Chronic hepatitis B and occult infection in chemotherapy patients-evaluation in oncology and hemato-oncology settings:The CHOICE study

BACKGROUND Reactivation of hepatitis B virus(HBV)infection is a well-known risk that can occur spontaneously or following immunosuppressive therapies,including cancer chemotherapy.HBV reactivation can cause significant morbidity and even mortality,which are preventable if at-risk individuals are identified through screening and started on antiviral prophylaxis.AIM To determine the prevalence of chronic HBV(CHB)and occult HBV infection(OBI)among oncology and hematology-oncology patients undergoing chemo-therapy.METHODS In this observational study,the prevalence of CHB and OBI was assessed among patients receiving chemotherapy.Serological markers of HBV infection[hepatitis B surface antigen(HBsAg)/anti-hepatitis B core antigen(HBc)]were evaluated for all patients.HBV DNA levels were assessed in those who tested negative for HBsAg but positive for total anti-HBc.RESULTS The prevalence of CHB in the study cohort was determined to be 2.3%[95%confidence interval(95%CI):1.0-4.2].Additionally,the prevalence of OBI among the study participants was found to be 0.8%(95%CI:0.2-2.3).CONCLUSION The findings of this study highlight the importance of screening for hepatitis B infection in oncology and hematology-oncology patients undergoing chemotherapy.Identifying individuals with CHB and OBI is crucial for implementing appropriate antiviral prophylaxis to prevent the reactivation of HBV infection,which can lead to increased morbidity and mortality.

Community-Based Oncology Nursing:Current Status and Prospects-A Secondary Publication

Objective:Currently,it is difficult to determine whether a comprehensive and systematic community-based cancer care project is properly implemented.The purpose of this article is to present the current status and prospects of community-based oncology nursing by reviewing related literature.Methods:A new cancer care model was established through the analysis of existing models and a literature review of community-based cancer prevention,cancer screening,cancer survivor care,and cancer patient hospice care.Results:The Comprehensive Cancer Care Model(CCCM)was esrablished.The CCCM organizes the stages of cancer treatment and the cancer journey on the horizontal axis.On the vertical axis,public health centers,oncology hospitals,cancer convalescent hospitals,primary care physicians,and prayer centers were involved.The levels of participation of human resources among institutions and the degree of interconnection between organizations was observed.Conclusion:It is expected that CCCM will be used for holistic,sustainable,and cost-effective cancer management.In community-based oncology nursing,the team of health promotion nurses in public health centers is in charge of population-based cancer prevention and early detection programs,while the visiting health management team of nurses is in charge of individual-based cancer survivor and hospice programs.

Cardio-Oncology: The Need of the Hour Subspeciality

There have been considerable advancements in cancer therapy in recent years. However, adverse effects often defeat the benefits, especially on the cardiovascular system. The effects of chemotherapeutic agents on the cardiovascular system can be directly on the heart by altering the coagulability state or by altering the hemodynamic system. Some drugs like Sunitinib and Bevacizumab show Heart Failure which is chemotherapy-induced. Other agents are notorious for showing QT prolongation like Vandetanib. Similarly, other agents with demonstrated cardiotoxicity would be molecular-targeted drugs (Trastuzumab and Pertuzumab) and cytostatic agents (Anthracycline antibiotics, Cyclophosphamide and 5-FU). These effects may present early or late, during or after the treatment. Most of the research has focused on the management and monitoring of patients for cancer who are under treatment, for example new biomarkers in the field of proteomics have been discovered for the diagnosis, treatment, and monitoring of patients. While the upgrades have been successful in reducing mortalities, with the advent of better treatment outcomes, the several adverse effects on the cardiac system cannot be dismissed. For instance, damage to the cardiomyocytes is most frequently associated with the treatment. The damage can further expedite LV failure, valvular dysfunction, conduction abnormalities, etc. Hence, a better management plan for patients with cancer would be one that not only caters to primary cancer treatment but also incorporates ventricular systolic function evaluation using echocardiography, electrocardiography, and cardiac biomarkers for the well-being of patients. Our article focuses on introducing an ideal cardio-oncology team along with the components required for setting up the team. This needs a multidisciplinary approach to reduce patients’ cardiovascular morbidity, during and after the interventions. With the growing population of patients undergoing cancer therapy, the risk of developing cardiovascular problems has further escalated. Hence, development of a cardio-oncology multidisciplinary team would be of utmost importance to not only improve patient care but also to improve quality of life.

Exercise and oncology:The role of physical activity in disease prevention and health promotion

The field of exercise-oncology has evolved significantly over the past 30 years.Numerous studies have examined the role of structured exercise interventions—often incorporating aerobic or resistance training at moderate-to-vigorous intensities,sometimes in conjunction with multi-modal strategies—for individuals living with and beyond cancer.

Clinical infections in neurosurgical oncology:An overview

Central nervous system(CNS)infections are urgent conditions with high morbidity and mortality.Bacteria,viruses,parasites or fungi can cause them.Intracranial infections after craniotomies are an important complication of treatment,especially in oncological patients that are already immunologically compromised due to the disease and treatment.The consequence of CNS infections in oncological patients includes longer treatment with antibiotics,additional surgical procedures,higher treatment costs and poorer treatment outcomes.Additionally,the management of primary pathology may be prolonged or postponed as a result of the active infection.By introducing new and improved protocols,tightening controls on their implementation,constantly educating the entire team involved in patient treatment and educating both patients and relatives,the incidence of infections can be reduced effectively.

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.

Nursing Care in Patient with Advanced Cancer: The Experience of the Adult Oncology Unit of Lomé

Background: Cancer patients suffer physical, psychological, spiritual, and social pains, especially in the advanced stage. Nurses spend more time with patients than any other healthcare team member. This study aimed to assess nurses’ behavior and care experiences in patients with advanced cancer and explore patients’ perceptions of nursing care. Methods: A cross-sectional study was conducted with eight nurses and thirty patients with advanced cancer hospitalized in the oncology unit at Sylvanus Olympio Teaching Hospital of Lomé from July to August 2020. Results: The mean age of nurses was 34.3 years ranging from 23 to 48 years. There were five men (62.5%) and three women (37.5%). The mean duration of working in oncology nursing of all was less than two years. Only one nurse has training in palliative care. Stress (100%), sadness (100%), and fear (50%) were the most frequently expressed feeling of nurses. The frequently expressed difficulties were the lack of training in palliative care (87.5%), insufficiency of nursing staff (75%), and helplessness in front of the patient’s distress (75%). Among the thirty patients, were 22 women (72.7%) and 8 men (27.3%). The needs expressed by the patients were psychological support (n = 11;36.7%), pain relief (n = 10;33.3%), and moral support (n = 9;30%). Most of the patients (73.3%) affirmed that nurses did not inform them well about their disease. Three (10%) were very satisfied with the care provided, 23 patients (76.7%) were satisfied and 4 (13.3%) were unsatisfied. Conclusion: This study revealed that nursing care in Togolese patients with cancer faces many difficulties and there is a need for providing specialized oncology nursing.

Analysis of Local Diagnostic Reference Levels for Pediatric Patients Undergoing 18F-FDG PET/CT Imaging for Oncology

Background: The PET/CT imaging studies have two doses components the dose from the PET radiopharmaceutical and the other from the low dose CT used for PET images attenuation correction. We have one PET/CT scanner at our institution a Philips Time of Flight scanner. Our local patient’s radiation protection rules requires continuous assessment of radiation doses delivered to our patients. Purposes: The objectives of this study are to develop a weight- based facility DRLs for paediatric F-18-FDG PET-CT imaging for oncology in a large tertiary hospital and to determine whether the calculated DRLs compares with internationally published DRLs. Materials & Methods: Radiation dose data and patient demographics of two-hundreds and sixteen paediatric PET-CT oncology patients imaging procedures from one large tertiary hospital were selected and analysed in order to establish a facility paediatric DRLs. Statistical analysis was performed. Results: The PET dose reference levels ranged between [62 - 525] MBq of injected activity for a range of pediatric age groups. The CTDIvol values were between 3.5 and 16.5 mGy for all age groups. Comparison with current EANM and SNMMI recommendations of patient’s dose are discussed. Conclusion: Our pediatric PET/CT reference levels are higher than the ones reported internationally with notable variations. .

Application of evidence-based medicine methods in integrative oncology research

To present the advances of evidence-based medicine and clinical research methodology in integrative oncology,we conducted a literature review of real-world studies of traditional Chinese medicine(TCM)in cancer care and summarized the available evidence.Pragmatic randomized controlled trials(pRCTs)and clinical registry studies are becoming more popular as they could compensate for the limitations of RCTs.Many RCTs of TCM for cancer treatment as well as systematic reviews have been published.The most investigated therapies are based on acupuncture,Chinese herbal compounds,and Chinese patent medicines.Acupuncture has a significant advantage in relieving cancer-related symptoms.Published studies focus more on improving clinical symptoms and laboratory indicators.However,the patient's quality of life deserves more attention.

北京某肿瘤医院肿瘤心理门诊10年就诊分析

回顾2010—2019年北京大学肿瘤医院肿瘤心理科患者构成、患者特征和门诊处方的变化情况,发现10年间,肿瘤心理门诊患者就诊人次为37 885,年就诊量逐年增长,高于该医院的门诊增长率。就诊患者中前五位常见癌症为肺癌、乳腺癌、直肠癌、结肠癌和胃癌。就诊患者中乳腺癌比例下降,肺癌和胃肠道肿瘤比例上升。患者因疼痛就诊的比例逐渐增加;处方镇痛药物联合精神科用药的比例增高,从84.4%上升到91.8%;治疗失眠的药物使用频率高,为35.9%。可见,恶性肿瘤患者对肿瘤心理服务的需求不断增加,肿瘤心理门诊在疼痛等症状管理方面具有优势。

2023年ESMO会议食管癌药物治疗进展

2023年欧洲肿瘤内科学会(European Society for Medical Oncology,ESMO)年会于2023年10月20日~24日在西班牙马德里隆重召开。本次大会报道多项食管癌领域的最新前沿研究。本文将从食管癌围手术期治疗和晚期食管癌药物治疗方面整理并解读此次会议中食管癌的重要进展。

临床医学八年制医学生肿瘤学教学需求调查

目的 调查临床医学八年制医学生对肿瘤学相关课程形式及内容的需求,为肿瘤学临床教学提供借鉴和参考。方法 以问卷星的方式于2020年9—11月对北京协和医学院临床医学八年制医学生、清华大学医学院临床医学八年制医学生、北京协和医学院“4+4”试点班八年制医学生展开调查,了解学生肿瘤学的知识来源、感兴趣的课程内容和教学形式偏好。结果 共发放问卷122份,回收率为100%。参与调查的学生共122人,89.3%(109/122)的学生对肿瘤学相关基础和临床科研项目感兴趣,84.4%(103/122)的学生认为采用情境模拟教学方式合理,91.0%(111/122)的学生希望通过线下讨论的方式进行学习。课程内容方面,医学生对肿瘤诊断、治疗方案、多学科综合治疗、循证医学等与临床情境直接相关的知识更感兴趣。亚组分析显示,传统八年制医学生(86%,92/107)较“4+4”试点班学生(60%,9/15)对缓和医疗认可度更高,在情境模拟教学中更愿意担任编剧(26%比7%,P=0.013);临床阶段学生较基础阶段学生在科研训练中增加了肿瘤学知识的了解,更倾向于在情境模拟教学中担任编剧(27%比11%,P=0.048)。结论 临床医学八年制医学生对肿瘤学课程中的肿瘤诊断、治疗方案及研究进展等方面感兴趣,期望通过情境模拟教学的方法进行学习且主动参与度较高。

肿瘤与心血管疾病:评估和管理

根据全球癌症数据显示,2020年全球新发癌症病例中高达23.7%的患者来自于中国,中国癌症死亡病例占全球癌症死亡病例的30.2%[1]。随着人口老龄化的进程及生活方式的改变,我国癌症的新发及死亡负担将会进一步加重。而随着肿瘤诊疗水平的进步,肿瘤患者的死因构成比发生了一定变化,心血管疾病逐渐成为仅次于肿瘤本身的死因,甚至在部分肿瘤类型中已经成为首要死因。肿瘤患者逐渐增加的心血管疾病负担与二者共同的危险因素有关,如高血压、高血脂、糖尿病等均在其中发挥重要作用[1-3];此外,抗肿瘤治疗相关心血管毒性仍然是肿瘤心脏病学领域临床及研究关注的重点及热点[4]。

叙事医学之于外科临床决策的价值思考

癌症的治疗理念和技术发展到微创和精准医学新时代,但临床决策更加复杂化。临床决策是癌症诊疗中重要环节,但传统临床决策模式无法满足癌症患者对高质量诊疗日益增长的需求,而建立在叙事医学基础上的医患共同决策是理想的决策模式。叙事医学让外科医生关注患者的故事、重现真实世界及真实需求等,构建医患信任的合作关系,让医学人文渗透到癌症外科临床决策的全过程。叙事医学融入癌症的临床诊疗过程中,有助于突破医患共同决策困境,实现叙事赋能、赋权,达成基于叙事医学的医患共同决策,但是当前仍需提升外科医生的叙事医学能力和素养,加强叙事医学本土化实践,营造优质叙事医学生态。

从临床肿瘤学的视角看缓和医疗

现代缓和医疗理念起源于20世纪60年代,该理念受到世界卫生组织的重视并以“癌症三阶梯止痛原则”为切入点在全球加以推广。我国于1990年引入“癌症三阶梯止痛原则”,发展至今已有30余年,这使得临床肿瘤学与缓和医疗的关系更加紧密,推动了缓和医疗在中国的进程。缓和医疗在中国的进一步发展有望显著改善癌症患者的生存时间和生活质量。

基于德尔菲法构建护理专业学位研究生与肿瘤专科护士核心能力联合培养方案

目的:构建护理专业学位研究生与肿瘤专科护士核心能力联合培养方案,为推动我国护理专业学位研究生教育的发展提供参考。方法:通过文献分析法及半结构化访谈初步形成护理专业学位研究生与肿瘤专科护士核心能力联合培养方案条目池,制定专家函询问卷,并采取德尔菲专家函询法对15名专家进行专家函询,最终形成护理专业学位研究生与肿瘤专科护士核心能力联合培养方案。结果:3轮函询专家积极性系数均为100.0%,专家权威系数分别为0.838,0.880和0.880。经过咨询最终形成包括理论知识掌握能力、临床综合实践应用能力、组织管理能力、教学及科研能力、发展能力5个一级指标、17个二级指标、96个三级指标的护理专业学位研究生与肿瘤专科护士核心能力联合培养方案。结论:构建的护理专业学位研究生与肿瘤专科护士核心能力联合培养方案具有良好的可靠性与科学性,对肿瘤护理方向专科人才培养提供参考。

脂肪层螺旋形缝合联合封闭式负压引流对妇科肿瘤患者腹部切口愈合的影响

目的研究脂肪层螺旋形缝合联合封闭式持续负压引流对妇科恶性肿瘤患者腹部切口愈合的作用。方法回顾分析肥胖妇科肿瘤手术患者154例。观察组66例患者采用脂肪层螺旋形缝合联合持续封闭式负压引流法治疗,对照组88采用单纯传统间断全层缝合或间断脂肪层缝合法;比较两组患者年龄、体重指数(BMI)、切口长度及切口愈合情况。结果两组的年龄、体重指数(BMI)、合并症等一般情况比较无差异(P≥0.05),观察组甲级愈合率高于对照组,观察组的切口感染率、切口脂肪液化率及切口愈合时间均优于对照组,差异有统计学意义(P<0.05)。结论与传统缝合法相比,螺旋形缝合联合封闭式持续负压引流法有助于减少肥胖患者妇科手术患者切口脂肪液化,减少腹部切口感染、能缩短切口愈合时间,减少住院天数。

肿瘤学新型教学模式的应用探讨

肿瘤学是一门专业性强、涉及面广的独立学科。我国肿瘤学教学虽已取得长足的发展,但是仍存在许多问题。本文从肿瘤学教学的现状切入分析,介绍当前肿瘤学教学中所应用到的新型教学模式,具体包括基于SPOC的翻转课堂教学模式、规范化临床试验教学模式、多学科综合治疗(MDT)教学模式、案例式教学模式、以问题为基础(PBL)教学模式、双语教学模式、循证医学与案例式(CBL)教学模式、思政教育教学模式等,并简要指出应用新型教学模式的要求,以期为肿瘤学教学提供可靠参考,有效提升医学院校肿瘤学专业的教学质量,并为培育更多的高素质医学人才提供强大助力。

全人健康视角下肿瘤专科医院门诊改善医疗服务路径探索

2023年国家卫健委、国家中医药局联合发布了《改善就医感受提升患者体验主题活动方案(2023—2025年)》,文件中详细规划了一系列关键任务,旨在引导医疗机构贯彻“以健康为中心”的理念,提升医疗服务的舒适性、智能化和数字化水平。为了全面提高患者的医疗体验和满意度,天津市某肿瘤专科医院门诊通过全人健康视角,以门诊服务体系建设、慢性病诊疗模式创新、人文内涵提升、环境改善、智慧门诊搭建等多方面路径探索与实践,进一步推动了门诊诊疗服务体系科学、连续、高效、高质、舒适的医疗服务模式的“落地”,进一步促进门诊服务标准化、规范化、品质化发展。

立德树人视域下肿瘤学概论整合课中思政建设的研究

立德树人是教育的本质特征和目标,而实现立德树人这一教育目标可以凭借思政教育这种方式来实现。肿瘤学概论整合课从立德树人角度出发,把思政教育融入课堂教学中,这种协同教学模式对学生的兴趣培养发挥了重要作用,使学生能够在学习过程中潜移默化地接受了思政与德育教育;为医学专业的教学模式开辟了新思路和新途径。本研究借助思想政治教育的本位回归,促进医学生的职业素养和专业能力的有效融合,培养出“德医双馨”的医学专业人才,并推广落实了教育的本质——立德树人,达到了预期的理想教学效果。