bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burnout and level of mental functioning in oncology staff.
Authors: Alcorta-Garza Adelina , Alcorta-Nuñez Fernando , Vidal-Gutiérrez Oscar , Gonzalez-Guerrero Juan Francisco , Garza-Guerrero Antonio César , Gómez-Meza Marco Vinicio , Alcorta-Garza Ángel Enrique 
Published: March 2020

10513 Background: The Burnout Syndrome takes relevance for its investigation since 1986, when Maslach developed a survey for its study with 3 subscales that include the symptoms generated by exhaustion and chronic labor stress. Health workers are especially vulnerable to the development of this syndrome, which is greater centers with exposure to patients with severe and/or chronic ailments. Thus, the mental structure maturity level with which the individual functions takes relevance, since it is linked to the quality of judgment of the clinician. Few studies consider this aspect because of the complexity of having the instruments and professionals to assess it. It has been questioned whether Burnout or this occupational exhaustion damages the quality of life of the individual, and if it also negatively impacts their work performance, and the quality of care provided to patients. Methods: Observational, cross-sectional and correlational study. It analyses the relationship between Burnout and the characteristics of the mental-structural functioning level in oncology staff, and its association with the level of functionality of the mental structures within the work environment. Prior validation of the instrument was conducted, FIAD-15, with acceptable Alpha of 0.81. Results: Data were obtained from 1,060 subjects, including administrative, nursing and medical members of the Oncology Service staff, as well as, students. Out of these, 1,036 subjects answered the questionnaire appropriately and were considered in the analysis. 413 (39.86%) presented Burnout. The prevalence was higher in men (45.17%) than in women (34.56%). A significant association was found between Burnout frequency and levels of mental functioning. On the functionality of the mental structures, 80% had functional, high and intermediate levels, while 20% of the total population showed a borderline level of functionality (severe). In women, Burnout frequency was higher in borderline levels, followed by those of functional and high level. In men, Burnout was higher in those at the borderline level, followed by functional and intermediate; it was much lower in high level subjects. Conclusions: The mental structure functionality levels found in the oncology staff are associated with Burnout; which is lower in men with structures with high functionality and in women in the intermediate level. Subjects with borderline structures suffer greater Burnout. Further studies should be carried out to support these findings in the future and open new lines of research.
Medical oncologists’ experience with returning molecular tumor profiling to patients.
Authors: Thavaneswaran Subotheni , Napier Christine , Goldstein David , Meiser Bettina , Butow Phyllis , Thomas David Morgan , Ballinger Mandy L. , Best Megan 
Published: March 2020

10521 Background: Molecular tumor profiling (MTP) to guide therapy is increasingly being applied in the clinic, although how medical oncologists (MOs) manage this in clinical practice is not fully understood. Methods: An online survey explored MOs’ experience with MTP interpretation, treatment (tx) decisions, identifying resources, and communicating results to patients with cancer. MOs were identified based on their participation in the Australian Molecular Screening and Therapeutics Program. Results: 108 MOs (57% male, median years of practice, 5-9 years, 83% urban-based practice and median age range, 40-49 years) participated from June 2018 – Jan 2019. Most MOs had experience with MTP (90%), and felt it was their role to discuss results. MOs felt confident discussing the process of MTP, the probability of a ‘therapeutically actionable finding’, and results (score 70-75, range 0 least confident - 100 completely confident). However, almost two-thirds of MOs needed/wanted assistance with interpretation of results, favouring a Family Cancer Clinic (FCC) helpline, patient information sheets on MTP, and decision aids. In particular, MOs were less confident discussing germline results and their implications (median score 56) but were comfortable (median score 96) to refer to an FCC. Most MOs felt there was sufficient information on the MTP report to understand results. Some preferred to receive ‘all cancer gene variants’ (36%), others only those with clinical actionability (45%), and some only those with therapeutic actionability (19%). Most MOs (85%) wanted to know the full list of genes assayed, tx recommendations, and/or a list of relevant trials. Interestingly, MOs indicated little confidence that MTP would guide useful tx decisions (median score 51) and most reserved it for the tx-refractory setting. A minimal level of evidence supporting treatment was required by 83% of MOs prior to recommending biomarker-guided tx. Conclusions: MOs are increasingly integrating MTP into clinical practice, despite uncertainty about result validity and clinical translation, particularly regarding germline results. Understanding these potential barriers is the first step in developing clinician supports to facilitate clinical translation.
Developing an inspired leader: How to maximize human talent to maximize operating results.
Authors: Greeter Aimee 
Published: March 2020

10522 Background: Healthcare is a personal industry–driven by people, for people. Developing the talent of individuals as leaders is critical to making the entire industry thrive. This session provides practical tools to develop highly competent leaders, who can then develop high-performing organizations. Methods: Using Noel Burch’s framework, this presentation shares effective methods of propelling leaders from uninspired to results-focused performers. With a focus on real-life examples, this interactive session gives instruction on how to maximize human talent as a means to driving enterprise-wide success. The topics to be covered include: (1) Conscious Competence Ladder: What Is It?; (2) Noel Burch’s work; (3) Key tenets of the Ladder; (4) Common misperceptions of the Ladder; (5) Conscious Competence Ladder and Healthcare: Why Does it Matter?; (6) Application of the Ladder to the healthcare industry; (7) Realities of Human Capital in healthcare; (8) “Exercising” Leadership: Is That Even Possible?; (9)Development of leadership as a skill; (10) Four-Step Process to Leadership Development in Healthcare: But How Do We Do That?; (11) Application of Leadership: But Won’t This Be Hard?; (11) Common pitfalls in leadership development; (12) Success Stories: Has Anyone Ever Even Done This in Healthcare?; (13) Conclusions, Q&A: What Happens Next? Results: This session will enable participants to: (1)Describe the Conscious Competence Ladder model and its relevance to healthcare organizations; (2) Authenticate leadership as a skill that can be developed, and understand how to mature that skill within healthcare leaders using an efficient four-step process; and (3) Provide practical, effective methods to help people understand, process and use leadership skills to maximize the success of their peers, patients and community. Conclusions: In Q4 2017, for the first time ever, healthcare passed both manufacturing and retail as the United States’ largest employer. Simply put, there are now more health care laborers than any other industry. In sheer numbers alone, this is impressive. But, more impressive is the need to utilize and motivate this work force. Using effective and appropriate tools (such as those to be provided in this presentation), this massive healthcare work force can be empowered to drive significant benefits for an organization, its patients and its broader community.
Oncology fellows’ knowledge and current practice regarding outpatient oncology and palliative care.
Authors: Johnson Amy , Newton Erin V. , Fettig Lyle , Comer Amber 
Published: March 2020

10527 Background: Patients with advanced cancers often suffer from a number of symptoms and need guidance when discussing treatment goals as their diseases’ progress. Palliative care competencies include the assessment and management of both physical and psychological symptoms, as well as, the conduct of goals of care conversations and advanced care planning. Palliative medicine is subspecialty that specially addresses these needs in patients with advanced cancers, but is not universally available. Oncology fellowship training must include these competencies and there is little evidence regarding the palliative care educational experiences of oncology fellows. This study examines fellows’ experiences with palliative care education and fellows’ attitudes about concurrent palliative care in the outpatient setting. Methods: An electronic nationwide survey of medical oncology fellows was conducted in the second half of the academic year in 2018. Results: 43 of 191, 22.5%, of oncology fellows contacted at 17 institutions responded. 96% of fellows indicated they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics. 93% of fellows agree or strongly agree with being comfortable managing cancer related pain, but only half agree or strongly agree with being comfortable managing depression and anxiety. 91% agree or strongly agree they are comfortable with discussions about transitions to best supportive care, while only 31% of fellows always or often assist patients in completing advance care documents. 70% of fellows are always, often, or sometimes receiving feedback on their communication and symptom management skills. Conclusions: Oncology fellows fell comfortable with some aspects of palliative care more than others. Fellows in this survey report feeling comfortable with goals of care conversations and pain management, but are not as comfortable managing other symptoms like depression and anxiety. Respondents are not universally assisting patients in advanced care documentation and only two-thirds of responding fellows are receiving frequent feedback on their communication and symptom skills. There is a consensus among responding fellows about a desire to have palliative care embedded in their future clinics.
Medical oncology trainees’ perceptions of their education and preparedness for independent practice.
Authors: Linford Geordie , Hammad Nazik , Dalgarno Nancy , Cofie Nicholas , Ramjeesingh Ravi , Tomiak Anna T. 
Published: March 2020

10536 Background: This original research assesses Canadian Medical Oncology (MO) residents’ perceptions and satisfaction with their education and preparedness for practice prior to initiation of Competency Based Medical Education (CBME). Methods: Digital surveys were sent to MO residents in Canadian training institutions yearly from 2014–2017. Because of lower than expected response rates, invitations were subsequently extended to recent graduates completing training between 2009–2014. Ethics and funding were granted by Queen’s University. Results: A total of 71 surveys were received with representation from 11 training programs. Preparedness for Practice: Current trainees and recent graduates ranked preparedness for practice similarly in all assessment domains except Medical Expert (trainee mean 3.50, graduate mean 4.45, p=0.004; 1=not prepared, 5=well prepared). Means for the combined cohort shown in table. Usefulness of teaching modalities: Participants ranked learning in a clinical setting as most useful (6.53/8, 1=least useful, 8=most useful) and educational sessions by residents (4.24/8) and Journal Club (3.74/8) as least useful. Most participants felt their training was a shared learner-teacher responsibility (56.1%) or was learner-centered (22.5%). Quality of teaching: Participants reported similar levels of satisfaction with teaching across domains except for Manager which scored lowest (3.46/5, 1=poor, 5=excellent). Self-assessment of skills: Participants were most satisfied by their ability to assess their own performance and competence at the end of training (7.16/10, 1=not satisfied, 10= very satisfied). The degree to which their programs set expectations about required knowledge, skills, or attitudes at various points in training (6.63/10) and participants abilities to self-assess these skills during their training (6.64/10) scored lower. Conclusions: Participants reported low satisfaction with their ability to self-assess during their training and their training programs’ ability to communicate expectations. Transition to CBME training may address these issues, and follow-up is required.[Table: see text]
Using blended learning to improve education on clinical pathways for breast cancer management in Nigeria: Preliminary results.
Authors: Eguzo Kelechi Ngozi , Ismaila Nofisat , Akpanudo Usenime , Chukwuemeka Oluoha , Jacob Aniekan , Udoekong Mfonobong , Adisa Charles Adeyinka 
Published: March 2020

10539 Background: Most Nigerian clinicians lack adequate skills and resources in screening, diagnosis, and managing women with breast cancer. The absence of locally-sensitive clinical pathways in hospitals in Abia State impact patient outcomes and clinicians job satisfaction. Blended learning (BL), a combination of online and face-to-face teaching methods, has been used in other settings to improve the competencies of clinicians. Research seeks to develop and evaluate a BL course that will train clinicians in Abia State on using NCCN breast cancer management guidelines, and to develop and implement locally-sensitive clinical pathways. Methods: The course is divided into four online modules delivered via Google Classroom and a workshop module to be delivered in 3 cities. Course evaluation involves an objective-focused method, following a mixed-methods design. Data collection includes pre-and-post-tests, course evaluation and focus group discussions. Data analysis involved descriptive statistics and t-test. Comments deductively analyzed to identify common themes. A sample size of 107 individuals is required to identify a moderate effect size for the BL course. Results: Forty-three participants (physicians=15, Nurses=28) have been recruited for cohort 1, with average age of 44 (±9.9) years. Most participants have never taken an online class (65%) but use mobile phones (60%) to access the course. With a maximum of 20 points in each test, there is a pattern of improvement in the post-tests performance compared with the pre-tests. Table shows mean scores. Most participants have expressed satisfaction with the course. Conclusions: Results show improvement in learning. More participants are being recruited. The workshops will hold at after the online modules.[Table: see text]
Implementing a quality improvement curriculum for medical oncology residents: A pilot study at the Ottawa Hospital Cancer Centre.
Authors: Brule Stephanie Yasmin 
Published: March 2020

10540 Background: With increasing cancer care costs and demands in Canada, quality improvement (QI) efforts are urgently needed. Yet no formal QI education exists in the Canadian Medical Oncology setting. We created an Oncology-specific QI curriculum and sought to assess its feasibility and efficacy among Medical Oncology residents. Methods: In this prospective, pre-experimental pilot study using a pre-post curriculum design, Medical Oncology residents at The Ottawa Hospital Cancer Centre participated in a new QI curriculum. It consisted of four 2-hour sessions encompassing a combination of didactic and interactive learning. The primary measures were self-assessment of confidence in QI skills with the Self-Assessment Program (SAP) and objective assessment of QI knowledge with the revised QIKAT (QIKAT-R). The SAP and QIKAT-R were completed at baseline and post-curriculum. The primary outcome was feasibility of the educational approach. Results: Five Medical Oncology participated, while four (80%) completed the assessments at both timepoints. Self-assessment in the skills needed to execute a process improvement project improved with participation in the curriculum. Mean SAP scores improved from 19.6 pre-curriculum to 33.5 post-curriculum. SAP scores improved for each of the 10 quality improvement skills evaluated. Objective assessment using the QIKAT-R also improved post-curriculum, with a mean score of 17 pre-curriculum and 24 post-curriculum. Mean scores of each domain of “Aim, Measure, and Change” evaluated by the QIKAT-R improved. Conclusions: Self-assessed confidence and objective knowledge in QI concepts in Medical Oncology residents improved after participation in this Oncology-specific QI curriculum. Feasibility of this approach was demonstrated, and therefore a larger scale study will be implemented in the future.
Neoadjuvant chemotherapy in high-risk soft tissue sarcomas: Final results of a randomized clinical trial from the Italian Sarcoma Group, the Spanish Sarcoma Group (GEIS), the French Sarcoma Group (FSG), and the Polish Sarcoma Group (PSG).
Authors: Gronchi Alessandro , Palmerini Emanuela , Quagliuolo Vittorio , Martin Broto Javier , Lopez Pousa Antonio , Grignani Giovanni , Brunello Antonella , Blay Jean-Yves , Diaz Beveridge Robert , Ferraresi Virginia , Lugowska Iwona , Merlo Franco Domenico , Fontana Valeria , Palassini Elena , Morosi Carlo , Stacchiotti Silvia , Dei Tos Angelo Paolo , Picci Piero , Bruzzi Paolo , Casali Paolo Giovanni 
Published: March 2020

11000 Background: A ISG randomized trial on 5 cycles of adjuvant epirubicin+ifosfamide (EI) versus no chemotherapy suggested an OS benefit in localized high-risk STS (JCO 2001;19:1238). A subsequent trial showed no difference between 3 vs 5 cycles of the same neoadjuvant regimen (JCO 2012;30:850). The aim of this trial was to compare 3 cycles of EI versus a histology-tailored (HT) neoadjuvant regimen in selected localized high-risk STS. Methods: This is a multicenter European randomized trial comparing EI versus a HT regimen: gemcitabine+docetaxel in undifferentiated pleomorphic sarcoma (UPS); trabectedin in high-grade myxoid liposarcoma; high-dose prolonged-infusion ifosfamide in synovial sarcoma (SS); etoposide+ifosfamide in malignant peripheral nerve sheath tumors (MPNST); gemcitabine+dacarbazine in leiomyosarcoma (LMS). Patients had localized high-risk (grade = 3; size ≥5 cm) STS of extremities or trunk wall. Primary end-point was Disease Free Survival (DFS). The final analysis was planned after the observation of 130 events. This allows an 80% power to detect a significant difference at the 5% 2-sided level, if the true HR is 0.6 in favor of EI, as shown by the interim analysis (Lancet Oncol 2017;18:812-822). Results: From May 2011 to May 2016, 287 patients were randomized (97 = UPS; 65 = myxoid liposarcoma; 70 = SS; 27 = MPNST; 28 = LMS). The median follow-up was 51.75 months for the alive patients (IQ 28.03) The DFS and OS probability at 60 months were 0.48 and 0.55 (HR:1.232; 95%CI: 0.875-1.733; log rank p=0.323) and 0.66 and 0.76 (HR:1.766; 95%CI:1.101-2.831; log rank p=0.018), in the HT and EI arm, respectively. Conclusions: The final analysis shows a non-statistically significant DFS difference in favor of EI over HT chemotherapy with a larger and statistically significant OS difference. The outcome of patients on EI overlapped previous ISG trials. EI should remain the regimen of choice when neoadjuvant chemotherapy is used in high-risk localized STS. However this trial cannot be used as a formal proof of efficacy of (neo)adjuvant chemotherapy per se. EUDRACT 2010 – 023484 – 17. Funding source: Eurosarc FP7 278472. Clinical trial information: NCT01710176.
Anlotinib and irinotecan for advanced Ewing sarcoma after failure of standard therapy: A multicenter, two-cohort, single-arm, open label, phase Ib/II trial (NCT03416517).
Authors: Xu Jie , Xie Lu , Guo Wei , Tang Xiaodong , Yang Rongli , Yan Taiqiang , Liu Kuisheng , Gu Jin 
Published: March 2020

11012 Background: Both protracted irinotecan and anti-angiogenesis therapy have shown promising results in Ewing sarcoma. We did this phase Ib/II trial to first define the proper dose of irinotecan in combination with anlotinib in Ewing sarcoma and then evaluate efficacy. Methods: Patients diagnosed with recurrent or refractory Ewing sarcoma were enrolled and sub-classified into cohort A (≥16y) or cohort B ( < 16y). In the dose-defining phase Ib portion, anlotinib was given at a fixed dose of 12mg D1-14every 21 days, while the de-escalated 3+3 design was used to detect the recommended dose of irinotecan in each cohort from an initial level of 20mg/m2/d dx5x2. Recommended phase 2 dose (RP2D) was defined as the highest dose at which no more than 30% patients experience a DLT in the first two courses. In the next dose-expanding phase II portion, the primary endpoint was objective response rate at 12 weeks (ORR12w). A conventional two-stage study design model was used. Results: 41 patients were enrolled with 29 in cohort A and 12 in cohort B. For cohort A, first 5 patients were treated at initial level in phase Ib portion, two of whom subsequently experienced delayed diarrhea as dose-limiting toxicity (DLT). Additional six patients were then treated at a lower dose of 15mg/m2. Since no more DLT was recorded, it was used as RP2D. 23/24 patients in cohort A phase II were available for response evaluation at 12 weeks, with one complete response (CR), 14 partial response (PR) (including one CMR who has a negative PET/CT scan but still abnormal lesions in MR scan), 2 stable disease (SD) and 6 progressive disease (PD). ORR12wwas 62.5%. For cohort B, no DLT was noticed in the first six patients treated at the initial level which was used as RP2D later. Finally, 12 patients were included in cohort B. ORR12wwas 83.3% with two CR, 8 PR (including one CMR) and two PD. Although effective, cohort B were closed because of slow enrollment. Most common grade 3/4 adverse events were diarrhea, abdominal pain and neutropenia. The genotype of UGT1A1*1 and UGT1A1*28 were not associated with the risk of diarrhea. Conclusions: The combination of irinotecan and anlotinib demonstrated an acceptable toxicity profile with promising evidence of clinical efficacy in advanced Ewing sarcoma. Clinical trial information: NCT03416517.