bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burnout among oncology physician assistants (PAs) from 2015 to 2019.
Authors: Tetzlaff Eric Daniel , Hylton Heather Marie , Ruth Karen , Hasse Zachary , Hall Michael J. 
Published: May 2020

11009 Background: Changes in the demand and delivery of healthcare have led to a significant increase in employment of PAs in Oncology (Onc). These changes may also increase PAs risk of burnout, a syndrome characterized by a high level of emotional exhaustion (EE) and/or depersonalization (DP). This study was initiated to explore temporal changes in burnout & the PA workforce. Methods: Using the same methods from 2015, a national survey of Onc PAs was conducted in 2019. Survey items (n = 74) examined personal and professional characteristics, collaborative practice (CP), team structure, organizational context (OC), and burnout. OC was assessed using Areas of Worklife Survey (AWS) domains: workload, control, reward, community, fairness, & values. Low AWS domain score indicated a workplace mismatch (WM). Burnout was assessed with the Maslach Burnout Inventory. Change in burnout was examined with repeated measures logistic regression. Results: 234 out of 917 PAs (25.5%) completed the full survey. Respondents were mostly female (86%), married/partnered (78%), in Med Onc (71%), and practicing in the outpatient setting (67%). Burnout increased from 34.8% in 2015 to 48.7% in 2019 [odds ratio for burnout, 2019 vs 2015 = 1.92 (95%CI 1.40-2.65), p < .001]. Adjustment for workforce variables did not explain the increase in burnout. Among 2019 respondents, increased hours worked (p = .003), sub-specialty (P = .018), less time (%) spent on direct patient care (p = .007), practicing below full extent of education and training (p = .048), dissatisfaction with CP (p < .001), and perceptions of poor collaborative physician leadership (p < .001) were associated with higher rates of burnout. No difference in burnout was seen for personal or team characteristics, practice setting, years in onc, or # of patient visits. AWS scores were lower for PAs with burnout vs. without burnout (p < .001). PAs with a WM had a higher rate of burnout for each AWS domain (p < .001); most common WMs were fairness (44%) and workload (43%). Conclusions: The rate of burnout for Onc PAs has significantly increased and is now at levels of nearly 50%. Burnout in Onc PAs related to WM in workload is common, significant, & not explained by patient volume alone. The causes of burnout are multifactorial and additional research is needed in this at risk group. [Table: see text]
Identifying burnout in young oncologists: The sooner the better.
Authors: Elez Elena , Cebria Annabel , Bosch-Barrera Joaquim , Almudena Cotes , Montosa Fernando Gálvez , Paez David , Quintanar Verduguez Maria Teresa , Vaswani Avinash Ramchandani , Rogado Revuelta Jacobo , Sánchez Cánovas Manuel , Sanz-Garcia Enrique , Miquel Josep M , González Flores Encarnación , Rodríguez-Lescure Álvaro , Vera Ruth 
Published: May 2020

11010 Background: Professional burnout is an important issue for the healthcare systems with potentially relevant consequences in the quality of patient care. Young oncologists are a special risk population, due to high workload, academic pressure and other specific factors related to cancer care. Work life and lifestyle factors are related with burnout levels and may define specific interventions to reduce and prevent burnout. Methods: A survey based on the validated Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS MP) was conducted. Additional questions to explore work life and lifestyle factors were included. We studied potential burnout amongst young Spanish oncologists (residents and oncologist in the first 5 years of professional performance). Statistical analyses, including linear regression, were carried out to test the relations between overall burnout score and work and lifestyle factors. Results: We obtained 243 responses to the survey. The sample was representative in terms of age, sex, geographic region, professional profile (residents and young oncologists) and a homogeneous distribution per year of residence (final participation rate was of 26.6%). Regarding 5 Burnout profiles, 32.1% of the participants were classified as Ineffective, 25.1% as Burnout, 21% as Engaged, 17.3% as Overextended and 4.5% as Disengaged. Percentage of Burnout profile is higher in medical oncology residents (28.24%) than in young oncologists (19.79%). The highest percentage of burnout profile was observed in the second-year residents (35,71%) and gradually decreases, in parallel to an increase in the engaged profile. The multivariable linear regression analysis showed a significant correlation between not having a good work life balance and adequate vacation time and the burnout score. Conclusions: Burnout affects a significant number of young oncologists with significantly different profiles and differences across regions. Adapted interventions to the most frequent profiles and at different stages of the training and professional career may be necessary particularly at the early beginning. Actions towards achieving a better work and personal life balance and stress management could be effective. These results are the basis for the prospective part of our study that aims to design an intervention and to assess its efficacy in this population.
Results of emotional burnout study among oncologists in Russia.
Authors: Semiglazova Tatiana , Safina Sufia , Tsimafeyeu Ilya , Karaseva Vera V. , Mukhamediarova Gulnara , Fairushina Aigul , Tjulandin Sergey 
Published: May 2020

11011 Background: Emotional burnout (EB) is a syndrome caused by chronic work-related stress. This is a non-adaptive reaction to chronic stress resulting from professional activities and leading to the depletion of emotional and personal resources. Oncologists have high burnout risk, because involuntarily involved in the negative experiences of patients and get emotional stress. So it is important to develop measures to prevent EB for medical oncologists. Aim: The aim is to study the prevalence and severity of EB among oncologists and to develop preventive measures. Methods: A screening survey of the Russian Society of Clinical Oncology (RUSSCO) was conducted among 389 oncologists in various regions of Russia. The Maslach Burnout Inventory and online self-administered questionnaire were used. The questionnaire was sent out in November 2019. The questionnaire was based on a multi-factor model, which includes the following components: emotional exhaustion, depersonalization, reduction of professional achievements. Results: The average age of the respondents was 49.5 years, 61% of them were female. Chemotherapists made up 47.5%, 28% were surgeons, 8.5% were radiotherapists, 7% were diagnostic profile specialists, administrators made up 3%, 14.5% of the respondents had related specialties: clinical psychologists, pathologists, palliative care doctors. 30% of respondents had scientific degree. The results of the study were the following. 71.6% of specialists have expressed EB syndrome; 28% at EB formation stage, 1% have no signs of EB. There wasn’t a significant difference in EB rates across oncologists of various specialties. All stages of EB were identified. Female specialists are more likely to have manifestations of EB. EB severity was the same for doctors of inpatient and outpatient care. The extreme mode of work did not show significant differences of EB among both male and female specialists. First 5 years and more than 15 years of professional activity are most vulnerable to development of EB. EB was least affected by specialists over 65 years old with extensive experience. Conclusions: Hight level of EB was revealed among oncologists. Study results should be used during EB prevention, development of psychotherapeutic assistance and in educational programs.
Exploring glocalization in the construction and implementation of global curricula.
Authors: Giuliani Meredith Elana , Frambach Janneke , Driessen Erik , Martimianakis Maria Athina (Tina) 
Published: May 2020

11020 Background: Despite proposed advantages of global oncology curricular harmonization including physician mobility and improving the quality of care the challenges and unintended consequences require greater study. The aim of this study was to problematize the concept and implementation of global oncology curricula and their relationship to local contexts of power and culture. Methods: Fourteen international participants involved in the development and implementation of global oncology curricula completed in-depth, one-on-one semi-structured interviews lasting 40-60 minutes. Snowball sampling was employed. The participant sample was representative of different geographic regions, genders and professional scopes of practice to ensure diverse perspectives were sought. Through iterative analyses, using an abductive approach, the study team discussed and reviewed the data and made revisions through collaborative analysis to enhance comprehensiveness and to improve credibility. In the final analysis the meaning and implication of the themes were discussed yielding a conceptual analysis. Results: Our data have articulated 5 key challenges for global curricula including 1) Ambiguous or conflicting perspectives on the purpose and scope of Global Oncology Curricula 2) Insufficient representation of diverse perspectives and realities in the creation of the final curricula 3) A rigid conceptualization of competency requirements 4) A mismatch between the curricular requirements and local context and 5) The influence of power relationships and decision makers. Leveraging the strengths of diversity including fostering representation, addressing power differentials and factoring local contexts may be an approach to mitigating these challenges. Conclusions: Global oncology curricula may serve important advocacy roles within the healthcare system. Leveraging diversity may positively impact the common challenges in the construction and implementation of global oncology curricula.
Setting focus on oncology in a German undergraduate medical training program: Our experience with a longitudinal elective Interdisciplinary Oncology.
Authors: Zschaebitz Stefanie , Jaeger Dirk , Winkler Eva Caroline , Halama Niels 
Published: May 2020

11034 Background: Compared to other academic disciplines such as social sciences and humanities, medical school curricula leave limited opportunities to meet individual interests of students. Methods: To allow students to set an individual focus in their MD education, and to promote a sound scientific basis, n = 11 longitudinal electives (“tracks”) were introduced within the Heidelberg Curriculum Medicinale (HeiCuMed) in 2017. The volume of additional training consists of 2 weekly lectures hours for at least 1.5 years of training. Participation in the program has been on a voluntary basis until 2019 and now is obligatory for every student. Results: n = 141 students are currently enrolled within the track “Interdisciplinary Oncology (IO)”. More than n = 50 optional courses are offered each semester covering oncologic subjects such as scientific methods in cancer research, ethical issues in research and clinical practice, communication and clinical skills training. The modular system of the IO elective allows for a wide selection of topics for participating students but also poses a challenge for graded assessments. Conclusions: Conducting a modular elective including graded assessments is feasible. The longitudinal track IO has a high voluntary participation rate and very positive feedback from students. This indicates that our teaching concept is very well suited to address the call for increased choice and specialization in medical curricula in Germany.
Results of the second interim assessment of rEECur, an international randomized controlled trial of chemotherapy for the treatment of recurrent and primary refractory Ewing sarcoma (RR-ES).
Authors: McCabe Martin G. , Kirton Laura , Khan Maria , Fenwick Nicola , Dirksen Uta , Gaspar Nathalie , Kanerva Jukka , Kuehne Thomas , Longhi Alessandra , Luksch Roberto , Mata Cristina , Phillips Marianne , Safwat Akmal , Strauss Sandra J. , Sundby Hall Kirsten , Valverde Morales Claudia Maria , Westwood Andrew J. , Winstanley Mark , Whelan Jeremy , Wheatley Keith 
Published: May 2020

11502 Background: Five-year survival of RR-ES is about 15%. Several chemotherapy regimens are used, but without robust evidence. rEECur, the first randomised controlled trial in this setting, is defining a standard of care, balancing efficacy and toxicity. Methods: Patients aged 4 to 50 with RR-ES and fit to receive chemotherapy were randomised between topotecan & cyclophosphamide (TC), irinotecan & temolozomide (IT), gemcitabine & docetaxel (GD) or high-dose ifosfamide (IFOS). Primary outcome measure was objective response (OR) after 4 cycles by RECIST 1.1. Secondary outcomes included PFS, OS and toxicity. A probability-based Bayesian approach was used with multiple pairwise comparisons. At the first interim analysis patients allocated to GD had worse OR and PFS than the other arms and accrual to the GD arm was halted. The second interim assessment was planned to determine which arm should be closed when at least 75 evaluable patients had been recruited to the remaining arms and evaluated for the primary outcome measure. Results: 366 patients (87% RECIST-evaluable), recruited between 18/12/14 and 17/12/19, were randomised to TC (n=124), IT (118), GD (72) and IFOS (53). Median age was 20 years (range 4-49). Patients had: refractory disease (19%), first recurrence (66%), > first recurrence (14%). Initial disease site was bone in (66%). Sites of progression were: primary site only (16%) pleuropulmonary only (32%), other metastatic (52%). At median follow up of 9.2 months, outcome in the IT arm was: response rate 20%, median PFS 4.7 months (95% CI: 3.4 to 5.7), median OS 13.9 months (95% CI: 10.6 to 18.1). The table shows, for each pairwise comparison of IT with the other open arms (randomly labelled A and B to maintain blinding), the probabilities that OR, PFS and OS were better for X than for each other arm (RR = risk ratio, HR = hazard ratio). For OR, PFS and OS, all comparisons favoured arms A and B. The main grade 3/4 adverse events (% patients with an event) for IT (left hand values) compared with A and B pooled were: vomiting (6% v 1%), nausea (6% v 0%), diarrhoea (17% v 0%), fatigue (3% v 1%) and febrile neutropenia (3% v 24%). Conclusions: The first randomised trial in RR-ES has shown that IT, used as a control arm in planned and ongoing randomised phase II studies in RR-ES, is less effective than A and B in achieving tumour shrinkage or prolonging PFS and OS. The remaining two arms are continuing to recruit patients. Clinical trial information: ISRCTN36453794 . [Table: see text]
A pilot study evaluating the safety, tolerability, and efficacy of doxorubicin and pembrolizumab in patients with metastatic or unresectable soft tissue sarcoma.
Authors: Livingston Michael B. , Jagosky Megan , Robinson Myra M. , Ahrens William , Benbow Jennifer H , Farhangfar Carol J. , Foureau David , Maxwell Deirdre , Baldrige Emily , Steuerwald Nury , Anderson Colin J , Patt Joshua , Kneisl Jeffrey , Kim Edward S. 
Published: May 2020

11519 Background: Doxorubicin has been the traditional standard therapy for treatment of advanced soft tissue sarcoma (STS). The addition of cytotoxic agents leads to increased toxicity with minimal improvement in efficacy. Pembrolizumab monotherapy has demonstrated activity and tolerability in previous study of advanced STS. This study combined pembrolizumab with doxorubicin to determine safety and efficacy in the frontline setting. Methods: This single-center, single-arm, phase 2 trial enrolled subjects with unresectable or metastatic STS and no prior anthracycline therapy. Subjects were treated with pembrolizumab 200 mg IV and doxorubicin 60 mg/m2 (75 mg/m2 dose escalation per investigator discretion) IV every 3 weeks. The primary endpoint of safety, based on Bayesian stopping rules, evaluated if the severe or life-threatening treatment emergent adverse event (TEAE) rate exceeded 0.55. Secondary endpoints included overall survival (OS), objective response rate (ORR), and progression free survival (PFS). Efficacy and safety were based on RECIST 1.1 and CTCAE v 4.0, respectively. Kaplan-Meier methods evaluated time to event outcomes. Results: From 4/2017 to 12/2019, 30 subjects (53% female, median age 61.5 years, 10 patients > 70 years (33%)) were enrolled in the study with 6 (20%) patients still on treatment and 27 evaluable for response. The most common histologic subtypes were leiomyosarcoma (33%) and liposarcoma (23%), and a majority of patients demonstrated high grade disease (60%). Current analysis shows a median follow-up of 9.9 months. One subject experienced a stopping rule event (grade 3 autoimmune disorder). ORR was 33% (95% CI 17-54%), with documented disease control in 78% (95% CI 57.7-91.4%) of patients. Eight (30%) patients achieved a partial response, one (4%) patient achieved a complete response and 12 (44%) patients had stable disease. Preliminary results demonstrate median PFS of 6.9 months (PFS-6 mo: 52%) and median OS of 15 months (OS-6 mo: 81%) compared to historical PFS-6mo of 4.6 months and OS of 12.8 months with doxorubicin alone.1 Most common grade 3+ TEAEs included neutropenia (11 [37%]), febrile neutropenia (6 [20%]), anemia (5 [17%]), and nausea (4 [13%]). Molecular and biomarker analysis is currently in progress. Conclusions: The combination of pembrolizumab with doxorubicin has manageable toxicity and preliminary promising activity in the treatment of anthracycline-naive advanced soft tissue sarcomas. Ref: 1. Lancet Oncol. 2014 Apr; 15(4):415-23. Clinical trial information: NCT03056001 .
Preliminary evaluate the safety and efficacy of anlotinib in advanced sarcoma patients in multi-line therapy.
Authors: Weitao Yao , Wang Jiaqiang , Zhang Peng , Wang Xin , Du Xinhui , Tian Zhichao , Niu Xiaoying 
Published: May 2020

11526 Background: Patients with advanced bone and soft tissue sarcoma are mostly treated with chemotherapy, but the effect is poor. Anlotinib hydrochloride is a multi-targeted receptor of tyrosine kinase inhibitors (TKI), which has demonstrated therapeutic effects on a variety of sarcoma subtypes, and is approved for the treatment of advanced soft tissue sarcomas in China. Methods: This is a single-arm, prospective, single-center clinical study. The included criteria were patients with pathological diagnose of bone and soft tissue sarcoma, at least one measurable lesion (according to RECIST 1.1), failed of more than first-line therapy (except for alveolar soft tissue sarcoma) in the last 6 months, with the normal function of main organs. All patients received anlotinib for more than 1 month. The primary study endpoint was objective response rate (ORR). Disease control rate (DCR) and side effects was also calculated. Results: At the latest follow up in Jan. 20th, 2020, a total of 31 patients were enrolled. The median age of the patients was 38 (8-79) years. The main subtypes included osteosarcoma (25.8%), undifferentiated pleomorphic sarcoma (19.4%), synovial sarcoma (16.1%), fibrosarcoma (12.9%). 83.9% of patients received for at least third-line therapy of anlotinib. The oral administration time was 1.5-15 months, with the average of 4.34 months. The ORR was 29%. The DCR was 77.4%. Patients who had received other TKI drugs had an ORR of 20% and a DCR of 70% in 10 cases (32.2%) in this group. mPFS and mOS have not been reached. Adverse events were mainly in grades I and II, including 6 (19.4%) of anorexia or diarrhea, 5 (16.1%) of pain, 4 (12.9%) of hand-foot syndrome, 3 (9.7%)of hypertension, fatigue and mucosa ulcer each. One case had hypertension in grades III. Conclusions: Anlotinib has shown a definite effect in the treatment of advanced sarcomas. Effectiveness can also be observed in patients who have failed in other targeted therapy. The adverse events are minor and can be tolerated. Clinical trial information: NCT04223583 .
Laparoscopic versus open surgery for gastrointestinal stromal tumor in esophagogastric junction: A multi-center, retrospective cohort analysis with propensity score matching.
Authors: Xiong Wenjun , Chen Tao , Feng Xingyu , Xu Yuting , Wan Jin , Zhou Rui , Li Yong , Li Guoxin , Wang Wei 
Published: May 2020

11534 Background: Laparoscopic resection is increasingly performed for Gastrointestinal stromal tumor (GIST). Nevertheless, laparoscopic approach for the GIST located in the esophagogastric junction (EGJ-GIST) represent a surgical challenge. This study aims to investigate the efficacy of laparoscopic surgery and open procedure for EGJ-GIST through the propensity score matching (PSM) method. Methods: Between April 2006 and April 2018, 1824 patients underwent surgery were finally diagnosed with primary gastric GIST at four medical centers in South China. EGJ-GIST was defined as a GIST with an upper border of less than 5 cm from the EG line. Among them, 228 patients were identified and retrospectively reviewed with regard to clinicopathological characteristics, operative information and long-term outcomes. The PSM methods was used to eliminate the selection bias. Results: After PSM, 102 cases, consisted of 51 laparoscopic (LA) and 51 open surgery (OP), were enrolled. The match factors contained year of surgery, gender, age, BMI, tumor size, mitotic rate, recurrence risk and adjuvant tyrosine kinase inhibitors treatment. The LA group was superior to the OP group in operative time (108.5±56.5 vs. 169.3±79.0 min, P <0.001), blood loss (54.6±81.9 vs. 104.9±156.4 ml, P = 0.042), time to liquid intake (3.1±1.8 vs. 4.3±2.2 d, P = 0.003), hospital stay (6.0±2.3 vs. 9.9±8.1, P = 0.001), and postoperative complication (5.9% vs. 25.5%, P = 0.006). The median follow-up was 55 (range, 2-153) months in the entire cohort. No significant differences were detected in either the relapse-free survival (RFS, P = 0.109) or overall survival (OS, P = 0.113) between two groups. The 1-, 3-, and 5-year RFS in the LA and OP groups were 100.0%, 95.5%, 91.0% and 100.0%, 90.8%, 85.7%, respectively. The 1-, 3-, and 5-year OS in the LA and OP group were 100%, 95.6%, 91.3% and 100.0%, 91.1%, 85.4%, respectively. Conclusions: Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time, reduced blood loss, shorter time to liquid intake and shorter length of stay, all without compromising post-operative outcomes and long-term survival.