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Humans, Medical Oncology, Precision Medicine, Neoplasms diagnostic imaging, Neoplasms therapy, Oncologists, and Radiation Oncology

Clinical Issue: Modern oncology has implemented several novel modalities, which increasingly warrant interdisciplinarity, dedicated imaging methods as well as intensive communication between imager and oncologists.
Standard Treatment: The classical pillars of cancer treatment are surgery, radiotherapy, and chemotherapy.
Treatment Innovations: Evidence-based oncology, radio-oncology, and surgery, individualized precision oncology, novel drug classes, immuno-oncology, minimally invasive diagnostic and treatment methods.
Diagnostic Work-Up: Standard imaging methods are undergoing constant innovation and are being supplemented by specific radiotracers that can be used for radionuclide therapy. Adapted response criteria are to be used in the context of targeted therapy or checkpoint inhibitors.
Performance and Achievement: Modern cancer treatment enables improved tumor control. Due to its complexity, however, it increasingly warrants structured reporting and intense communication between imager and oncologists, to make best use of its potential.

Attitude of Health Personnel, Clergy, Directive Counseling standards, Directive Counseling statistics numerical data, Evidence-Based Practice statistics numerical data, Health Personnel psychology, Health Personnel statistics numerical data, Humans, Iran epidemiology, Medical Oncology standards, Medical Oncology statistics numerical data, Neoplasms psychology, Qualitative Research, Spiritual Therapies psychology, Spirituality, Neoplasms nursing, Oncology Nursing standards, Oncology Nursing statistics numerical data, Palliative Care methods, Palliative Care psychology, Palliative Care standards, Palliative Care statistics numerical data, Practice Guidelines as Topic, Practice Patterns, Nurses' standards, Practice Patterns, Nurses' statistics numerical data, and Spiritual Therapies standards

Background: In spite of the necessity of implementing spiritual care practices for cancer patients, there is no clear process in this regard in palliative care programs of the health system of countries. The present study was designed with the aim of developing a clinical practice guideline of spiritual care in cancer patients for oncology nurses in the current context.
Methods: This is a multi-method study which was conducted in five stages within the framework of the National Institute for Health and Care Excellence (NICE) guideline. A research committee consisting of four focal and 16 secondary members was formed. The stages included determining the scope of the study, developing guideline (a qualitative study and a systematic review, triangulation of the data, and producing a preliminary draft), consultation stage (validation of the guideline in three rounds of the Delphi study), as well as revision and publication stages.
Results: The clinical guideline of spiritual care with 84 evidence-based recommendations was developed in three main areas, including the human resources, care settings, and the process of spiritual care.
Conclusions: We are hoping by applying this clinical guideline in oncology settings to move towards an integrated spiritual care plan for cancer patients in the context of our health system. Healthcare organizations should support to form spiritual care teams under supervision of the oncology nurses with qualified healthcare providers and a trained clergy. Through holistic care, they can constantly examine the spiritual needs of cancer patients alongside their other needs by focusing on the phases of the nursing process.

Attitude of Health Personnel, Cost-Benefit Analysis, Gastroenterology, Humans, Patient Acceptance of Health Care, Surgical Oncology, Aftercare methods, Attitude to Health, Cancer Survivors, Colorectal Neoplasms therapy, Medical Oncology, Neoplasm Recurrence, Local diagnosis, Primary Health Care, and Telemedicine

Follow-up after curative treatment for colorectal cancer (CRC) puts pressure on outpatient services due to the growing number of CRC survivors. The aim of this state-of-the-art review was to evaluate setting, manner and provider of follow-up. Moreover, perceptions of CRC survivors and health care providers regarding standard and alternative follow-up were examined. After a comprehensive literature search of the PubMed database, 69 articles were included reporting on CRC follow-up in the hospital, primary care and home setting. Hospital-based follow-up is most common and has been provided by surgeons, medical oncologists, and gastroenterologists, as well as nurses. Primary care-based follow-up has been provided by general practitioners or nurses. Even though most hospital- or primary care-based follow-up care requires patients to visit the clinic, telephone-based care has proven to be a feasible alternative. Most patients perceived follow-up as positive; valuing screening and detection for disease recurrence and appreciating support for physical and psychosocial symptoms. Hospital-based follow-up performed by the medical specialist or nurse is highly preferred by patients and health care providers. However, willingness of both patients and health care providers for alternative, primary care or remote follow-up exists. Nurse-led and GP-led follow-up have proven to be cost-effective alternatives compared to specialist-led follow-up. If proven safe and acceptable, remote follow-up can become a cost-effective alternative. To decrease the personal and financial burden of follow-up for a growing number of colorectal cancer survivors, a more acceptable, flexible and dynamic care follow-up mode consisting of enhanced communication and role definitions among clinicians is warranted.
(Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Adolescent, Adult, Aged, Aged, 80 and over, Austria epidemiology, Betacoronavirus pathogenicity, Biomarkers blood, COVID-19, COVID-19 Testing, Coronavirus Infections epidemiology, Coronavirus Infections transmission, Coronavirus Infections virology, Female, Host-Pathogen Interactions, Humans, Male, Middle Aged, Nursing Staff, Hospital, Oncologists, Oncology Nursing, Pandemics, Pneumonia, Viral epidemiology, Pneumonia, Viral transmission, Pneumonia, Viral virology, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Retrospective Studies, SARS-CoV-2, Seroepidemiologic Studies, Young Adult, Antibodies, Viral blood, Betacoronavirus immunology, Clinical Laboratory Techniques, Coronavirus Infections diagnosis, Medical Staff, Hospital, Oncology Service, Hospital, Patients, Pneumonia, Viral diagnosis, Serologic Tests, and Tertiary Care Centers

Background: During the COVID-19 outbreak, healthcare professionals (HCP) are at the frontline of clinical management and at increased risk for infection. The SARS-CoV-2 seroprevalence of oncological HCP and their patients has significant implications for oncological care.
Methods: HCP and patients with cancer at the Division of Oncology, Medical University of Vienna were included between 21 March and 4 June and tested for total antibodies against SARS-CoV-2 employing the Roche Elecsys Anti-SARS-CoV-2 immunoassay. Reactive samples were confirmed or disproved by the Abbott SARS-CoV-2 IgG test. Additionally, a structured questionnaire regarding basic demographic parameters, travel history and COVID-19-associated symptoms had to be completed by HCP.
Results: 146 subjects (62 HCP and 84 patients with cancer) were enrolled. In the oncological HCP cohort, 20 (32.3%) subjects were medical oncologists, 28 (45.2%) nurses at our ward and 14 (22.6%) fulfil other functions such as study coordinators. In the patient cohort, most individuals are on active anticancer treatment (96.4%). 26% of the HCP and 6% of the patients had symptoms potentially associated with COVID-19 since the end of February 2020. However, only in 2 (3.2%) HCP and in 3 (3.6%) patients, anti-SARS-Cov-2 total antibodies were detected. The second assay for anti-SARS-Cov-2 IgG antibodies confirmed the positive result in all HCP and in 2 (2.4%) patients, suggesting an initial assay's unspecific reaction in one case. In individuals with a confirmed test result, an active COVID-19 infection was documented by a positive SARS-CoV-2 RNA PCR test.
Conclusion: Specific anti-SARS-CoV-2 antibodies were found solely in persons after a documented SARS-CoV-2 viral infection, thus supporting the test methods' high sensitivity and specificity. The low prevalence of anti-SARS-CoV-2 antibodies in our cohorts indicates a lack of immunity against SARS-CoV-2. It highlights the need for continued strict safety measures to prevent uncontrolled viral spread among oncological HCPs and patients with cancer.
(© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.)

Adult, Clinical Competence, Female, Humans, Interviews as Topic, Male, Medical Oncology standards, Middle Aged, Nurse Clinicians statistics numerical data, Nurse-Patient Relations, Qualitative Research, Surveys and Questionnaires, Attitude of Health Personnel, Empathy physiology, Nurse Clinicians psychology, Oncology Nursing standards, and Perception

Purpose: Clinical empathy is the ability to understand the patient's situation, perspective, feelings, and actions, based on the patient's perception, in a helping or therapeutic way. This study was conducted with the aim of exploring oncology nurses' perception of the consequences of clinical empathy in patients and nurses and the factors influencing it.
Methods: A qualitative study was conducted by semi-structured face-to-face interviews. The participants were 6 male and 9 female oncology nurses who were selected by purposive sampling. Data were analyzed using conventional content analysis.
Results: The theme of "empathy as a double-sided mirror" was created, based on oncology nurses' perception of the effects of clinical empathy in patients and nurses. Two themes of "organizational factors" and "contextual factors" were generated in response to influencing factors on clinical empathy.
Conclusions: By awareness of the effects of clinical empathy, controlling the barriers and strengthening the facilitators, there is a possibility to design interventional programs to develop empathy as a clinical competency in oncology nurses.

Humans, Medical Oncology, and Surgical Oncology

Cancer Vaccines therapeutic use, Chemoembolization, Therapeutic methods, Chemoembolization, Therapeutic trends, History, 21st Century, Humans, Immunization, Passive methods, Immunomodulation, Immunotherapy methods, Immunotherapy, Active methods, Neoplasms immunology, Radiation Oncology trends, Radiofrequency Ablation methods, Radiofrequency Ablation trends, Yttrium Radioisotopes therapeutic use, Immunotherapy trends, Medical Oncology trends, and Neoplasms therapy

Interventional oncology (IO) has proven to be highly efficient in the local therapy of numerous malignant tumors in addition to surgery, chemotherapy, and radiotherapy. Due to the advent of immune-oncology with the possibility of tumor control at the molecular and cellular levels, a system change is currently emerging. This will significantly rule oncology in the coming decades. Therefore, one cannot think about IO in the 21st century without considering immunology. For IO, this means paying much more attention to the immunomodulatory effects of the interventional techniques, which have so far been neglected, and to explore the synergistic possibilities with immuno-oncology. It can be expected that the combined use of IO and immuno-oncology will help to overcome the limitations of the latter, such as limited local effects and a high rate of side-effects. To do this, however, sectoral boundaries must be removed and interdisciplinary research efforts must be strengthened. In case of success, IO will face an exciting future.

Humans, Medical Oncology, Time-to-Treatment, Pancreatic Neoplasms, and Surgical Oncology

Burnout, Professional epidemiology, COVID-19, Coronavirus Infections epidemiology, Humans, Medical Oncology standards, Nurse Clinicians psychology, Nursing Staff, Hospital psychology, Pandemics, Pneumonia, Viral epidemiology, SARS-CoV-2, Betacoronavirus, Coronavirus Infections nursing, Nurse Clinicians statistics numerical data, Nursing Staff, Hospital statistics numerical data, Oncology Nursing statistics numerical data, and Pneumonia, Viral nursing

Objectives: To provide a critical reflection of COVID-19 in the context of oncology nursing and provide recommendations for caring for people affected by cancer during this pandemic.
Data Sources: Electronic databases, including CINAHL, MEDLINE, PsychINFO, Scopus, professional web sites, and grey literature were searched using Google Scholar.
Conclusion: Nurses are key stakeholders in developing and implementing policies regarding standards of care during the COVID-19 pandemic. This pandemic poses several challenges for oncology services. Oncology nurses are providing a pivotal role in the care and management of the novel COVID-19 in the year landmarked as the International Year of the Nurse.
Implications for Nursing Practice: It is too early to tell what shape this pandemic will take and its impact on oncology care. However, several important clinical considerations have been discussed to inform oncology nursing care and practice.
(Copyright © 2020 Elsevier Inc. All rights reserved.)

Aerosols, Betacoronavirus, COVID-19, Head and Neck Neoplasms surgery, Humans, Infection Control, Pandemics, Personal Protective Equipment, SARS-CoV-2, Surgical Oncology, Coronavirus Infections epidemiology, Head and Neck Neoplasms therapy, Medical Oncology methods, and Pneumonia, Viral epidemiology

The COVID-19 pandemic demands reassessment of head and neck oncology treatment paradigms. Head and neck cancer (HNC) patients are generally at high-risk for COVID-19 infection and severe adverse outcomes. Further, there are new, multilevel COVID-19-specific risks to patients, surgeons, health care workers (HCWs), institutions and society. Urgent guidance in the delivery of safe, quality head and neck oncologic care is needed. Novel barriers to safe HNC surgery include: (1) imperfect presurgical screening for COVID-19; (2) prolonged SARS-CoV-2 aerosolization; (3) occurrence of multiple, potentially lengthy, aerosol generating procedures (AGPs) within a single surgery; (4) potential incompatibility of enhanced personal protective equipment (PPE) with routine operative equipment; (5) existential or anticipated PPE shortages. Additionally, novel, COVID-19-specific multilevel risks to HNC patients, HCWs and institutions, and society include: use of immunosuppressive therapy, nosocomial COVID-19 transmission, institutional COVID-19 outbreaks, and, at some locations, societal resource deficiencies requiring health care rationing. Traditional head and neck oncology doctrines require reassessment given the extraordinary COVID-19-specific risks of surgery. Emergent, comprehensive management of these novel, multilevel surgical risks are needed. Until these risks are managed, we temporarily favor nonsurgical therapy over surgery for most mucosal squamous cell carcinomas, wherein surgery and nonsurgical therapy are both first-line options. Where surgery is traditionally preferred, we recommend multidisciplinary evaluation of multilevel surgical-risks, discussion of possible alternative nonsurgical therapies and shared-decision-making with the patient. Where surgery remains indicated, we recommend judicious preoperative planning and development of COVID-19-specific perioperative protocols to maximize the safety and quality of surgical and oncologic care.
(Copyright © 2020 Elsevier Ltd. All rights reserved.)

COVID-19 epidemiology, COVID-19 virology, Clinical Trials as Topic standards, Clinical Trials as Topic statistics numerical data, Disease Outbreaks, Humans, Medical Oncology standards, Medical Oncology statistics numerical data, Neoplasms classification, Neoplasms diagnosis, Outcome Assessment, Health Care methods, Outcome Assessment, Health Care standards, Outcome Assessment, Health Care statistics numerical data, Research Report standards, SARS-CoV-2 physiology, Telemedicine standards, Telemedicine statistics numerical data, COVID-19 prevention control, Clinical Trials as Topic methods, Medical Oncology methods, Neoplasms therapy, SARS-CoV-2 isolation purification, and Telemedicine methods

Coronavirus disease outbreak has affected all aspect of clinical care including cancer clinical trials. To minimize exposure of frail cancer patients, an implementation of telemedicine was retained. The impact of this implementation on primary and secondary endpoints criteria of ongoing clinical trials was analyzed. Out of 128 oncology clinical trials, 25 (19%) had an implementation of teleconsultation. Poor data reporting induced mainly a bias on qualitative and descriptive primary endpoints than those assessing efficacy (80% vs 20%; p  < 0.001). The integration of telemedicine and E-technologies in the medical practices and clinical trials must be designed and validated.

Humans, Neoplasm Staging, Neoplasms pathology, Referral and Consultation, Tertiary Care Centers, COVID-19 prevention control, Neoplasms surgery, Pathology, Surgical, SARS-CoV-2, and Surgical Oncology

Background and Objectives: Italy was severely affected by the severe acute respiratory syndrome coronavirus 2 pandemic. Our Institution, Piedmont's largest tertiary referral center, was designated as a non-COVID-19 hospital and activities were reorganized to prioritize critical services like oncological care. The aim of this study was to investigate the efficacy in preserving the oncological surgical practice at our Institution during the most critical months of the COVID-19 epidemic by analyzing the surgical pathology activity.
Methods: The number of oncological surgical resections submitted to histopathological examination from 9th March 2020 to 8th May 2020 were collected as well staging/grading data and compared with the previous three pre-COVID-19 years (2017-2019).
Results: Overall, no decrease was observed for most tumor sites (5/9) while breast resections showed the largest drop (109 vs. 160; -31.9%), although a full recovery was already noticed during the second half of the period. Conversely, the selected control benchmarks showed a sharp decrease (-80.4%). Distribution of pathological TNM stages (or tumor grades for central nervous system tumors) showed no significant differences during the lockdown compared with previous years (p > .05).
Conclusions: The present data suggest the possibility of preserving this cornerstone oncological activity during an evolving public health emergency thanks to a prompt workflow reorganization.
(© 2020 Wiley Periodicals LLC.)

Disease Management, Humans, Medical Oncology methods, Medical Oncology standards, Neoplasms diagnosis, Neoplasms therapy, Quality of Life, Integrative Oncology methods, Integrative Oncology standards, Neoplasms epidemiology, and Patient Reported Outcome Measures

There is growing interest in the value of routine collection and monitoring of patient-reported outcomes as part of high-quality, patient-centered, oncology care. Integrative oncology, with its focus on providing symptom and lifestyle support for patients throughout the cancer care continuum, serves a diverse patient population with a complex, changing symptom burden. Monitoring of patient-reported outcomes can contribute significantly to the successful comprehensive evaluation and management of patients receiving integrative oncology care. Data collected as part of an integrative oncology evaluation can also support real-world clinical research efforts to help learn more about the effects of integrative oncology interventions on patient symptoms, quality of life, and treatment outcomes.

COVID-19, COVID-19 Testing, Clinical Laboratory Techniques, Communicable Disease Control organization administration, Coronavirus Infections diagnosis, Coronavirus Infections prevention control, Databases, Factual, Female, Head and Neck Neoplasms pathology, Humans, Male, Medical Oncology organization administration, Patient Safety statistics numerical data, Pneumonia, Viral prevention control, Program Evaluation, Retrospective Studies, Societies, Medical, Surveys and Questionnaires, United States, Coronavirus Infections epidemiology, Head and Neck Neoplasms surgery, Microsurgery methods, Pandemics prevention control, Pneumonia, Viral epidemiology, Practice Patterns, Physicians' organization administration, and Surgical Oncology organization administration

Background: The SARS-CoV-2 (COVID-19) pandemic has caused rapid changes in head and neck cancer (HNC) care. "Real-time" methods to monitor practice patterns can optimize provider safety and patient care.
Methods: Head and neck surgeons from 14 institutions in the United States regularly contributed their practice patterns to a shared spreadsheet. Data from 27 March 2020 to 5 April 2020 was analyzed.
Results: All institutions had significantly restricted HNC clinic evaluations. Two institutions stopped free-flap surgery with the remaining scheduling surgery by committee review. Factors contributing to reduced clinical volume included lack of personal protective equipment (PPE) (35%) and lack of rapid COVID-19 testing (86%).
Conclusions: The COVID-19 pandemic has caused a reduction in HNC care. Rapid COVID-19 testing and correlation with infectious potential remain paramount to resuming the care of patients with head and neck cancer. Cloud-based platforms to share practice patterns will be essential as the pandemic evolves.
(© 2020 Wiley Periodicals, Inc.)