Burnout among German oncologists: a cross-sectional study in cooperation with the Arbeitsgemeinschaft Internistische Onkologie Quality of Life Working Group.

PURPOSE: Oncologists are at an increased risk of developing burnout, leading to negative consequences in patient care and in professional satisfaction and quality of life. This study was designed to investigate exhaustion and disengagement among German oncologists and assess the prevalence of burnout among oncologists within different professional settings. Furthermore, we wanted to examine possible relations between sociodemographic factors, the oncological setting, professional experience and different aspects of burnout. METHODS: In a cross-sectional study design, an Internet-based survey was conducted with 121 oncologists between April and July 2020 using the Oldenburg Burnout Inventory, which contains items on exhaustion, disengagement, and burnout. Furthermore, sociodemographic data of the participants were assessed. The participants were members of the Working Group Medical Oncology (Arbeitsgemeinschaft Internistische Onkologie) within the German Cancer Society. RESULTS: The survey showed a burnout prevalence of 43.8%, which correlated with age and professional experience; that is, the prevalence is particularly high among younger oncologists. Exhaustion is closely related to employment status; that is, it was significantly higher among employed oncologists. There were remarkably low levels of disengagement among oncologists, highlighting the own demand to fulfil job requirements despite imminent or actual overburdening in daily work. CONCLUSION: More support is necessary to mitigate the professional stressors in the healthcare system. To ensure quality medical care, employees should be offered preventive mental health services early in their careers.

Neoadjuvant chemotherapy with gemcitabine plus cisplatin followed by radical liver resection versus immediate radical liver resection alone with or without adjuvant chemotherapy in incidentally detected gallbladder carcinoma after simple cholecystectomy or in front of radical resection of BTC (ICC/ECC) - a phase III study of the German registry of incidental gallbladder carcinoma platform (GR)- the AIO/ CALGP/ ACO- GAIN-trial.

BACKGROUND: Currently, complete surgical resection represents the only potentially curative treatment option for Biliary Tract Cancer (BTC) including Gallbladder Cancer (GBC). Even after curative resection, 5-year OS is only 20-40%. Gallbladder carcinoma is relatively rare, but still the fifth most common neoplasm of the digestive tract and even the most frequent cancer of the biliary system. Gallbladder carcinoma is suspected preoperatively in only 30% of all pts., while the majority of cases are discovered incidentally by the pathologist after cholecystectomy for a benign indication. For improving curative rates in BTC and GBC, early systemic therapy combined with radical resection seems to be a promising approach. The earliest moment to apply chemotherapy would be in front of radical surgery. The encouraging results of neoadjuvant/perioperative concepts in other malignancies provide an additional rationale to use this treatment in the early phase of GBC management and even ICC/ECC. Especially because data regarding pure adjuvant chemotherapy in BTC's are conflicting. METHODS: This is a multicenter, randomized, controlled, open-label phase III study including pts. with incidentally discovered GBCs after simple cholecystectomy in front of radical liver resection and pts. with resectable/ borderline resectable cholangiocarcinomas (ICC/ ECC) scheduled to receive perioperative chemotherapy (Gemcitabine + Cisplatin 3 cycles pre- and post-surgery) or surgery alone followed by a therapy of investigator's choice. Primary endpoint is OS; secondary endpoints are PFS, R0-resection rate, toxicity, perioperative morbidity, mortality and QoL. A total of N = 333 patients with GBC or BTC will be included. Recruitment has started in August 2019. DISCUSSION: The current proposed phase III GAIN study investigates whether induction chemotherapy followed by radical resection in ICC/ECC and re-resection in IGBC (and - if possible - postoperative chemotherapy) prolongs overall survival compared to radical surgery alone for incidental gallbladder carcinoma and primary resectable or borderline resectable cholangiocarcinoma. Utilizing a neoadjuvant approach including a second radical surgery will help to raise awareness for the necessity of radical surgery, especially second radical completion surgery in IGBC and improve the adherence to the guidelines. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03673072 from 17.09.2018. EudraCT number: 2017-004444-38 from 02.11.2017.

Measuring subjective complaints of attention and performance failures--development and psychometric validation in tinnitus of the self-assessment scale APSA.

BACKGROUND: There is a need for a validated self-assessment questionnaire for cognitive impairment in subjects reporting subjective tinnitus. The objective was to develop a patient-reported outcome measure. METHODS: This was a prospective, non-interventional, multicultural study. The 30-item "Attention and Performance Self-Assessment Scale" (APSA) was linguistically validated in Germany, Mexico and USA and was analyzed for content and structure. The analysis included descriptive statistics of baseline data, item characteristics, test-retest reliability (intra-class correlation coefficients, ICC), definition of internal consistency (Cronbach' s alpha), and explorative and confirmatory factor analysis to define the structure of the scale. Correlations with various tinnitus scales and subscales from the Hospital Anxiety and Depression Scale (HADS) were done to estimate convergent validity. RESULTS: The data for 211 subjects aged 30 through 60 years, (mean= 48.5 years, SD= 8.3) with mild to moderate tinnitus (mean Tinnitus Handicap Inventory-12 (THI-12) total score 11.2, SD= 5.3) were analyzed. The majority of subjects had sub-clinical scores for anxiety and depression (HADS below 11 points). Sequential principal factor analyses of the APSA resulted in a subscale which included 20 (APS20) of the original 30 items and two correlated subscales (AP-F1, AP-F2) defined by 9 items each. Both factor solutions were confirmed by confirmatory factor analysis. Test retest reliability of the APS20, AP-F1 and AP-F2 (ICC ≥ 0.87) and internal consistency (Cronbach's alpha ≥ 0.89) are high. APS20 correlated moderately high with HADS (depression: 0.54; anxiety: 0.62) and THI-12 total (0.52). In a few cases, AP-F2 correlated higher than AP-F1 with other scales (e.g. HADS-depression with AP-F1: only 0.46, but AP-F2: 0.59). CONCLUSIONS: APS20, AP-F1, and AP-F2 have good psychometrical properties. The scales will add value to the assessment of cognitive aspects of quality of life and mental health in the population with subjective tinnitus. The subscales AP-F1 and AP-F2 may be helpful for detecting specific cognitive failures and may be sensitive to different interventional effects.