Outcomes of Patients with Small Intestine Adenocarcinoma in a Canadian Province: A Retrospective Multi-Center Population-Based Cohort Study.

Background: Small intestine adenocarcinoma is a rare cancer. The current study aims to determine the outcomes of patients with small intestine adenocarcinoma in a Canadian province. Methods: This retrospective population-based cohort study assessed patients with small intestine adenocarcinoma who were diagnosed from 2008 to 2017 in Saskatchewan. A Cox proportional multivariate regression analysis was performed to determine the correlation between survival and exploratory factors. Results: 112 eligible patients with a median age of 73 years and M:F of 47:53 were identified. Overall, 75% had a comorbid illness, and 45% had a WHO performance status >1. Of the 112 patients, 51 (46%) had early-stage disease and 61 (54%) had advanced-stage disease. The median overall survival (mOS) was as follows: stage one, 59 months; stage two, 30 months; stage three, 20 months; and stage four, 3 months (p < 0.001). The median disease-free survival of patients with stage three disease who received adjuvant chemotherapy was 26 months (95% CI:23.1−28.9) vs. 4 months (0.0−9.1) with observation (p = 0.04). Patients who received chemotherapy for advanced disease had a mOS of 10 months (3.5−16.5) vs. 2 months (0.45−3.6) without chemotherapy (p < 0.001). In the multivariate analysis, stage four disease, hazard ratio (HR), 3.20 (1.84−5.40); WHO performance status >1, HR, 2.22 (1.42−3.45); lack of surgery, HR, 2.10 (1.25−3.50); and a neutrophil:lymphocyte ratio of >4.5, HR, 1.72 (1.10−2.71) were significantly correlated with inferior survival. Conclusions: Most patients with small intestine adenocarcinoma were diagnosed with advanced-stage disease. Advanced-stage disease, poor performance status, lack of surgery and a baseline neutrophil:lymphocyte ratio >4.5 were correlated with inferior survival.

Attitudes and factors contributing to attrition in Canadian surgical specialty residency programs.

BACKGROUND: We recently studied attrition in Canadian general surgical programs; however, there are no data on whether residents enrolled in other surgical residencies harbour the same intents as their general surgical peers. We sought to determine how many residents in surgical disciplines in Canada consider leaving their programs and why. METHODS: An anonymous survey was administered to all residents in 9 surgical disciplines in Canada. Significance of association was determined using the Pearson χ2 test. The Canadian Post-MD Education Registry (CAPER) website was used to calculate the response rate. RESULTS: We received 523 responses (27.6% response rate). Of these respondents, 140 (26.8%) were either "somewhat" or "seriously" considering leaving their program. Residents wanting to pursue additional fellowship training and those aspiring to an academic career were significantly less likely to be considering changing specialties (p = 0.003 and p = 0.005, respectively). Poor work-life balance and fear of unemployment/underemployment were the top reasons why residents would change specialty (55.5% and 40.8%, respectively), although the reasons cited were not significantly different between those considering changing and those who were not (p = 0.64). Residents who were considering changing programs were significantly less likely to enjoy their work and more likely to cite having already invested too much time to change as a reason for continuing (p < 0.001). CONCLUSION: More than one-quarter of residents in surgical training programs in Canada harbour desires to abandon their surgical careers, primarily because of unsatisfactory work-life balance and limited employment prospects. Efforts to educate prospective residents about the reality of the surgical lifestyle and to optimize employment prospects may improve completion rates.

CONTEXTE: Nous avons récemment étudié les taux d'attrition dans les programmes de chirurgie générale canadiens; toutefois, on ne dispose pas de données pour déterminer si les résidents inscrits dans d'autres programmes de chirurgie ont les mêmes intentions que leurs collègues de chirurgie générale. Nous avons voulu savoir combien de résidents des disciplines chirurgicales au Canada envisagent de quitter leur programme et pourquoi. MÉTHODES: Tous les résidents de 9 disciplines chirurgicales au Canada ont passé un sondage anonyme. La portée de la corrélation a été déterminée à l'aide du test χ2 de Pearson. Le site Web du Répertoire canadien sur l'éducation post-MD (RCEP) a été utilisé pour calculer le taux de réponse. RÉSULTATS: Nous avons reçu 523 réponses (taux de réponse de 27,6 %). Parmi les répondants, 140 (26,8 %) envisageaient « peut-être ¼ ou « sérieusement ¼ de quitter leur programme. Les résidents qui souhaitaient suivre une formation de surspécialité et ceux qui aspiraient à une carrière universitaire étaient notablement moins susceptibles d'envisager un changement de programme (p = 0,003 et p = 0,005, respectivement). Les problèmes de conciliation travail-famille et la crainte du chômage ou du sous-emploi ont été les principales raisons invoquées par les résidents pour changer de spécialité (55,5 % et 40,8 %, respectivement), même si les raisons citées n'étaient pas sensiblement différentes selon que les répondants envisageaient ou non un tel changement (p = 0,64). Les résidents qui envisageaient un changement de programme étaient notablement moins susceptibles d'apprécier leur travail et plus susceptibles d'invoquer le considérable investissement de temps déjà consenti comme raison pour ne pas changer de programme (p < 0,001). CONCLUSION: Plus du quart de résidents des programmes de formation en chirurgie au Canada souhaitent abandonner leur carrière en chirurgie, principalement en raison des problèmes de conciliation travail-famille et des perspectives d'emploi limitées. Des efforts pour renseigner les candidats sur ce que représente réellement la vie de chirurgien et pour optimiser les perspectives d'emploi pourraient améliorer les taux d'achèvement des programmes.

Thoughts of Quitting General Surgery Residency: Factors in Canada.

OBJECTIVE: Attrition rates in general surgery training are higher than other surgical disciplines. We sought to determine the prevalence with which Canadian general surgery residents consider leaving their training and the contributing factors. DESIGN, SETTING, AND PARTICIPANTS: An anonymous survey was administered to all general surgery residents in Canada. Responses from residents who considered leaving their training were assessed for importance of contributing factors. The study was conducted at the Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, a tertiary academic center. RESULTS: The response rate was approximately 34.0%. A minority (32.0%) reported very seriously or somewhat seriously considering leaving their training, whereas 35.2% casually considered doing so. Poor work-life balance in residency (38.9%) was the single-most important factor, whereas concern about future unemployment (16.7%) and poor future quality of life (15.7%) were next. Enjoyment of work (41.7%) was the most frequent mitigating factor. Harassment and intimidation were reported factors in 16.7%. On analysis, only intention to practice in a nonacademic setting approached significant association with thoughts of leaving (odds ratio = 1.92, CI = 0.99-3.74, p = 0.052). There was no association with sex, program, postgraduate year, relationship status, or subspecialty interest. There was a nonsignificant trend toward more thoughts of leaving with older age. CONCLUSION: Canadian general surgery residents appear less likely to seriously consider quitting than their American counterparts. Poor work-life balance in residency, fear of future unemployment, and anticipated poor future quality of life are significant contributors to thoughts of quitting. Efforts to educate prospective residents about the reality of the surgical lifestyle, and to assist residents in securing employment, may improve completion rates.