scientific articles, and non-English content were excluded. Videos were evaluated for content, intended audience, and perceived sex and race/ethnicity of speakers. Two independent reviewers evaluated understandability and quality of health information using two validated tools for consumer health information (PEMAT, DISCERN). Any disagreements were resolved by a 3rd independent reviewer. Webpages were evaluated for accessibility (use of visual aids, other languages), quality of information (authors, citations, indications, limitations, cost), reading level, and presence of commercial bias. Reading level was evaluated using the validated Flesch-Kincaid (FK), Gunning Fog (GF), and SMOG indices. Data was summarized with descriptive statistics. Results: We reviewed 100 videos, with 190 median views per video (IQR: 75-719). Most videos were intended for a scientific audience (72%) and lacked diversity of speakers. The majority of featured speakers were perceived as male (65%) and non-Hispanic white (72%). Overall, liquid biopsy videos were complex and low quality. Only 9% of videos were understandable and 8% presented moderate to high quality health information. Furthermore, we reviewed 100 webpages about liquid biopsies; key characteristics are summarized in the table. About a third of webpages included indications (36%) and limitations (35%) of liquid biopsies. Webpages had a median text reading level of 14.1 (IQR: 12.1-15.8), 16.4 (IQR: 14.4-18.6), and 15.9 (IQR: 13.9-16.9) based on FK, GF, and SMOG indices, respectively. Only 2 websites had one index reading level of 8th grade or lower as recommended by the NIH and CDC. Conclusions: Online content about liquid biopsies is complex and requires education levels exceeding the reading level of the general US population. Extensive shortcomings in sources of unbiased and understandable information for patients with cancer exist. As novel diagnostic technologies and treatments emerge, efforts should be made to develop understandable, unbiased, and high-quality information resources for patients with cancer. Characteristics of liquid biopsy webpages. [Table: see text]
Novel curriculum for training in medical cannabis in oncologic populations for oncology trainees.
Authors: Patell Rushad , Bindal Poorva , Dodge Laura E. , Nagaraj Gayathri , LaCasce Ann S. , Buss Mary K. , Schonberg Mara A. , Braun Ilana Monica , Freed Jason , Rangachari Deepa
Published: June 2023

11013

Background: There is continued uptake in the use of medical cannabis (MC) among patients with cancer. Our group previously conducted a national study that showed that while a majority of oncology fellows discussed MC with patients, very few feel well informed in doing so. We hypothesized that an evidence-based curriculum on the use of MC for oncology trainees is feasible to develop and would be effective in improving confidence to discuss MC with patients. Methods: A multidisciplinary expert team designed an evidence-based educational curriculum in 5 modules specifically for MC in oncology populations that included pharmacology/history, symptom management, cancer-directed effects, toxicities and practical/logistic concerns. The curriculum was piloted as a one-hour webinar at three US hematology oncology fellowship training programs in 2022-2023. Anonymous incentivized survey instruments that were designed to assess self-perceived knowledge, attitudes and behaviors pertaining to MC (on a 5-point Likert scale; strongly agree to strongly disagree) were distributed anonymously via email at the pilot (t = 0) and immediately after (t + 7 days); additional delayed surveys (t+90 days) are in progress. Results: Of 35 eligible trainees, 31 completed the pre-training surveys (88.6%), and 26 (74.3%) completed the post-training surveys. Most trainees indicated that the curriculum is helpful (88.5%, 95% CI: 69.8-97.6) and that they would recommend it to their colleagues (80.8%, 95% CI: 60.6-93.4). Following the webinar, there was significant improvement in self-reported comfort with discussing MC for symptom management (3.2% vs. 92.3%, P < 0.001), risks of MC (9.7% vs. 76.9%, P < 0.001) and modes of MC use (16.1 vs. 80.8%, P < 0.001). The majority of participants (80.0%, 95% CI: 59.3-93.2) reported that they were more likely to initiate conversations about MC with their patients after attending the webinar. Conclusions: In this multi-center study, we demonstrate that it is feasible to develop and deliver a fellow-focused, evidence-based curriculum for MC use in patients with cancer. The webinar was well received and demonstrated significant improvement in fellow-reported attitudes surrounding MC efficacy, risks, and modes of use. Further work to assess durability of the curriculum on knowledge, attitudes, and behaviors is ongoing.
Creating an infrastructure to address physician and advanced practice provider burnout at a complex community cancer care delivery system.
Authors: Tray Alison , Eanniello Mary Kate , Yu Peter Paul
Published: June 2023

11015

Background: Oncology clinicians are at risk for developing burnout due to work-related factors such as high acuity patients, long work hours, limited autonomy, administrative and documentation demands (Copur, 2019; Eelen et al, 2014). The COVID-19 Pandemic has intensified burnout due to rapid and multiple changes in clinical practice, lack of fulfillment, and heightened moral distress and personal challenges (Hlubocky et al 2021). As a multi-center community cancer care system, an infrastructure was created and operationalized to address the work-related factors contributing to burnout. The purpose of the project was improved identification and prioritization of clinician (physician and APP) needs with subsequent targeted intervention. Methods: To measure success, a partnership with the American Medical Association (AMA) was formed to deploy the Mini-Z burnout survey. The survey was administered on July 2-August 20, 2021 to all Medical Oncology physicians and Advanced Practice Providers (APPs), n = 60. The survey was re-deployed from July 13-September 2nd, 2022. Data was collated by the AMA and presented back to executive leadership. Through this survey and follow up focus groups, it was identified that physicians tended to struggle more with the EHR and inability to disconnect from work compared to APPs. Our APPs identified several areas of opportunity including onboarding/orientation, mentorship/professional development, pay and scope of practice. An EHR Well-being Committee was established to evaluate EPIC signal reports to address both system and individual clinician needs. To address APP needs, key factors were addressed in the realm of professional development/orientation, compensation and scope of practice. This was approached with the goal of short-term gains and long-term sustainability. Results: The results indicated a 23.8% improvement in job satisfaction, 4.9% improvement in job stress, and 26.3% improvement in employment outlook. A decrease was also noted in EHR Time outside of work (4.5%) and burnout (16.1%). All areas of improvement met or exceeded national benchmarks. Analysis of these results indicate statistical significance for job satisfaction (p = 0.028, CI 2.8-40.4%) and employment outlook (p = 0.033, CI2.4-45.8%). Results that indicated improvement but were not statistically significant were job stress (p = 0.688, CI 17.6-27.4%), burnout (p = 0.191, CI 7.4-37.5%) and EHR time outside of work (p = 0.806). Conclusions: While the survey data does not account for clinician turnover between 2021 and 2022, initial review indicates a positive impact on job satisfaction and employment outlook which may be an early indication of improved colleague appreciation. Further study, post-pandemic is needed to evaluate effectiveness of care team efficiency and ongoing work to streamline EHR usage.
Reliability of audiovisual information on lung cancer from cancer organizations.
Authors: Dand Hardik , Macarulay Celinne , Reddy Preetham , Papakonstantinou Michael
Published: June 2023

11020

Background: In the US, lung cancer is the leading cause of cancer death and second most common cancer. YouTube (YT), a social media platform with billions of users, can improve knowledge but also disseminate inaccurate information. Research has shown YT plays a key role in public health. This study assesses the reliability of YT videos about lung cancer using its own algorithm compared to videos from three cancer organizations. Methods: We searched “lung cancer” on YT and selected 8 videos with the most views. Then, “lung” was searched from YT profiles of American Cancer Society (ACS), National Cancer Institute (NCI), and National Comprehensive Cancer Network (NCCN). Criteria required videos to be less than 10 minutes and have “lung” in the description. Videos were excluded if not in English, older than 15 years, patient stories, or sponsored by pharmaceutical entities. The videos were graded by 3 independent medicine residents using the validated methods of Patient Education Materials Assessment Tool Understandability and Actionability (PU and PA) and Journal of the American Medical Association (JAMA) scoring. Higher percentages of PU and PA represented more understandable and actionable material. Higher JAMA score (up to 4) indicated better quality of information. Descriptive statistics and non-parametric Kruskal-Wallis tests were done. Results: A total of 36 videos were identified. PU mean was 74.2% (SD 21.4) in YT compared to 62.4% (SD 15.2), 53.1% (SD 28), and 58.8% (SD 13.9) for ACS, NCI, and NCCN respectively. PA mean was 46.6% (SD 46.8) for YT compared to 12.9% (SD 31.7), 38.9% (SD 53.6), and 8.2% (SD 21.2) for ACS, NCI, and NCCN respectively. A statistically significant higher median actionability score can be seen in YT. The JAMA average was 1.9 (SD 0.2) for YT compared to 2.1 (SD 0.1), 2.3 (SD 0.6), and 2.0 (SD 0) for ACS, NCI, and NCCN respectively. While a statistically significantly higher median JAMA score is seen in NCI videos, no meaningful difference can be extrapolated given all average scores of roughly 2. Conclusions: YT produced videos of higher understandability and actionability compared to videos from cancer organizations. As patients continue to rely on social media for information, trusted cancer sources should develop more reliable material for improved patient education. Comparison of scores from averages of 3 reviewers. [Table: see text]
How reliable are post-mastectomy breast reconstruction videos on YouTube?
Authors: Morena Nina , Ben-Zvi Libby , Hayman Victoria , Hou Mary , Nguyen Diana , Rentschler Carrie A. , Meguerditchian Ari N.
Published: June 2023

11021

Background: Social media are a significant source of information for young women with breast cancer (YWBC) undergoing post-mastectomy breast reconstruction (PMBR). The emphasis on visual storytelling and building community in online spaces renders YouTube (YT) to be a common platform for discussions of BR. This study aims to assess the quality of YT videos about PMBR, identify themes related to the PMBR experience, and quantify perceptions of BR as an option PM. Methods: YT was searched incognito with terms “young women breast cancer reconstruction” in 08/2022, in order from most to least viewed. Title, upload date, length, poster identity, number of likes and comments were collected. The Patient Education Materials Assessment Tool for audiovisual materials (PEMAT A/V) evaluated understandability and actionability. DISCERN assessed quality and reliability. Presence of sponsorship, intended audience, patient and healthcare professional narratives, and perceptions of PMBR were collected. Reviewers noted whether PMBR was shown and how. Themes were collected inductively and deductively for thematic analysis. Results: 193 videos were identified. Mean video length was 14.6 minutes (SD 20.0 min). 87.1% included sponsorships. 95.9% of videos were posted by an organization. 60.6% were information-based; 45.6% experience-based. Mean PEMAT scores for understandability and actionability were 71.3% (SD 13.4) and 35.7% (SD 41.8), respectively. Mean DISCERN was 2.6/5 (SD 1.2). Patient narrative was present in 52.6% and healthcare professionals’ in 68.4%. PMBR was visually presented 22.8% of the time. 13.5% of videos explicitly recommended PMBR. 2.6% explicitly discouraged it. Patients (77.7%) represent the majority of the intended audience. Most common deductively identified themes included treatment (87.1%), family relationship (17.1%), motherhood (15.5%), fertility (11.9%). Inductively identified subthemes included differentiating between various options for PMBR surgery, BRCA genetic testing, psychosocial effects of breast cancer and PMBR, and recovery from surgery. Conclusions: YT is a platform wherein various PMBR options are widely discussed and explained. PMBR videos are highly understandable but have moderate levels of actionability, quality, and reliability. Videos are highly sponsored, demonstrating significant institutional bias. Themes are overwhelmingly treatment and surgery-based. Personal themes were present but not dominant. Distribution of PEMAT and DISCERN scores. [Table: see text]
A review of diversity, equity, and inclusion (DEI) efforts by medical oncology journals.
Authors: Abuali Inas , Parikh Aparna Raj , Kunz Pamela L.
Published: June 2023

11023

Background: In recent years, there has been a growing awareness of the ongoing structural inequities impacting all facets of academic medicine. Efforts are underway to adopt an intentional and systemic approach to meaningful incorporation of DEI in academia. Here, we review the ongoing efforts by scientific peer-reviewed journals to ensure an equitable publication process, and an inclusive and diverse participation and distribution of oncological research. Methods: Medical oncology journals with the highest impact factor were identified using the SCImago Journal Rank (SJR), a publicly available portal that includes the journals and country scientific indicators developed from the information contained in the Scopus database. 39 Journals in the first ranking quartile (Q1) with the highest impact were identified to have an SJR >2. An online review of journal websites’ content was performed between Jan 8th – Feb 8th, 2023, to extract the data available in the accompanying table. Results: 38.5% of journals include a DEI statement on their website. One journal has a dedicated editorial director of equity. Three journals (8%) have a specific online DEI corner highlighting related articles and initiatives. 20% of the journals publicly outlined specific DEI policies, such as formalizing the process for assessment and reporting, and identifying and inviting peer reviewers with DEI expertise. Finally, 20% of journals published limited specific metrics assessing the impact of their DEI efforts, such as data regarding the primary corresponding authors at country and region level in the last five years, and the gender diversity of their editorial boards. Conclusions: Our study highlights the limited publicly available data online regarding ongoing DEI initiatives and dedicated editorial positions in high impact medical oncology journals. It is imperative that we aim for greater intentionality and transparency about such efforts, with reporting of clear and specific impact metrics. In addition, these efforts cannot be performative and must foster a more equitable scholarly publication process, promote accountability, and assist in formulating best practices. Our analysis suggests a clear unmet need and represents a call to action. High impact oncology journals have an opportunity to set the tone for the entire oncology medical community. [Table: see text]
Fellow-led didactics in a hematology/oncology fellowship program.
Authors: Thawani Rajat , Cetnar Jeremy Paul
Published: June 2023

11026

Background: The pandemic in 2020 made us used to virtual learning, but as we recover from the pandemic, we are forced to rethink how we deliver education to trainees in medicine. The pandemic has led to a significantly decreased attention span and face to face interactions, in addition to an increased screen time. In our program, this led to us noting a lower engagement in the fellowship didactics as we recovered from the pandemic. This forced us to rethink how the Oregon Health & Science University (OHSU) hematology and oncology fellowship delivers educational content. After interviewing all stakeholders, we moved to an in-person fellow led didactic approach, under the mentorship of a faculty expert who helps trainees design content and is present for discussion. The rationale behind this approach was to boost peer-to-peer learning, supply relevant content and increase engagement. The fellows and faculty were provided guidelines about length of talk, presentation of data and use of interactive tools. Methods: After 6 months of introducing fellow led didactics, we surveyed all fellows and select faculty who were mentors on more than one occasion about their opinion. A survey link was sent to all 12 fellows and 18 faculty members who regularly took part in fellowship didactics. Results: All 12 fellows responded to the survey. On a Likert scale of 1-5, they scored improvement in knowledge at 4.58 (0.64) and rated both the content and presenter at 4.25 (0.43). A third felt that this way of delivering didactics was a lot better and the rest felt it was a little better. On the negative side, they felt that they were spending more time preparing content (40% spent 7-9 hours a month) but were optimistic about lesser commitment next year as we bank the PowerPoint presentations. Nine of the 18 (50%) invited faculty responded to the survey, and on a scale of 1-5, they rated their improvement of knowledge as 4.44 (0.68). They scored the content and presenter at 4.44 (0.5) and 4.56 (0.68) respectively. 88.9% felt that the didactics were either a little or a lot better, and 11.1% felt them to be the same. On average, they spent less time on the content than they did if they were presenting. Conclusions: Overall, both faculty and fellows felt that this method of delivering didactics in a hematology oncology fellowship program was more effective. The fellows felt that they needed to put in extra hours for preparation, but this will probably go down as they build on earlier presentations.
Teaching how to navigate difficult conversations: A combined palliative care–oncology didactic simulation intervention for hematology/oncology fellows.
Authors: Dupuis Megan , Walsh Katherine Jean , Agarwal Rajiv
Published: June 2023

11028

Background: ASCO strongly endorses the integration of palliative care to improve patient outcomes and support patients in their cancer trajectories. Developing core palliative care skills for trainees is therefore essential, with few ACGME approved pilot programs offering combined fellowship training. Our institution’s Heme/Onc fellows reported a need for additional education in leading difficult conversations. Methods: We piloted a didactic simulation (sim) session for each fellowship class, led by a faculty member who is dual board-certified in Medical Oncology and Hospice/Palliative Medicine. Trainees received a lecture on validated communication tools and oncology-specific language to help navigate difficult conversations. Trainees then role-played in small groups using sample cases, with Heme/Onc faculty supervision and real-time feedback, followed by class reflection. Pre- and post-sim surveys were electronically administered to assess knowledge of communication tools and comfort in discussing difficult topics. Comfort questions were scored on a 5-point Likert Scale, using student t-tests to detect differences pre- and post-sim, and ANOVA to compare responses among classes. Results: A total of 16/21 (76.2%) fellows completed both pre- and post-sim surveys. Knowledge of communication tools increased from 21.9% pre-sim to 79.7% post-sim. Comfort significantly increased for explaining palliative-intent chemotherapy, hospice, and discussing an uncertain prognosis (Table). There was a significant difference among classes pre-sim for addressing negative emotions (mean comfort level: 1st years 2.8, 2nd years 3.4, 3rd years 3.83; p=0.046) and for discussing an uncertain prognosis (mean comfort level: 1st years 2.6, 2nd years 3.6, 3rd years 3.83; p=0.043); however, these interclass discrepancies were eliminated post-sim. Overall, fellows reported that the sim sessions were effective for developing their knowledge and comfort in having difficult conversations. Conclusions: A novel sim intervention led by a physician who is dual board-certified in palliative care and medical oncology improves trainee competency with navigating difficult conversations. Analysis of the intervention’s durability of response and iterative refinement of its curriculum are ongoing. [Table: see text]
Hematology and oncology fellow education about sexual and reproductive health: A survey of program directors in the United States.
Authors: Reese Jennifer B. , Bauman Jessica R , Sorice Kristen A. , Middleton Danny , McIlhenny Sarah , Bober Sharon L.
Published: June 2023

11029

Background: Sexual and reproductive health (SRH) concerns are important areas of health and quality of life for patients with cancer that should be included in routine cancer care, according to clinical guidelines. Yet, oncologists often hesitate to raise SRH with their patients due to lack of training. We conducted a national survey of hematology/oncology fellowship program directors (PDs) in the U.S. to understand the state of current fellowship education on three key SRH subjects: fertility, sexual health, and safe sex practices. We assessed rates of provision of formal/informal instruction and endorsement of barriers to formal instruction. Methods: A 13-item survey of education on fertility, sexual health, and safe sex practices in adult hematology/oncology programs was sent to all PDs in the U.S. via an online link or paper survey. PD’s received a $5 gift card for participating. Descriptive statistics and McNemar tests were used. Results: One hundred-twelve PDs responded to the survey (63% response rate). Of these, 75% of PDs reported their programs offered >1 hour of formal instruction on fertility, 42% on sexual health, and 31% on safe sex practices; formal instruction was more common for fertility than either other subject (p’s < .001). Male and female fertility preservation was addressed in 62% and 59% of programs, respectively. Cancer-related sexual side effects for women and men were covered in less than one-quarter of programs (23% and 20%, respectively). Regarding informal instruction, > 73% of programs reported using clinical experience to train fellows in SRH; other informal instruction methods (i.e., case-based methods, webinars, journal clubs, grand rounds) were less common. Lack of experts/resources was the most widely endorsed barrier to providing education about fertility (55%), sexual health (75%), and safe sex practices (69%) and was more widely endorsed for sexual health and safe sex practices compared to fertility (p’s < .01). Lack of space in the curriculum and the topic not being required were also commonly endorsed barriers. Conclusions: Data from this national survey of fellowship program directors show that training in SRH is rare, particularly for sexual health. Barriers to training, especially difficulties in finding content experts, may be leading to a heavy reliance on informal methods of instruction, which are both variable and incomplete. Concerted efforts to integrate SRH into fellowship training, including novel educational curricula, are needed if SRH is to be addressed in routine cancer care.
Association between baseline radiological tumor burden and outcomes in patients with metastatic breast cancer treated with an immune checkpoint inhibitor.
Authors: Brown Lauren Claire , Moodie Kate , VanGeelen Courtney , Dixon-Douglas Julia , David Steven Philip , Francis Prudence A. , Savas Peter , Loi Sherene
Published: June 2023

1103

Background: Lower baseline radiological tumor burden is associated with more favorable outcomes for patients with metastatic non-small cell lung cancer and melanoma treated with immunotherapy. However, minimal data is available for metastatic breast cancer patients. This is despite immunotherapy, in combination with chemotherapy, now being standard-of-care for a subset of metastatic breast cancer patients who have triple-negative disease and are PD-L1 positive. Methods: We reviewed data of 82 patients with metastatic breast cancer consecutively treated at our institution from August 2015 to October 2021, who received > 1 dose of an immune checkpoint inhibitor (anti-PD-1 or -PD-L1) within the context of a clinical trial. Baseline tumour burden was assessed by a single radiologist and calculated as sum of Response Evaluation Criteria in Solid Tumours 1.1 baseline target lesions (baseline tumour size [BTS]) or as sum of all measurable baseline lesions (total tumour burden [TTB]); the impact of both parameters on treatment outcomes was investigated. Treatment outcomes assessed were clinical benefit rate (complete response, partial response or stable disease for 6 months or more [CBR6]), disease free survival (DFS) and overall survival (OS). Multivariate analysis adjusted for ECOG status, line of treatment (first line vs second line or beyond), and whether immunotherapy was given in combination with chemotherapy or as monotherapy. Results: A total of 82 patients were included in the analysis. 43 patients (52%) received combination chemotherapy with immunotherapy, 39 patients (48%) received immune checkpoint inhibitor monotherapy. Median BTS and TTB were 36.5mm (range 0 -204mm) and 43mm (range 0 – 1123mm) respectively. CBR6 was significantly associated with BTS (p=0.004) and TTB (P=0.002) quartiles, with clinical benefit time progressively increasing with decreasing tumor burden quartiles. Both increasing BTS (p<0.001) and TTB (p<0.001) across quartiles were significantly associated with shorter OS. There was a numerical, but not statistically significant, association between both parameters as quartiles (BTS, p=0.25; TTB, p=0.07) and PFS. In the bottom BTS quartile, 32% of patients were progression-free and 95% alive at 12 months, compared with 15% and 40% respectively in the top quartile. Similar results were seen when TTB was used as the baseline measurement: 32% progression-free and 95% alive at 12 months in the bottom quartile compared with 1% and 33% in the top quartile. Multivariate analysis confirmed that both BTS and TTB, considered as continuous variables, are independently associated with OS. Conclusions: Lower baseline radiological tumor burden is associated with better outcomes in patients with metastatic breast cancer treated with immune checkpoint inhibitors.
Recommendations for medical cannabis use in cancer patients by US oncology fellows and the impact of receiving prior training.
Authors: Tehranchi Kian , Patell Rushad , Bindal Poorva , Dodge Laura E. , Freed Jason , Buss Mary K. , Schonberg Mara A. , Braun Ilana Monica , Rangachari Deepa
Published: June 2023

11030

Background: Despite the rising use of medical cannabis, limited evidence informs the safety and efficacy of cannabis use in cancer patients. A national survey of oncology fellows found that fellows felt insufficiently informed to make clinical recommendations about cannabis. In this secondary analysis of that survey, we aimed to measure how frequently trainees recommend cannabis and determine factors that influence this practice. Given the lack of evidence, we hypothesized that fellows who had been trained in medical cannabis use would be less likely to recommend cannabis to their patients. Methods: An online survey assessing trainee practices on medical cannabis was sent to 155 oncology fellowship program directors between January - March 2021 and directors were asked to distribute it to their fellows. The primary outcome was the number of times oncology fellows recommended cannabis in the prior year. Log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI) to evaluate whether the number of cannabis recommendations varied by participant age, gender, legality of cannabis in the state of practice, and prior training in medical cannabis. Results: Nationally, 40 programs from 25 states participated, with 189 of 462 trainees across these programs responding (40% response rate). Twenty-two percent (95% binomial CI: 16.3-29.0%) of participants reported recommending medical cannabis to >5 patients in the past year. Twenty-four percent (95% binomial CI: 18.4-30.5%) of participants had prior training in medical cannabis. Among participant characteristics, only prior training in medical cannabis was associated with recommending cannabis to >5 patients (RR: 2.42; 95% CI: 1.39–4.20). Conclusions: Despite limited evidence to support medical cannabis use among cancer patients, one in five oncology fellows participating in our study recommended it to >5 patients in the past year. Prior training was associated with doubling of rates of recommending medical cannabis in this group. It is thus of critical importance that fellowship training on this subject reflects best available evidence to guide trainees in well-informed decision-making. Factors associated with trainees recommending medical cannabis to >5 patients. [Table: see text]
The brown university cancer prevention and survivorship curriculum: A case study on program development in an internal medicine residency.
Authors: Francis Elizabeth , Pounardjian Tamar , Li Jennifer , Moku Prashanth , Avidan Olivia , DeCarli Kathryn , Manzullo Ellen F. , Sanft Tara B. , McGarry Kelly , Dizon Don S. , Duffy Christine Mary
Published: June 2023

11031

Background: Advances in screening, early detection, and treatment have increased the number of cancer survivors. Cancer survivors have a unique set of medical, psychosocial, physical, and financial challenges. Though it is critical for provider teams to be attuned and equipped to address these issues, we identified two training programs in this discipline. Medical residency clinical education does not fully explore the role of cancer preventative services and survivorship experiences available to patients and their families. We developed an elective at Alpert Medical School at Brown University/Lifespan Internal Medicine Residency Program (Brown) to improve medicine residents’ knowledge and clinical skills on different aspects of the cancer control continuum, with a focus on prevention, early detection, survivorship and surveillance. Methods: In 2020, a team of Brown internal medicine (IM) residents, faculty and one hematology oncology (heme/onc) fellow examined the existing cancer prevention and survivorship infrastructure, identified key faculty and clinics, and examined existing programs at peer institutions. A needs assessment was completed by Brown IM residents and heme/onc fellows. We then designed the Cancer Prevention & Survivorship Elective, an innovative and novel educational elective for medical residents to promote interest, awareness, and understanding of cancer prevention and survivorship. The 6 module one month elective features didactics and clinical experiences offered via a live and independent study fashion. The elective brought together 27 disciplines, 64 faculty lecturers from 10 peer institutions across the United States and included 20 unique clinics. Residents completed anonymous pre- and post-course surveys to measure their understanding and degree of confidence in different aspects of cancer prevention and survivorship, not limited to surveillance, health disparities and global perspective, primary and secondary prevention, late and long-term effects, and quality of life. Results: In January 2023, ten residents, ranging from first- to third-year IM and medicine-pediatrics, participated in the live elective. Two IM residents have registered to complete the elective via independent study in 2023. To date, the Cancer Prevention and Survivorship Elective has improved IM residents’ confidence, comfort and clinical skills in treating patients along the cancer care continuum. Conclusions: This curricula serves as an example for inter-institutional collaboration, and highlights the need for a multidisciplinary approach when caring for patients at high-risk of developing cancer and surviving cancer.
Mapping objectives of a new interprofessional morbidity and mortality conference to ACGME core competencies in hematology/oncology.
Authors: Sharma Aditya , Dhawan Natasha , Hayes Christi Ann , Silvius Katherine C , Lansigan Frederick
Published: June 2023

11032

Background: Safety and quality improvement requirements are a part of the core competencies for ACGME-accredited hematology/oncology fellowships. The morbidity and mortality conference (MM) is a tool that has been used to identify safety issues and areas for improvement. The traditional format primarily includes an audience of clinicians. We sought to develop an interactive, interprofessional MM (i-MM), including institutional leadership, physicians, fellows, residents, advanced practice providers, nursing, and pharmacy, while meeting the ACGME Core competencies for Patient Safety and Quality Improvement in Hematology and Medical Oncology. Methods: A pilot i-MM was designed to create an enriching, interprofessional discussion regarding patient safety and quality improvement. We implemented a Plan-Do-Study-Act (PDSA) design to create the i-MM model that map to the core competencies. The first session was focused on two mortality events in immunocompromised hosts that triggered the sepsis bundle, one of which was due to toxic megacolon. The i-MM objectives were aligned with ACGME hematology/oncology fellowship requirements of quality and safety. The effectiveness of the pilot session was gauged via an anonymous post-session survey using a 4-point Likert scale. Results: A total of 32 people attended the pilot i-MM, including quality and safety leaders, faculty, fellows, medical residents, pharmacy, and nursing. A total of 10 participants across professions completed the post-i-MM survey. The survey demonstrated an average of 3.8/4 for all interprofessional educational goals, which included demonstration of mutual respect between healthcare professionals, engaging in effective interprofessional communication, and working within an interprofessional team. Content-specific aspects of the survey were rated with an average effectiveness of 3.60/4. Feedback on the survey recommended limiting i-MM to one case presentation instead of multiple. During the debrief session, it was reported that several nurses felt the moderated session was “inclusive and empowering”. Conclusions: The i-MM was an effective approach to meeting ACGME requirements for safety and quality learning objectives while creating an inclusive environment for all team members. Future PDSA cycles will continue to map i-MM learning objectives to ACGME hematology/oncology fellowship program core competencies in Section VI.A.1 and the section on Professionalism. Core competency mapping will guide future presentations that address issues on quality, safety, and health care disparities. Specific presenters and moderators from different professions will be chosen to lead each i-MM, with the goal of examining each case from different perspectives to provide a holistic interprofessional view of delivering quality medical care to patients.
The cognitive load of inpatient consults involving immune-related adverse events.
Authors: Brondfield Sam , Silverstein Jordyn , de Dios Kimberly , Quandt Zoe
Published: June 2023

11033

Background: Immune-related adverse events (irAE) requiring hospitalization involve complex, multidisciplinary management. Expertise in oncology and/or the affected organ(s) may be required in the form of inpatient consults. Trainees (fellows and residents) often provide such consults. irAE consults may be rich learning opportunities, but it is unclear whether the cognitive load, or mental effort, required for these complex cases may overwhelm trainees and impair learning. To investigate the cognitive load of irAE consults, we surveyed trainees who had recently completed an irAE consult and compared the results to a control dataset. Methods: Between October 2021 and January 2023, we identified patients hospitalized due to irAEs at the University of California, San Francisco by reviewing patient lists (oncology consults and hospital medicine admissions) daily. We emailed the published Consult Cognitive Load (CCL) survey to any residents or fellows who had signed initial consult notes in the charts of identified patients. The CCL uses 4-point scales to measure three types of cognitive load related to one consult: intrinsic load (IL) related to the consult task itself, extraneous load (EL) related to distractions during the consult, and germane load (GL), the mental effort left over for learning after IL and EL are accounted for. IL, EL, and GL scores range from 4 to 16. Using two-tailed t tests, we compared mean IL, EL, GL, and total cognitive load (the sum of IL, EL, and GL) between the irAE group and a control group of fellows and residents who performed a variety of consults at five University of California hospitals during a 2018-2019 study (n = 142). Detecting a difference of 0.5 with a variance of 0.5 (calculated for the control group), 80% power, and 95% confidence required an irAE group sample size of 18. Results: Of 36 trainees contacted for the irAE group, 18 completed the CCL (50% response rate, 61% fellows, 39% residents). The irAE group and the control group (80% fellows, 17% residents, 3% not reported) spanned multiple specialties. Total cognitive load (p = 0.49) and IL (p = 0.95) did not differ. EL was significantly lower (8.4 vs 10.3, p = 0.002) and GL higher (11.9 vs 10.8, p = 0.04) in the irAE group. Conclusions: Trainees experienced similar cognitive load when performing irAE consults as compared to other consults, but the sources of cognitive load differed. Trainees performing irAE consults expended less mental effort on distractions (EL) and more on learning (GL) as compared to other consults. The consult task itself (IL) imposed a similar amount of cognitive load whether or not it was an irAE consult. Complex irAE cases did not overwhelm trainees or preclude learning; rather, trainees performing irAE consults exhibited a sharpened focus on the task at hand and extracted more learning than trainees performing other consults. Educators should foster trainee exposure to inpatient irAE consults to promote worthwhile learning.
Multimodality, online oncology learning resources: Meeting residents where they are—A pilot to create a new oncology curriculum.
Authors: King Jennifer , Pham Phillip , Khalid Ahmed Bilal , Sabra Mohamad , Schwartz Jennifer E.
Published: June 2023

11035

Background: The Accreditation Council for Graduate Medical Education (ACGME) requires internal medicine residents to have access to different medical subspecialties, including hematology/oncology. While inpatient rotations in hematology/oncology have been associated with a decreased interest in a career in oncology, dedicated educational sessions have been shown to improve residents’ interest in the field. In recognition of different learning styles and modalities and the need for asynchronous delivery, we aimed to build an effective curriculum for oncology learners using interactive, multimodality, online learning tools and resources. Methods: Using the Canvas online learning management system, individual learning modules covering major cancer types were created. Each learning module consisted of a pre-survey assessing the learners’ evaluation of their own knowledge and comfort with the topic, a brief audio or video file covering high-yield information about the cancer type, interactive case-based questions reviewing and reinforcing the information, and a post-survey assessing the change in the learners’ evaluation of their knowledge and comfort in clinical application of the information. The pre- and post-surveys were rated on a 5-point Likert scale. Median values and interquartile ranges are reported. A one-sided t-test was used to compare responses. Results: Two fully completed learning modules have been created. The lung cancer module included a high-yield, 10-minute voice-over PowerPoint presentation followed by interactive, case-based questions. The breast cancer module used a high-yield, 10-minute podcast with an accompanying handout for notes followed by case-based interactive questions. Seven learners have completed both pre- and post-survey responses for comparison. Two were completed by PGY1, 4 by PGY2, and 1 by a PGY3 resident. Median rating of the learners’ knowledge of the specific cancer type increased from 2- Fair (1.5) on the pre-survey to 3- Neutral (1) after completing the learning module (p = 0.001). 100% of learners agreed or strongly agreed that their knowledge increased after completing the module. All 7 residents felt more comfortable with their clinical application of the cancer topic material after completing the module, median 2(1) on pre-survey vs. 3(0.5) on post-survey; p = 0.0004. Conclusions: The creation of online, multimodality learning resources has resulted in improvements in learners’ perceived knowledge and comfort with clinical application of oncology topics. Using learning science principles, this pilot project serves as the foundation for further innovative and interactive educational resources and modules created for oncology learners.