Survivorship programs and care planning.

Formal cancer survivorship care is a growing focus internationally. This article provides a broad overview of the national strategies currently in progress for the development of survivorship programs and care plans within the United States and across Europe. The different approaches taken in their implementation, staffing, and clinical focus are highlighted, with an emphasis on how they are incorporated into various models of care. The considerable variation in making survivorship a formal period of care across countries and health care systems is discussed, including the factors influencing these differences. A review of research focused on the evaluation of definitions and outcomes is provided along with a discussion of important areas requiring future research.

Structured gastroenterological intervention and improved outcome for patients with chronic gastrointestinal symptoms following pelvic radiotherapy.

PURPOSE: Fifty percent of patients develop chronic gastrointestinal (GI) symptoms following pelvic radiotherapy that adversely affect quality of life. Fewer than 20 % are referred to a gastroenterologist. We aimed to determine if structured gastroenterological evaluation is of benefit to this patient group. METHODS: Sixty patients with GI symptoms at ≥ 6 months after radical pelvic radiotherapy were identified prospectively from oncology clinics in this service evaluation. Those requiring urgent investigation were excluded. Patients were assessed at baseline using patient-reported questionnaires: inflammatory bowel disease questionnaire (IBDQ), Vaizey incontinence questionnaire, and the Common Terminology Criteria for Adverse Events (CTCAE) pelvis questionnaire. Participants were referred for gastroenterological evaluation using an algorithmic approach. Further assessments were made at 3 and 6 months. RESULTS: Twenty men and 36 women with primary gynecological (31), urological (17), or lower GI (8) tumors were included (mean age, 58.5 years). Median time from radiotherapy to baseline assessment was 3.0 years. Multiple GI symptoms were reported (median, 8; range, 4-16) including frequency, urgency, loose stool, fecal incontinence, flatulence, bloating/distension, and rectal bleeding. Common diagnoses included radiation proctopathy, bile acid malabsorption, diverticulosis, and colonic polyps. Statistically significant improvements in all questionnaire scores between baseline and 6 months were found: IBDQ (p = 0.014), Vaizey (p < 0.0005), and CTCAE rectum-bowel subset (p = 0.001). CONCLUSIONS: Gastroenterological evaluation identifies significant, potentially treatable diagnoses in patients who develop chronic GI symptoms following pelvic radiotherapy. Some findings are incidental and unrelated to previous cancer treatment. Radiation-induced GI symptoms have historically been considered "untreatable." We report the first data to show that structured gastroenterological assessment has the potential to improve outcome by identifying diagnoses and facilitating focused treatment.

Occupational stress in palliative medicine, medical oncology and clinical oncology specialist registrars.

A cross-sectional complete enumeration postal survey was conducted to compare stress levels between specialist registrars (SpRs) in palliative medicine, clinical oncology and medical oncology. Four hundred and one UK-registered SpRs responded (response rate 63.1%). Levels of psychological distress and depression were measured by GHQ-12 and SCL-D: 102/390 (26.2%, 95% confidence interval (CI) = 21.8-30.5%)) scored > 3 on GHQ-12 indicating psychological distress, 44/391 (11.3%, 95% CI = 8.1-14.4%) scored > or = 1.5 on SCL-D indicative of depression. Suicidal ideation was indicated by 15 responders. There were no significant differences between specialties. The effect of stress on personal or family life was the dominant predictor of both psychological distress and depression, although dissatisfaction with choice of specialty and feeling underutilised also contributed. One in four SpRs experience stress. These results are similar to studies of general practitioner principals and consultants from other specialties. Stress needs to be managed if doctors are to survive professional life.