Early discontinuation of adjuvant chemotherapy in patients with early-stage pancreatic cancer correlates with inferior survival: A multicenter population-based cohort study.

BACKGROUND: The current study aimed to determine the association between timing and completion of adjuvant chemotherapy and outcomes in real-world patients with early-stage pancreatic cancer. METHODS: In this multi-center cohort study patients with early-stage pancreatic cancer who were diagnosed from 2007-2017 and underwent complete resection in the province of Saskatchewan were examined. Cox proportional multivariate analyses were performed for correlation with recurrence and survival. RESULTS: Of 168 patients, 71 eligible patients with median age of 69 years and M:F of 37:34 were identified. Median time to the start of adjuvant therapy from surgery was 73 days. Of all patients, 49 (69%) patients completed adjuvant chemotherapy and 22 (31%) required early treatment discontinuation. Median recurrence-free survival of patients who completed treatment was 22 months (95%CI:15.8-28.2) vs. 9 months (3.3-14.7) if treatment was discontinued early (P<0.001). Median overall survival of those who completed treatment was 33 (17.5-48.5) vs. 16 months (17.5-48.5) with early treatment discontinuation (P<0.001). In the multivariate analysis, treatment discontinuation was significantly correlated with recurrent disease, hazard ratio (HR), 2.57 (1.41-4.68), P = 0.002 and inferior survival, HR, 2.55 (1.39-4.68), P = 0.003. No correlation between treatment timing and survival was noted. CONCLUSIONS: Early discontinuation but not the timing of adjuvant chemotherapy correlates with inferior outcomes.

Towards a better understanding of medical students' mentorship needs: a self-determination theory perspective.

INTRODUCTION: Mentorship programs are ubiquitous in medical education. However, few emphasize equal development for learners and mentors, or incorporate clinical skills, which may be important for promoting medical students' self-determination. Central to this consideration are the three basic psychological needs for autonomy, competence, and relatedness, described by Self-Determination Theory (SDT). Grounded in SDT, this study assesses the extent that meeting these needs, in a near-peer mentoring program, impacts learners' and mentors' motivation and perceived competence about learning and teaching of clinical knowledge, respectively. METHODS: Medical students from the University of Saskatchewan, who participated in its near-peer mentoring program (PULSE: Peers United in Leadership & Skills Enhancement), were invited to complete an anonymous survey. Regression was used to determine how the program's learning climate impacted learners' and mentors' psychological need satisfaction and perceived competence within their mentorship role. RESULTS: Learners and mentors both rated PULSE as highly needs-satisfying. In turn, this was associated with greater perceived competence about learning and teaching of the material. CONCLUSIONS: Findings from this study suggest that mentoring programs in medical education, which support learners' basic psychological needs, may promote their motivation and perceived competence-both about learning and also teaching of clinical skills. The implications of these results are discussed from an SDT perspective, with respect to mentoring programs in medical education.

INTRODUCTION: Les programmes de mentorat sont très répandus en éducation médicale. Ceux qui mettent l'accent sur un statut égal des apprenants et des mentors ou qui intègrent des compétences cliniques pouvant favoriser l'autodétermination des étudiants en médecine sont toutefois rares. Les trois besoins psychologiques fondamentaux décrits par la théorie de l'autodétermination (TAD), à savoir l'autonomie, la compétence et l'appartenance, sont au cœur de cette préoccupation. Fondée sur la théorie de l'autodétermination, la présente étude évalue dans quelle mesure la satisfaction de ces besoins, dans le cadre d'un programme de mentorat par les quasi-pairs, a un impact sur la motivation et la compétence perçue des apprenants et des mentors en matière d'apprentissage et d'enseignement des connaissances cliniques. MÉTHODES: Les étudiants en médecine de l'Université de Saskatchewan, qui ont participé au programme de mentorat par les quasi-pairs (PULSE: Peers United in Leadership & Skills Enhancement), ont été invités à remplir de façon anonyme un sondage. Des analyses de régression ont été réalisées pour déterminer l'impact du climat d'apprentissage dans le programme sur la satisfaction des besoins psychologiques des apprenants et des mentors et sur la compétence perçue de ces derniers dans leur rôle de mentors. RÉSULTATS: Les apprenants et les mentors ont estimé PULSE comme hautement satisfaisant pour leurs besoins. Cela a été associé à une plus grande compétence perçue en ce qui concerne l'apprentissage et l'enseignement des contenus. CONCLUSIONS: Les résultats de cette étude suggèrent que les programmes de mentorat en éducation médicale qui soutiennent les besoins psychologiques fondamentaux des apprenants peuvent renforcer leur motivation et leur compétence perçue, à la fois pour l'apprentissage et pour l'enseignement des compétences cliniques. Les incidences de ces résultats pour les programmes de mentorat par les pairs en éducation médicale sont analysées du point de vue de la TAD.