The Psychological Experience of the Nursing Staff of the Medical Oncology Department in Cameroon: Case of the YaoundéGeneral Hospital

Background: The world of cancer care is an emotional place, given the severity of the disease being treated, the heavy workload, the suffering of patients, and the high number of deaths. The nursing staff who work there may be exposed to constant stress from these factors. This study aimed to explore the psychological experience of the nursing staff of the Medical Oncology Department of the Yaoundé General Hospital. Methods: We carried out a cross-sectional study, in June 2017, involving the nursing staff of the Medical Oncology Department of the Yaoundé General Hospital. Results: Sixteen out of 18 nurses were interviewed. All had worked in at least one other department prior to Oncology. The number of years of experience in Oncology ranged from less than one year to 13 years. The choice of the Oncology department was involuntary for 100% of the staff;of these, 62% had intentions of changing departments. Twenty-five percent had applied for a change of department, which was unsuccessful. Stress was expressed by 94% of the staff;93% thought that there was a solution to the stress experienced on a daily basis in the Oncology department. The main solutions proposed to manage this stress were: support for the staff, provision of work materials, and staff training. Conclusion: The nursing staff of the Medical Oncology Department of the Yaoundé General Hospital experiences a high level of stress and are in need of solutions.

A cross-sectional study on oncology nurses' knowledge and practice of oral mucositis among cancer patients in Jordan

Objectives: This study was conducted to evaluate oncology nurses' knowledge and compliance with oral mucositis (OM) management guidelines.Methods: A cross-sectional design with a nonparticipant observation approach was utilized.In phase Ⅰ,a cross-sectional convenience sample (n =140) of oncology nurses completed the knowledge test.In phase Ⅱ,a random sample (n =20) of oncology nurses from participants in phase I was observed during their practice.Results: Fifty-seven (40.7%) of the participants had an unsatisfactory level of knowledge.Most of them had knowledge deficits regarding pathology,OM definition,assessment,scoring,treatment,and patient education and advice.A significant difference existed among nurses with diploma,bachelor,and postgraduate degrees as determined by one-way ANOVA (P =0.001).There were no significant difference between average scores of male and female nurses were higher than those of nurses (P=0.45).No significant difference was observed among knowledge scores of nurses with different job titles (P =0.51).The average score of male nurses in terms of skill performance was higher than that of female nurses (29.20 ± 2.10 vs 27.10 ± 1.80) without statistical significance.Conclusion: The knowledge and compliance with OM management guidelines among Jordanian oncology nurses need to be improved.National OM prevention and management guidelines are adopted in Jordan.Continuing education and training are also recommended.

Up to seven criteria in selection of systemic therapy for hepatocellular carcinoma

Barcelona clinic liver cancer(BCLC)intermediate stage hepatocellular carcinoma is a heterogenous disease.Transarterial chemoembolization is offered as the first line therapy in this disease stage.Recent advances in systemic therapy have markedly improved outcomes even in advanced stage disease.The use of systemic therapy in BCLC intermediate stage disease may now be of therapeutic benefit in selected patients.We will focus on“the up to seven”criteria and its utility in selecting systemic therapy.

Pancreatic cancer in the era of COVID-19 pandemic:Which one is the lesser of two evils?

Pancreatic adenocarcinoma remains one of the deadliest malignancies affecting the older population.We are experiencing a paradigm shift in the treatment of pancreatic cancer in the era of coronavirus disease 2019(COVID-19)pandemic.Utilizing neoadjuvant treatment and further conducting a safe surgery while protecting patients in a controlled environment can improve oncological outcomes.On the other hand,an optimal oncologic procedure performed in a hazardous setting could shorten patient survival if recovery is complicated by COVID-19 infection.We believe that oncological treatment protocols must adapt to this new health threat,and pancreatic cancer is not unique in this regard.Although survival may not be as optimistic as most other malignancies,as caregivers and researchers,we are committed to innovating and reshaping the treatment algorithms to minimize morbidity and maximize survival as caregivers and researchers.

Scoring systems in critically ill: Which one to use in cancer patients?

BACKGROUND Scoring systems have not been evaluated in oncology patients.We aimed to assess the performance of Acute Physiology and Chronic Health Evaluation(APACHE)II,APACHE III,APACHE IV,Simplified Acute Physiology Score(SAPS)II,SAPS III,Mortality Probability Model(MPM)II0 and Sequential Organ Failure Assessment(SOFA)score in critically ill oncology patients.AIM To compare the efficacy of seven commonly employed scoring systems to predict outcomes of critically ill cancer patients.METHODS We conducted a retrospective analysis of 400 consecutive cancer patients admitted in the medical intensive care unit over a two-year period.Primary outcome was hospital mortality and the secondary outcome measure was comparison of various scoring systems in predicting hospital mortality.RESULTS In our study,the overall intensive care unit and hospital mortality was 43.5%and 57.8%,respectively.All of the seven tested scores underestimated mortality.The mortality as predicted by MPM II0 predicted death rate(PDR)was nearest to the actual mortality followed by that predicted by APACHE II,with a standardized mortality rate(SMR)of 1.305 and 1.547,respectively.The best calibration was shown by the APACHE III score(χ^(2)=4.704,P=0.788).On the other hand,SOFA score(χ^(2)=15.966,P=0.025)had the worst calibration,although the difference was not statistically significant.All of the seven scores had acceptable discrimination with good efficacy however,SAPS III PDR and MPM II0 PDR(AUROC=0.762),had a better performance as compared to others.The correlation between the different scoring systems was significant(P<0.001).CONCLUSION All the severity scores were tested under-predicted mortality in the present study.As the difference in efficacy and performance was not statistically significant,the choice of scoring system used may depend on the ease of use and local preferences.

Hepatobiliary phases in magnetic resonance imaging using liverspecific contrast for focal lesions in clinical practice

BACKGROUND Challenging lesions,difficult to diagnose through non-invasive methods,constitute an important emotional burden for each patient regarding a still uncertain diagnosis(malignant x benign).In addition,from a therapeutic and prognostic point of view,delay in a definitive diagnosis can lead to worse outcomes.One of the main innovative trends currently is the use of molecular and functional methods to diagnosis.Numerous liver-specific contrast agents havebeen developed and studied in recent years to improve the performance of liver magnetic resonance imaging(MRI).More recently,one of the contrast agents introduced in clinical practice is gadoxetic acid(gadoxetate disodium).AIM To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions(FLL)in clinical practice.METHODS Overall,302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of FLL.Two radiologists independently reviewed the MRI exams using four stages,and categorized them on a 6-point scale,from 0(lesion not detected)to 5(definitely malignant).The stages were:stage 1-images without contrast,stage 2-addition of dynamic phases after contrast(analogous to usual extracellular contrasts),stage 3-addition of hepatobiliary phase after 10 min(HBP 10’),stage 4-hepatobiliary phase after 20 min(HBP 20’)in addition to stage 2.RESULTS The interobserver agreement was high(weighted Kappa coefficient:0.81-1)at all stages in the characterization of benign and malignant FLL.The diagnostic weighted accuracy(Az)was 0.80 in stage 1 and was increased to 0.90 in stage 2.Addition of the hepatobiliary phase increased Az to 0.98 in stage 3,which was also 0.98 in stage 4.CONCLUSION The hepatobiliary sequences improve diagnostic accuracy.With growing potential in the era of precision medicine,the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients with FLL that are difficult to diagnose.

Integrative Oncology in Australia

The use of alternative medicine（AM） in Australia dates back to its earliest times,with the indigenous medicine of the aboriginal peoples and the folk medicine of the early English settlers.AM has until recently existed quite separately from Western biomedicine（WB） and there has been little integration of the two systems.Now,referred to as complementary medicine（CM）,there has been a movement over the last 20 years to include CM in WB mainstream practices.Varying degrees of success have been reported but for the discipline of oncology.Medical oncology（MO） in Australia is demanding CM provide high levels of evidence for any inclusion in cancer protocols.There are just now the beginnings of this integration, particularly as CM is now being taught in the public university system to a PhD level as well as the public demand for their medical doctors to communicate with their CM practitioners.MO specialists are now open to a dialogue with their CM counterparts.

Geriatric assessment for older people with cancer:policy recommendations

Most cancers occur in older people and the burden in this age group is increasing.Over the past two decades the evidence on how best to treat this population has increased rapidly.However,implementation of new best practices has been slow and needs involvement of policymakers.This perspective paper explains why older people with cancer have different needs than the wider population.An overview is given of the recommended approach for older people with cancer and its benefits on clinical outcomes and cost-effectiveness.In older patients,the geriatric assessment(GA)is the gold standard to measure level of fitness and to determine treatment tolerability.The GA,with multiple domains of physical health,functional status,psychological health and socio-environmental factors,prevents initiation of inappropriate oncologic treatment and recommends geriatric interventions to optimize the patient’s general health and thus resilience for receiving treatments.Multiple studies have proven its benefits such as reduced toxicity,better quality of life,better patient-centred communication and lower healthcare use.Although GA might require investment of time and resources,this is relatively small compared to the improved outcomes,possible cost-savings and compared to the large cost of oncologic treatments as a whole.