scholarly journals Medical oncology workload in Canada: infrastructure, supports, and delivery of clinical care

2018 ◽  
Vol 25 (3) ◽  
pp. 206 ◽  
Author(s):  
A. Fundytus ◽  
W.M. Hopman ◽  
N. Hammad ◽  
J.J. Biagi ◽  
R. Sullivan ◽  
...  
Keyword(s):  
Online Survey ◽  
Task Force ◽  
Clinical Care ◽  
Median Number ◽  
Models Of Care ◽  
Annual Number ◽  
Canadian Association ◽  
Level Of Activity ◽  
Medical Oncologists ◽  
Number Of Patients

Background In 2000, a Canadian task force recommended that medical oncologists (mos) meet a target of 160–175 new patient consultations per year. Here, we report the Canadian results of a global survey of mo workload compared with mo workload in other high-income countries (hics).Methods Using a snowball method, an online survey was distributed by national oncology societies to chemotherapy-prescribing physicians in 22 hics (World Bank criteria). The survey was distributed within Canada to all members of the Canadian Association of Medical Oncologists. Workload was measured as the annual number of new cancer patient consults per oncologist.Results The survey was completed by 782 oncologists from hics, including 58 from Canada. Median annual consults per mo were 175 in Canada compared with 125 in other hics. The proportions of mos having 100 or fewer consults or more than 300 consults per year were 3% (2/58) and 5% (3/58) in Canada compared with 31% (222/724) and 16% (116/724) in other hics (p < 0.001 and p = 0.023 respectively). The median number of patients seen in a full-day clinic was 15 in Canada and 25 in other hics (p = 0.220). Canadian mos reported spending a median of 55 minutes per new consultation; new consultations of 35 minutes were reported in other hics (p < 0.001). Median hours worked per week was 55 in Canada and 45 in other hics (p = 0.200).Conclusions Although the median annual clinical volume for Canadian mos aligns with recommended targets, half the respondents exceeded that level of activity. Health policymakers and educators have to consider mo workforce supply and alternative models of care in preparation for the anticipated surge in cancer incidence in the coming decade.

scholarly journals Delivery of Global Cancer Care: An International Study of Medical Oncology Workload

2018 ◽  
pp. 1-11 ◽  
Author(s):  
Adam Fundytus ◽  
Richard Sullivan ◽  
Verna Vanderpuye ◽  
Bostjan Seruga ◽  
Gilberto Lopes ◽  
...  
Keyword(s):  
Online Survey ◽  
Medical Oncology ◽  
International Study ◽  
Median Number ◽  
Models Of Care ◽  
Annual Number ◽  
Case Volume ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

Background To our knowledge, there is no literature that has described medical oncology (MO) workload in the global context. Here, we report results of an international study of global MO workload. Methods An online survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 65 countries. Countries were classified into low- or low-middle–income countries (LMICs), upper-middle–income countries (UMICs), and high-income countries (HICs) on the basis of World Bank criteria. Workload was measured as the annual number of new consultations provided to patients with cancer per oncologist. Results A total of 1,115 physicians completed the survey: 13% (147 of 1,115) from LMICs, 17% (186 of 1,115) from UMICs, and 70% (782 of 1,115) from HICs. Eighty percent (897 of 1,115) of respondents were medical oncologists, 10% (109 of 1,115) were clinical oncologists, and 10% (109 of 1,115) were other. The median number of annual consults per oncologist was 175 (interquartile range, 75 to 275); 13% (140 of 1,103) saw ≥ 500 new patients in a year. Annual case volume in LMICs (median consults, 425; 40% of respondents seeing > 500 consults) was substantially higher than in UMICs (median consults, 175; 14% > 500) and HICs (median consults, 175; 7% > 500; P < .001). Among LMICs, UMICs, and HICs, median working days per week were 6, 5, and 5, respectively ( P < .001). The highest annual case volumes per oncologist were in Pakistan (median consults, 950; 73% > 500 consults), India (median consults, 475; 43% > 500), and Turkey (median consults, 475; 27% > 500). Conclusion There is substantial global variation in medical oncology case volumes and clinical workload; this is most striking among LMICs, where huge deficits exist. Additional work is needed, particularly detailed country-level mapping, to quantify activity-based global MO practice and workload to inform training needs and the design of new pathways and models of care.

Delivering global cancer care: An international study of medical oncology workload.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18080-e18080
Author(s):  
Adam Michael Fundytus ◽  
Richard Sullivan ◽  
Verna D. Vanderpuye ◽  
Bostjan Seruga ◽  
Gilberto Lopes ◽  
...  
Keyword(s):  
Online Survey ◽  
Medical Oncology ◽  
International Study ◽  
Median Number ◽  
Models Of Care ◽  
Primary Objective ◽  
Annual Number ◽  
Case Volume ◽  
Middle Income ◽  
Low Middle Income Countries

e18080 Background: With a disproportionate global burden of cancer, access to care in low-middle income countries (LMICs) is a pressing issue. To our knowledge there is no literature that has described medical oncology (MO) workload in the global context. Here, we report the first results of an international study of global MO training, infrastructure and workload. Methods: A multinational panel of oncologists from diverse practice settings designed a 51 item online survey. The survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 50 countries. Countries were classified into low or low-middle (LMIC), upper-middle (UMIC) and high-income countries (HIC) based on World Bank criteria. Due to small numbers, African nations were reported as a region. The primary objective of this study was to describe the annual number of new cancer patient consults seen per oncologist. Results: 708 physicians completed the survey; 14% (96/708) from LMICs, 21% (152/708) UMICs, and 65% (460/708) HICs. 85% (604/708) of respondents were MOs, 9% (65/708) clinical oncologists, 6% (39/708) other. Respondents worked a median 5 days/week and had 4 weeks of annual paid vacation. The median number of annual consults per oncologist was 175 (IQR 125-375); 16% (114/708) of respondents saw 500+ new patients in a year. Annual case volume in LMICs (median consults 425, 46% respondents seeing > 500 consults) was substantially higher than UMICs (175, 15% > 500) and HICs (175, 10% > 500) (p < 0.001). Among LMICs, UMICs, and HICs, median days worked per week were 6, 5, 5 respectively (p < 0.001); annual weeks of paid vacation were 3, 3, 5 respectively (p < 0.001). Among countries/regions with 10+ responses, the highest annual case volumes per oncologist were Pakistan (median consults 950, 73% > 500 consults), India (475, 47% > 500), Turkey (475, 25% > 500), Africa (400, 42% > 500) and China (325, 31% > 500). Conclusions: There is substantial global variation in oncology case volumes and clinical workload; this is most striking among LMICs. Further work is needed to quantify activity-based global MO practice and workload to inform training needs and the design of new pathways and models of care.

scholarly journals Report of the European Respiratory Society/European Cystic Fibrosis Society task force on the care of adults with cystic fibrosis

2015 ◽  
Vol 47 (2) ◽  
pp. 420-428 ◽  
Author(s):  
J. Stuart Elborn ◽  
Scott C. Bell ◽  
Susan L. Madge ◽  
Pierre-Regis Burgel ◽  
Carlo Castellani ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Core Curriculum ◽  
Task Force ◽  
Clinical Care ◽  
Multidisciplinary Care ◽  
European Respiratory Society ◽  
Major Life ◽  
Psychological Burden ◽  
Number Of Patients ◽  
Respiratory Physician

The improved survival in people with cystic fibrosis has led to an increasing number of patients reaching adulthood. This trend is likely to be maintained over the next decades, suggesting a need to increase the number of centres with expertise in the management of adult patients with cystic fibrosis. These centres should be capable of delivering multidisciplinary care addressing the complexity of the disease, in addition to addressing the psychological burden on patients and their families. Further issues that require attention are organ transplantation and end of life management.Lung disease in adults with cystic fibrosis drives most of the clinical care requirements, and major life-threatening complications, such as respiratory infection, respiratory failure, pneumothorax and haemoptysis, and the management of lung transplantation require expertise from trained respiratory physicians. The taskforce therefore strongly reccommends that medical leadership in multidisciplinary adult teams should be attributed to a respiratory physician adequately trained in cystic fibrosis management.The task force suggests the implementation of a core curriculum for trainees in adult respiratory medicine and the selection and accreditation of training centres that deliver postgraduate training to the standards of the HERMES programme.

scholarly journals Oncologists and medical assistance in dying: where do we stand? Results of a national survey of Canadian oncologists

2020 ◽  
Vol 27 (5) ◽  
Author(s):  
G. Chandhoke ◽  
Gregory Pond ◽  
O. Levine ◽  
S. Oczkowski
Keyword(s):  
End Of Life ◽  
National Survey ◽  
Online Survey ◽  
Therapeutic Option ◽  
Willingness To Participate ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Radiation Oncologists ◽  
Canadian Association ◽  
Medical Oncologists

Background In June 2016, when the Parliament of Canada passed Bill C-14, the country joined the small number of jurisdictions that have legalized medical assistance in dying (maid). Since legalization, nearly 7000 Canadians have received maid, most of whom (65%) had an underlying diagnosis of cancer. Although Bill C-14 specifies the need for government oversight and monitoring of maid, the government-collected data to date have tracked patient charac­teristics, rather than clinician encounters and beliefs. We aimed to understand the views of Canadian oncologists 2 years after the legalization of maid. Methods We developed and administered an online survey to medical and radiation oncologists to understand their exposure to maid, self-perceived knowledge, willingness to participate, and perception of the role of oncologists in introducing maid as an end-of-life care option. We used complete sampling through the Canadian Association of Medical Oncologists and the Canadian Association of Radiation Oncology membership e-mail lists. The survey was sent to 691 physicians: 366 radiation oncologists and 325 medical oncologists. Data were collected during March–June 2018. Results are presented using descriptive statistics and univariate or multivariate analysis. Results The survey attracted 224 responses (response rate: 32.4%). Of the responding oncologists, 70% have been approached by patients requesting maid. Oncologists were of mixed confidence in their knowledge of the eligibility criteria. Oncologists were most willing to engage in maid with an assessment for eligibility, and yet most refer to specialized teams for assessments. In terms of introducing maid as an end-of-life option, slight more than half the responding physicians (52.8%) would initiate a conversation about maid with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress. Conclusions In this first national survey of Canadian oncologists about maid, we found that most respondents encounter patient requests for maid, are confident in their knowledge about eligibility, and are willing to act as assessors of eligibility. Many oncologists believe that, under some circumstances, it is appropriate to present maid as a therapeutic option at end of life. That finding warrants further deliberation by national or regional bodies for the development of consensus guidelines to ensure equitable access to maid for patients who wish to pursue it.  

Oncologists and medical assistance in dying: Where do we stand?

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 64-64
Author(s):  
Gur Chandhoke ◽  
Gregory Russell Pond ◽  
Oren Hannun Levine ◽  
Simon Oczkowski
Keyword(s):  
End Of Life ◽  
Online Survey ◽  
Therapeutic Option ◽  
P Value ◽  
Willingness To Participate ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Radiation Oncologists ◽  
Canadian Association ◽  
Medical Oncologists

64 Background: With the passage of Bill C-14 in June 2016, medical assistance in dying (MAiD) was formally enacted into Canadian law. Since then, approximately 2,000 patients have died with medical assistance across the country, with cancer being the most common qualifying condition. We aimed to understand the views of oncology providers (OPs) regarding MAiD. Methods: We designed and administered an online survey to Canadian OPs’ to assess experience with MAiD, self-perceived knowledge, willingness to participate, and perception of the role of OPs in introducing MAiD as an end-of-life care option. We used complete sampling via the Canadian Association of Medical Oncologists (CAMO) and the Canadian Association of Radiation Oncologists (CARO) membership email lists. The survey was sent to 366 Radiation Oncologists, and 325 Medical Oncologists. Data was collected from April-June 2018. Results were analyzed using descriptive statistics as well as univariate and multivariate analysis. Results: We received 224 responses (response rate 32.4%). 70% of OPs have been approached by patients requesting MAiD. OPs were confident in their knowledge of the eligibility criteria, and previous exposure to MAiD was associated with confidence in this domain (odds ratio [OR]=3.77, 95% CI=2.05-6.94, p value<0.001). OPs were most willing to engage in MAiD with an assessment for eligibility, yet most refer to specialized teams for assessments. A majority of physicians (52.8%) would initiate a conversation of MAiD with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress. Conclusions: In this first national survey of Canadian OP’s regarding MAiD, we found that most OP’s encounter patient requests for MAiD, are confident in knowledge of eligibility, and are willing to act as assessors of eligibility. Many OP’s believe that it is appropriate to present MAiD as a therapeutic option at the end of life under some circumstances. This finding warrants further deliberation amongst national/regional bodies for the development of consensus guidelines in order to ensure equitable access to MAiD for patients who wish to pursue it.

scholarly journals Perspectives on endoscopic surveillance of dysplasia in inflammatory bowel disease: a survey of academic gastroenterologists

2017 ◽  
Vol 05 (10) ◽  
pp. E974-E979 ◽  
Author(s):  
Zane Gallinger ◽  
Amir Rumman ◽  
Sanjay Murthy ◽  
Geoffrey Nguyen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Online Survey ◽  
Screening Method ◽  
Median Number ◽  
Subspecialty Training ◽  
Barriers To Adoption ◽  
White Light Endoscopy ◽  
Canadian Association ◽  
Inflammatory Bowel

Abstract Background and study aims Dye-based chromoendoscopy (DBC) is the preferred method for endoscopic dysplasia surveillance in patients with inflammatory bowel disease (IBD). We sought to examine the uptake of, and perception toward DBC among academic gastroenterologists. Methods We conducted an online survey of academic members of the Canadian Association of Gastroenterology to assess their current dysplasia surveillance practice, uptake of DBC, and perceived barriers to adoption of DBC. Results Of the 150 physicians contacted, 49 (32.7 %) responded to the survey. The majority of respondents reported subspecialty training in IBD (71.4 %), and the median number of years in practice was 12. White-light endoscopy with random colonic biopsies was the preferred dysplasia screening method (73.5 %). Only 26.5 % of respondents routinely used DBC, despite institutional availability of over 60 %. The major barriers to adoption of DBC were concerns about procedure duration (46.9 %), concerns about cost (44.9 %), and inadequate training (40.8 %). Conclusion There is low uptake of DBC for dysplasia surveillance in IBD patients among academic gastroenterologists practicing in Canada. Additional studies should be completed to determine how to improve the uptake of DBC.

Current practice for screening and management of financial distress at NCCN member institutions.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11615-11615
Author(s):  
Nandita Khera ◽  
Jessica Sugalski ◽  
Diana Krause ◽  
Richard Butterfield ◽  
Nan Zhang ◽  
...  
Keyword(s):  
Best Practices ◽  
Financial Distress ◽  
Online Survey ◽  
Management Practices ◽  
Median Number ◽  
Institutional Practice ◽  
Quality Metric ◽  
Number Of Patients ◽  
Oncology Practice ◽  
The Impact

11615 Background: Deficiencies and barriers exist to delivering comprehensive and affordable cancer care. Understanding the variation in organizational commitment, existing programs, and expected outcomes for screening and management of financial distress is needed. Methods: Representatives from 17 of 27 NCCN Member Institutions (63%) completed an online survey in November 2018 conducted by the NCCN Best Practices Committee. Centers were classified based on number of unique patients seen per year, as large ( > 10,000) (76%), or small ( < 10,000) (34%). The survey focused on institutions’ screening and management practices for patient financial distress, perceived barriers in implementation, and leadership attitudes. Results: Routine screening for financial distress was reported by 77% of centers, and most used social worker assessments (94%). 56% screened patients throughout the cancer journey. Help with drug costs, meal or gas vouchers and payment plans were offered by 100% of centers. Formal pre-authorization programs and assistance with claims and denials was offered by 81%. Charity care for medical costs was provided by 100% of the large centers compared to only 33% of small centers (p = 0.03). Median number of social workers (24 vs. 3; p = 0.01) and pharmacy representatives (6 vs. 2; p = 0.02) was also different between large and small centers. 76% evaluated the impact of financial advocacy services through number of patients assisted (85%), bad debt and charity write-offs (85%) or patient satisfaction surveys (54%). 6% and 12% reported overall effectiveness of institutional practice for screening and management of financial distress as poor/ very poor respectively. Inadequate staffing and real time resources (69%), limited institutional budget (50%), lack of reimbursement (50%), and clinical time constraints (50%) were reported as potential barriers in provision of these services. 94% agreed about stronger integration of financial advocacy services into oncology practice and 84% felt that success of these services should be a quality metric. 31% of large centers vs. 100% of small centers plan to increase staffing in this area in the next 5 years. Conclusions: Majority of NCCN Member Institutions report screening and management programs for financial distress, though the actual practices and range of services vary widely. Information from this study can help centers benchmark their performance relative to similar cancer programs and identify best practices in this area.

Consensus statement: evaluation of new and existing therapeutics for pediatric multiple sclerosis

2011 ◽  
Vol 18 (1) ◽  
pp. 116-127 ◽  
Author(s):  
T Chitnis ◽  
S Tenembaum ◽  
B Banwell ◽  
L Krupp ◽  
D Pohl ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Online Survey ◽  
Consensus Statement ◽  
Clinical Care ◽  
Phase Iii ◽  
European Medicines Agency ◽  
Multicenter Studies ◽  
Survey Tool ◽  
Emerging Therapies ◽  
Number Of Patients

New therapies are being evaluated by clinical trials and, if efficacious, introduced for the treatment of adult MS. The role of these new and existing agents in the management of pediatric MS has yet to be defined. Pediatric investigation plans are now required by the Food and Drug Administration and European Medicines Agency for approval of new biological agents, providing an important opportunity to gather much-needed data for clinicians caring for children and adolescents with MS. However, challenges include the small number of patients, and the need for efficient yet comprehensive study designs incorporating factors necessary to inform the clinical care of children with MS. The elected Steering committee of the International Pediatric MS Study Group (IPMSSG) conducted a structured review of existing data on the disease-modifying therapies in pediatric MS and developed a consensus statement, which was further modified by the IPMSSG general membership, using an online survey tool. Fifty-one IPMSSG members from 21 countries responded to the survey, and 50 approved the final statement. Consensus recommendations regarding use of existing first- and second-line therapies, as well as a proposed definition for inadequate treatment response, are presented. Recommendations for the use and evaluation of emerging therapies (currently in phase III clinical trials or recently approved for adult MS) are discussed. The IPMSSG endorses the inclusion of pediatric MS patients in trials evaluating appropriate new and emerging therapies. Mechanisms for conducting high-impact, multicenter studies, including long-term follow-up in pediatric MS, are required to ensure that all MS patients, irrespective of age, benefit from advances in MS therapeutics.

scholarly journals Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

2019 ◽  
Vol 8 (4) ◽  
pp. 555 ◽  
Author(s):  
Cátia Caneiras ◽  
Cristina Jácome ◽  
Sagrario Mayoralas-Alises ◽  
José Ramon Calvo ◽  
João Almeida Fonseca ◽  
...  
Keyword(s):  
Clinical Research ◽  
Patient Experience ◽  
Clinical Care ◽  
Research Priorities ◽  
Specific Patient ◽  
Quality Healthcare ◽  
Body Of Knowledge ◽  
Number Of Patients ◽  
Patient Reported ◽  
System Sustainability

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.

scholarly journals Polypharmacy-associated potential contraindications of drug prescriptions in patients with primary angle closure disease in a real-world setting

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Fumiaki Tanaka ◽  
Naoki Shibatani ◽  
Kazumi Fujita ◽  
Hiroaki Ikesue ◽  
Satoru Yoshimizu ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Anterior Chamber Depth ◽  
Japanese Patients ◽  
Median Number ◽  
Angle Closure ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Number Of Patients ◽  
Multiple Drugs

Abstract Background Primary angle closure disease (PACD) is a type of glaucoma in which the intraocular pressure (IOP) is increased because of the blockage of the anterior chamber angle. Medications contraindicated for patients with PACD, such as anticholinergics, cause mydriasis, and can elevate IOP. However, anticholinergics are currently contraindicated only for primary angle closure glaucoma (PACG) in Japanese package inserts. In this study, we investigated the prescription status of medications contraindicated for PACD, such as anticholinergics, in patients with PACD scheduled for eye surgeries. Methods Forty-three Japanese patients diagnosed with PACD at Kobe City Eye Hospital, Japan, and scheduled hospitalization for eye surgeries between December 2017 and July 2018, were included. Data, including sex, age, diagnosis, IOP, anterior chamber depth, and patients’ regular medications prior to hospitalization, were collected for each patient from the electronic medical records. Results The number of patients with chronic primary angle closure (CPAC) and acute primary angle closure (APAC) was 35 (81.4%) and 8 (18.6%), respectively. Among all the 43 patients with PACD, 8 (18.6%) received 15 medications that are potentially contraindicated for PACD by non-ophthalmologist. According to medication categories, benzodiazepine hypnotics were the most commonly prescribed. Among the 8 patients with APAC, 2 (25.0%) had routinely received medications contraindicated for PACD. The median number of all kinds of prescriptions on the day of hospitalization was significantly higher for patients who received medications contraindicated for PACD than for those who did not receive them (p = 0.010). Conclusions About 20% of patients with PACD received medications potentially contraindicated for PACD, such as anticholinergics. Attention should be paid to patients prescribed multiple drugs for adverse events, such as increase in intraocular pressure.

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