bluuebunny/crossref_metadata_2025_split huggingface dataset:
The positive impact of mentoring on burnout: Organizational research and best practice interventions for cancer hospital employees.
Authors: Cavanaugh Katelyn , Belfer Bret , Cline Debbie , Holladay Courtney , Pickard Todd Alan , Thoman Evan , Chang Shine 
Published: June 2021

11012 Background: While burnout is not a new concept, combating it is becoming an increasingly important focus for organizations across all industries. Recently, the World Health Organization recognized burnout as an “occupational phenomenon” (WHO, 2019), and it was included in the 11th Revision of the International Classification of Diseases, where it is defined as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” The University of Texas MD Anderson Cancer Center addresses burnout at the institutional level in support of all 22,000 workforce members. One avenue of this work focuses on mentoring. Mentorship, both formal and informal, has demonstrated positive effects to include empirical investigations that demonstrate its benefit in reducing risk of burnout in multiple settings for a variety of audiences (Qian et al., 2014; Thomas & Lankau, 2009; van Emmerik, 2004; Varghese at al., 2020). Although mentoring is not as flashy as other interventions, what the last year has shown is that people need human connection now more than ever. Methods: In order to investigate the relationship between burnout and mentoring in our organization, we analyzed responses to our biennial voluntary employee survey, in which all employees were asked whether they are involved in a mentoring relationship and completed a single-item burnout scale. Results: We analyzed the survey data using a chi-square test and found that employees participating in mentoring relationships were less likely to report burnout than employees who are not participating in a mentoring relationship, χ2 (1, 14,486) = 17.431, p < 0.005. The same pattern held for all types of employees; faculty, classified staff, leaders, clinical employees, and non-clinical employees, indicating that the experience of mentorship may be universal regardless of role, rank, and type of work. We suspect that the benefits of mentoring are bi-directional for mentors and mentees, though this should be investigated directly. Conclusions: Both formal and informal types of mentoring programs exist within MD Anderson to support retention, professional fulfillment, and reduce burnout. All employees have access to a centralized online mentoring platform to find a mentor. Formal mentoring support is also provided through various programs developed for specific professional cohorts, including physicians, advanced practice providers, and registered nurses. In addition, informal mentoring support is offered in the form of employee volunteer wellness champions. Together, these formal and informal mentoring programs have positively influenced burnout across the organization.[Table: see text]
A pilot study to prevent burnout in junior oncology doctors during the COVID-19 pandemic in a tertiary U.K. center.
Authors: So Alfred Chung Pui , Hunter Sarah , Chan Karen , Rigg Anne Sagar , Smith Sue , Miller Raselle , Thillai Kiruthikah 
Published: June 2021

11015 Background: Burnout is a syndrome defined by emotional exhaustion, depersonalisation and loss of personal accomplishment. It is a growing concern amongst doctors, particularly in oncology, who face the added stress of delivering life changing results to patients and managing end of life care. This has potential for negatively impacting mental health, job satisfaction and ultimately patient care. This has been compounded by the COVID-19 pandemic and the uncertainty around complex oncological treatment decisions, longer working hours, redeployment, and constant changes to working patterns to meet the evolving clinical need. In response to this, a novel wellbeing intervention was designed by the educational lead consultant and psychologists to prevent burnout during the pandemic. Methods: Junior doctors working at a single UK cancer centre during the COVID-19 pandemic were invited to attend weekly 30 minute wellbeing sessions facilitated by a clinical psychologist throughout their oncology placement (average 4-6 months). Sessions had an average attendance of 3-6 doctors and began with a 5 minute breathing and relaxation exercise followed by a mixture of clinical debriefing, reflective practice, and mindfulness strategies. Trainees were invited to have individual sessions if required. Surveys based on the 14 point Warwick Edinburgh Well Being Scale (WEMWBS) were conducted at the start and end of placement. Additional qualitative feedback was collated. Results: Throughout a 6 month period, 10 doctors participated in this study. Baseline WEMWBS scores revealed average mental wellbeing (n = 8), high mental wellbeing (n = 1) and probable depression (n = 1). Median baseline WEMWBS score was 52(41-62). Median number of sessions attended was 11(3-14). Post intervention, there was no significant deterioration in baseline WEMWBS score (mean change +2.2; p= 0.34). When doctors were asked about their optimism for the future, there was a significant increase by +0.4 points ( p= 0.037). With respect to participant feedback, 100% were either ‘satisfied’ (n = 1) or ’very satisfied’ (n = 9) with the group facilitation and 100% found the group sessions either ‘helpful’ (n = 7) or ‘very helpful’ (n = 3). Trainee feedback described the benefits of reflecting in a structured and safe environment, breathing exercises, and learning mindfulness strategies. Conclusions: Burnout is a serious concern amongst junior oncologists and is rising as a result of COVID-19. We present a novel intervention that promoted psychological flexibility and importantly maintained mental wellbeing throughout the pandemic. Further studies are planned to develop evidence based interventions to tackle this important issue.
Moral distress, organizational climate, and the risk of burnout among oncology physician assistants.
Authors: Tetzlaff Eric Daniel , Hylton Heather Marie , Ruth Karen , Hasse Zachary , Hall Michael J. 
Published: June 2021

11018 Background: Moral Distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care and has been associated with burnout. Advances have been made in our understanding of burnout in the oncology (Onc) workforce but our understanding of MD remains limited. This study was initiated to explore associations between moral distress, burnout, and the organizational climate (OC) for Onc Physician Assistants (PAs). Methods: A national survey of onc PAs was conducted in 2020. MD and Burnout were assessed with the Maslach Burnout Inventory and the Measure of MD – Healthcare Professionals (MMD-HP). To assess OC, the Nurse Practitioner Primary Care OC Questionnaire (NP-PCOCQ) was revised for Onc PAs and assessed professional visibility (PV), administrative relations (AR), physician relations (PR), and professional autonomy and support (PAS). A robust Poisson regression model was used to estimate risk ratios (RR) for burnout associated with MD and OC variables. Results: Respondents who completed the survey included 146 Onc PAs that were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical Onc (73%). Mean MMD-HP score was 71.5 and burnout was reported by 39.7% of PAs. MMD-HP scores did not differ based on specialty, practice setting or practice type. PCOCQ subscale scores were lower for PAs with burnout vs. without burnout (p=0.003 to p < 0.001). Increasing levels of MD were associated with increased levels of emotional exhaustion (p<0.001), depersonalization (p<0.001) and a higher overall rate of burnout. For Low, Medium and High MMD, burnout rates were 10%, 44% and 66% respectively (p<0.001). Risk of burnout was associated with increasing levels of MD, which remained when adjusted for the PCOCQ subscales. An interaction model with the PCOCQ subscales and the association between burnout and MD was not significant. Conclusions: Higher levels of MD and unfavorable organizational climate are associated with Onc PA burnout. The relationship between MD and burnout does not appear to be moderated by organizational climate. Additional research is needed to identify potential moderators of the MD/Burnout relationship. Risk Ratio estimate for Burnout.[Table: see text]
Hematology/medical oncology fellow responses to the initial development of an antiracism curriculum.
Authors: Nakajima Erica C. , Messmer Marcus , Jones Jennifer Marie , Mathieu Luckson , Phillips Tanyanika , Weekes Colin D. , Marshall Catherine Handy , Sanderford Honor , Donehower Ross C. , Marrone Kristen , Moyo Victor M. 
Published: June 2021

11042 Background: While the American Council on Graduate Medical Education (ACGME) set up a Planning Committee for Diversity in GME in 2018, no formalized milestones or training mandates have been announced. The nation-wide protests for racial justice following the senseless killings of Breonna Taylor, Ahmaud Arbery and George Floyd further brought to the forefront the need for immediate action to address widespread inequities across graduate medical education, our healthcare system and society as a whole. Therefore, the Johns Hopkins Hematology/Medical Oncology Fellowship Program focused on creating an anti-racism curriculum to foster dialogue on systemic racism and discrimination, grounded in the institutional and geographic context of our training program. Methods: Using the Kern six step curriculum development method, we created a comprehensive anti-racism initiative, which included virtual townhalls with Black alumni of the fellowship, book clubs, readings, and lectures. We sought to deepen the fellowship’s awareness of the impact of racism and inequity upon trainees, underrepresented minority oncologists and hematologists, and patients in order to develop initiatives to confront them productively. Trainees received a survey 6 months after the start of the curriculum to assess the impact of the initiatives upon trainees, and inform iterative changes to the curriculum. Results: 25 of 34 fellows across all post-graduate years (PGY) completed the survey. Fellows agreed that the curriculum was helpful (68%) and encouraging (60%). Collectively, fellows reported that the curriculum increased their awareness of instances of racism in medicine, caused them to think about next steps that the fellowship could take to address racism, and enabled them to identify available resources for support and further education. Respondents selected community engagement and recruitment of diverse fellowship classes as the most pressing priorities for the program. Conclusions: Social justice and anti-racism education belong in the formalized training of our hematology/medical oncology fellows. To this end, our ongoing curricular expansion is focusing on anti-racism training, diverse recruitment and youth mentorship. Collectively, a comprehensive yet program-specific approach facilitates opportunities for learning, engagement and development of the skills necessary to engage in this life-long work for ourselves, our communities and our patients.
A phase III study (APROMISS) of AL3818 (Catequentinib, Anlotinib) hydrochloride monotherapy in subjects with metastatic or advanced synovial sarcoma.
Authors: Van Tine Brian Andrew , Chawla Sant P. , Trent Jonathan C. , Wilky Breelyn A. , Chugh Rashmi , Chmielowski Bartosz , Kummar Shivaani , Basu Mallick Atrayee , Somaiah Neeta , Cranmer Lee D. , Agulnik Mark , Keedy Vicki Leigh , Stacchiotti Silvia , Vincenzi Bruno , Badalamenti Giuseppe , Siontis Brittany L , Attia Steven 
Published: June 2021

11505 Background: AL3818 (Catequentinib, Anlotinib) is a novel, orally administered, small molecule tyrosine kinase inhibitor. The primary objective of this Phase 3 study is to evaluate the efficacy of AL3818 monotherapy in patients (pts) with synovial sarcoma (SS) comparing with dacarbazine in randomization setting. Methods: Patients with a diagnosis of synovial sarcoma requiring second line or further line treatment were eligible for enrollment. The regimen was a 21-day cycle with oral AL3818 administered on 14 days on and 7 days off. This phase 3 trial is randomized in 2:1 ratio of AL3818 comparing to dacarbazine with option of crossover after PD of dacarbazine treatment. Progression free survival (PFS) with Log Rank test is the primary endpoint and this trial for SS is currently completed enrolled in US and Italy. Results: Total 79 pts initiated treatment and are evaluable, 52 received AL3818 as treatment arm (T), and 27 received dacarbazine (D) as control arm (C). Arms T/C median ages were 40.5/42.0 years (range: 18-70+) and 20/16 (38.5%/59.3%) were male. Overall, PFS was 2.89 months (95% CI: 2.73 – 6.87) for AL3818 and 1.64 (95% CI: 1.45 – 2.70) for D. The PFS of study met the primary endpoint with a p-value of 0.0015 and a HR of 0.449 (95% CI: 0.270– 0.744). At the month 4, 6, and 12, the percentages of progression free patients for AL3818 were 48.1%, 42.3% and 26.9%; and for D were 14.85%, 11.1% and 3.7%. For grade 3 treatment-related adverse events, 12(23.1%) of pts experienced for AL3818 and 7(25.9%) of pts experienced for D. The most common AL3818 related grade 3 AEs were diarrhea (5.8%) and hypertension (3.8%). Conclusions: This phase III trial demonstrates improved disease control and superior progression free survival for AL3818 vs dacarbazine in advanced SS. In addition, the study further confirms the acceptable benefit-risk profile of AL3818 from the prior randomized Phase 2b soft tissue sarcoma study (NCT02449343). AL3818 is a meaningful treatment option for pts with advanced SS. Clinical trial information: NCT 03016819 Clinical trial information: NCT03016819.
Outcomes in the dedifferentiated liposarcoma cohort of SAR-096, a phase II trial of ribociclib in combination with everolimus in advanced dedifferentiated liposarcoma (DDL), and leiomyosarcoma (LMS).
Authors: von Mehren Margaret , Movva Sujana , Handorf Elizabeth A. , Merriam Priscilla , Morgan Jeffrey A. , Choy Edwin , Tetzlaff Eric Daniel , Barker Emma , Harley Allisa Cherae , King April , Matloob Sahar , Jerome Erika , Rink Lori , George Suzanne 
Published: June 2021

11515 Background: Dedifferentiated liposarcoma (DDL) is characterized by ring chromosomes of chromosone12, which includes amplification of MDM2 and CDK4. Exposure to CDK4 inhibitors in Rb+ leiomyosarcoma (LMS) cell lines leads to decreased cell proliferation, and increased senescence, and G0/G1-phase arrest. When combined, ribociclib a CDK4 inhibitor and everolimus, an mTOR inhibitor show synergistic growth inhibition in multiple tumor models. We hypothesized that this combination could lead to increased disease control in patients with DDL. Methods: This study enrolled patients (pts) into one of two cohorts: DDL or Rb+ LMS. LMS pts were required to have 1 prior line of therapy; DDL pts required no prior therapy. There were no limits to prior therapies in either group. Measurable disease by RECIST 1.1 was also required. Ribociclib was given at 300 mg daily for 21/28 days and everolimus was given continuously at 2.5 mg daily in 28 day cycles. The primary endpoint was progression free rate at 16 weeks. A Simon two-stage design was utilized and if at least 8 out of 24 pts were progression free at 16 weeks, the treatment was declared promising for the cohort. Here in we present data on the DDL cohort. Results: To date, 21 DDS pts, median age of 63 (range 40-79), of which 43% (n = 9) female were treated. Median prior lines of therapy was 1 (range 0-6). Of 19 pts with complete data, 8 (42%) met the primary endpoint of non-progression at 16 weeks. Confirmed partial response was seen in 2 pts (10%). Median PFS was 16 weeks, and stable disease occurring as best response in 11 (55%) pts. Grade 3-4 toxicities were uncommon except for lymphopenia (24%) and neutropenia (33%); no episode of neutropenic fever were observed. There was one death on study secondary to myocardial infarction, considered possibly related to therapy. Results of optional tissue biopsies pre and on therapy obtained to assess pharmacodynamic changes in PTEN, pAKT, CDK4, Rb and pS6 will be presented. Conclusions: The combination of ribociclib and everolimus demonstrates activity in DDL with prolonged stable disease (>16 weeks) meeting the primary protocol endpoint. Notably partial responses were also observed. The combination was well tolerated with acceptable side effects. Updated outcomes will be presented. Clinical trial information: NCT03114527.
Giant cell tumor of bone: Effect of longer dosing intervals of denosumab on tumor control and bone related complications.
Authors: Jiang Cindy , Zhao Lili , Schuetze Scott , Chugh Rashmi 
Published: June 2021

11525 Background: Giant cell tumor of bone (GCTB) is a benign but locally aggressive bone neoplasm characterized by osteoclast activation causing destructive osteolysis. Denosumab, a human monoclonal antibody against RANK ligand, has emerged as an effective treatment option when surgery is not recommended, but can cause significant bone toxicity. Current standard dosing is every 4 weeks after 3 weekly loading doses. As patients (pts) with GCTB are often young adults, frequent denosumab administration long-term may be burdensome and associated with increased risk of complications. We assessed whether alternative, longer dosing intervals are associated with differences in efficacy or bone toxicity. Methods: Retrospective chart review was conducted on GCTB pts over 18 years old at University of Michigan who received at least 1 year of standard denosumab treatment. Pts were identified using a free-text medical record search engine with keywords “giant cell tumor” and “denosumab” until August 2020. We compared bone-related adverse effects and tumor control in pts who continued denosumab every 4 weeks versus longer treatment intervals. Decision to increase interval between doses was based on provider and pt discussion and preference as part of routine medical care. Results: 37 GCTB pts were identified; 51% female and 49% male. Average age was 41 years (range 22-73). Most common primary location was lower extremity (38%), followed by pelvis (35%), upper extremity (14%), spine (8%), and head/neck (5%). Metastasis were present at start of treatment in 14% of pts, involving lung (n = 4) and spine (n = 1). Pts received median of 71 (range 15-139) total doses of denosumab. Dosing interval was increased in 38% (n = 14). With the first interval change, 43% changed to every 6 weeks, 29% every 8 weeks, and 29% every 12 weeks dosing. Most common final dosing interval was 12 weeks (n = 8). 6 pts (16%) had bone complications after mean of 56 doses. This included osteonecrosis of the jaw (n = 4), atypical fracture (n = 1), and non-healing dental wounds (n = 2). All pts with bone complications were treated on the monthly dosing schedule, but there was no statistically significant difference compared to longer intervals (p = 0.22). Pts with GCT progression (n = 10) were either no longer receiving therapy or had missed denosumab doses. There was no statistically significant difference in PFS with standard vs. interval increased dosing (p = 0.97). However, 5-year PFS was superior with interval increased vs standard dosing (p = 0.036). Conclusions: Increasing the interval of denosumab dosing for GCTB provided similar tumor control as compared to standard dosing and is potentially associated with less bone toxicity and more convenience for afflicted pts. Further larger scale studies are needed to better define the optimal interval of denosumab administration in GCTB and the effect on efficacy, toxicity, and associated health care expense.
Efficacy and safety of JMT103 in patients with giant cell tumor of bone: A multicenter, single-arm, open-label, phase Ib/II study.
Authors: Niu Xiaohui , Wei Feng , Tu Chongqi , Huang Gang , Bi Wenzhi , Li Jianmin , Yao Weitao , Zhang Xiaojing , Shen Jingnan , Zhang Guochuan , Yan Wangjun , Yang Jilong , Lin Jianhua , Ye Zhaoming , Wang Dong , Guo Zheng , Tong Zhichao , Zhou Yuhong , Xu Hairong , Li Tao 
Published: June 2021

11526 Background: JMT103 is a novel, fully humanized IgG4 monoclonal antibody targeting RANKL, inhibiting osteoclastogenesis and osteoclast-mediated bone resorption. A multicenter, single-arm, open-label, phase Ib/II study was conducted to evaluate the efficacy and safety of JMT103 in patients (pts) with Giant cell tumor of bone (GCTB). Methods: Eligible pts (ECOG: 0-2) were adults with pathologically confirmed unresectable GCTB or their planned surgery is associated with severe morbidity. Pts with active dental or jaw condition requiring oral surgery, other anti-tumor therapies, anti-RANKL antibody or concurrent use of bisphosphonates were excluded. 2 mg/kg JMT103 was administrated subcutaneously every 4 weeks with a loading dose on days 8 and day 15 of the first 4 week of therapy. The primary endpoint was tumor response, defined as elimination of at least 90% giant cells or objective response of the target lesion assessed by radiologic imaging as per Modified Inverse Choi density/size (ICDS) or the Modified European Organization for Research and Treatment of Cancer (EORTC) criteria within 12 weeks. Secondary endpoints included safety profile, change of pain score using Brief Pain Inventory-Short Form, and suppression of bone-resorption biomarkers. Results: 38 pts (14 males) were enrolled between June 3 and December 24, 2020. The median age was 31 years (range 18-57). Lesions sites included lower extremities (39.5%), upper extremities (31.6%), spine (21.1%) and pelvis (13.2%). Among 32 pts with at least 1 efficacy evaluation within 12 weeks, 26 (81.3%, 95% CI: 63.6-92.8) had a tumor response by at least one response criteria. All 7 pts who underwent histological assessments had a tumor response. 25 of 32 pts assessed by radiology had a tumor response. As per ICDS criteria, 23 of 32 (71.9%) had a response; as per EORTC criteria, 15 of 17 (88.2%) had a response. 21 of 26 (80.8%) pts who complained of pain at baseline experienced reduced pain during the treatment. The median reductions in bone-resorption biomarkers were 71.8% (IQR 67.7-82.4) for uNTx/Cr (p < 0.001) and 81.4% (IQR 68.3-84.7) for sCTx (p < 0.001) at day 8. Of all 38 pts who were included in safety analyses, treatment-related adverse events (TRAEs) occurred in 14 pts. The most common TRAEs were hypophosphatemia (18.4%), hypocalcemia (7.9%) and blood bilirubin increased (7.9%). 1 patient (2.6%) was reported a grade 3 AE but it was not related to the treatment; other AEs were grade 1–2. Conclusions: JMT103 demonstrated encouraging anti-tumor efficacy and manageable safety profile in pts with unresectable GCTB or at high risk of severe morbidity after surgery. Clinical trial information: NCT04255576.