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Currently, there is no formal curriculum addressing geriatric oncology within Canadian radiation oncology (RO) residency programs. Knowledge related to geriatric medicine may help radiation oncologists modify RT based on frailty status and geriatric considerations. Understanding specific learning needs allow program coordinators to align the current curriculum with residents’ geriatric oncology learning needs. The purpose of this study is to determine the geriatric oncology educational needs of the Canadian RO residents and to inform Canadian RO residency training. A cross-sectional survey, with Likert, multiple choice, and open-ended questions, was pretested and distributed electronically by program directors to Canadian RO residents over 6 weeks. Responses were analyzed with descriptive statistics and common themes. One-hundred and thirty-five Canadian RO residents were contacted and 63 responded (47%). Half (49%) lacked confidence managing the elderly with multiple comorbidities, polypharmacy, functional and cognitive impairment, and challenging social circumstances;73% agreed additional training would be helpful. Forty-four percent lacked confidence regarding psychogeriatric referrals, fall prevention, palliative and hospice care, and community resources preventing re-hospitalization; 63% agreed additional training would be helpful. Seventy-six percent believed discussion groups, continuing education, geriatric oncology electives, and journal clubs would provide learning opportunities. Seventy-one percent agreed integrating geriatric assessment into RO curricula would improve care. Seventy-nine percent believed geriatric oncology principles have not been adequately integrated into radiation oncology curricula. There are significant gaps specific to geriatric assessment and management of older cancer patients in the current Canadian RO curricula. Most residents agreed that it is important to integrate geriatric oncology training to improve and personalize the care of older cancer patients.

This study explored older women’s perceptions and expectations of the prospective Senior Women’s Breast Cancer Clinic (SWBCC) at Sunnybrook Odette Cancer Centre (SOCC) in Toronto, Ontario, Canada. In our previous studies, older breast cancer patients had expressed a greater need for informational, decisional, and post-treatment support. This study also assessed women’s perspectives on the involvement of geriatricians and incorporation of geriatric assessment in their cancer care. Twelve breast cancer patients aged 68 years or older who were treated at the SOCC participated in the study. We recorded and transcribed 11 interviews and analyzed them using qualitative thematic analysis methods to identify major themes; one interview was excluded due to recording defect. Eight major themes were identified: transportation issues, service, communication between patient and healthcare professionals, communication between healthcare professionals, support during treatment, support after treatment, informational resources, and patient suggestions. Important issues were raised by participants, such as difficulties in arranging transportation to the clinic, barriers in accessing family physician service, and communication breakdown that result in treatment delay and unaddressed complications. In conclusion, there were important gaps in the cancer care of older women with breast cancer that could be detected earlier and better addressed in the new multidisciplinary SWBCC. The participating women were highly supportive of the initiative and made several suggestions on how the clinic could better accommodate their specific needs during and after breast cancer treatment.

The American Society for Radiation Oncology (ASTRO) and American Urological Association (AUA) developed post-prostatectomy radiotherapy (RT) guidelines to aid patient counseling on adjuvant (ART) and salvage radiotherapy (SRT). Our study compared how aware and compliant Canadian radiation oncologists and urologists are to these guidelines. Our online survey was distributed through the Canadian Association of Radiation Oncology (CARO) and Canadian Urology Association (CUA) to radiation oncologists and urologists that treat prostate cancer. We used Wilcoxon rank-sum test and Chi-square test to compare radiation oncologists and urologists. P values for significant findings are reported. A total of 128 participants responded the survey, 52 radiation oncologists, and 76 urologists. The majority (82%) of radiation oncologists had read these guidelines, compared to only 49% of urologists (p < 0.001). Radiation oncologists were more likely to recommend ART >50% for adverse pathological findings post-radical prostatectomy compared to urologists (76 vs. 51%, p = 0.011). Urologists were more likely to monitor their patient’s PSA level post-prostatectomy compared to radiation oncologists (93 vs. 77%, p = 0.016). Post-thematic analysis of open-ended questions revealed that urologists rarely refer patients to radiation oncologists for ART, with radiation oncologists confirming that they rarely receive referrals. This study demonstrates the low compliance to ASTRO/AUA guidelines. While radiation oncologists were more aware and compliant to guidelines, urologists were significantly more likely to monitor their patient’s PSA. This study highlighted the need for better communication between urologists and radiation oncologists, especially in referrals for ART, to facilitate treatment delivery that is concordant with ASTRO/AUA guidelines.

Abstract Objective Caring is a fundamental tenet of healthcare. Caring 'too much' can result in compassion fatigue syndrome and is often linked to burnout and low morale. The objective of this study was to examine compassion fatigue, secondary traumatic stress (STS) and burnout by investigating the relationship between levels of compassion (compassion satisfaction) and STS and burnout. The study also aimed to identify radiation therapist (RTTs) groups who may be at risk for developing (STS) and burnout. Finally, we investigated the level of social support that RTTs receive. Methods RTTs practicing across Canada were invited to participate in an electronic questionnaire. The questionnaire consisted of: demographic information including health-related issues and occupational variables; the Professional Quality of Life Compassion Satisfaction and Fatigue Questionnaire (ProQOL-V) to assess the potential for compassion satisfaction and vulnerability for STS and burnout; and the Multidimensional Scale of Perceived Social Support (MSPSS) to examine the level and sources of social support. A two-way ANOVA was performed to test the statistical significance between varying groups within the study population. A linear regression analysis using potential co-factors was used to test correlations between compassion fatigue, compassion satisfaction and burnout and variables in age, education, years of experience and levels of caring to patients. Results A total of 477 survey responses were received representing a 36% response rate. Results of the regression analyses generally indicate inverse correlations between the risks associated with compassion satisfaction, burnout and STS compared with the independent study variables of age, education, years of experience and levels of caring to patients. It was observed that responses were not linear within subgroups (age groups, education classifications, years of study). Conclusion RTTs practicing in Canada have a substantial social support network and demonstrate high levels of compassion satisfaction in their daily practice. The results of the study indicate that compassion levels are inversely correlated with burnout and compassion fatigue, although some groups may be at higher risk than others. A possible risk catalyst for compassion fatigue and burnout is associated with underdeveloped managerial workplace support programmes.

Providing cancer patients with more information regarding their treatments allows them to feel more in control, increases self efficacy, and can decrease anxiety. The aims of the present study were to develop an interprofessional group education session and to evaluate the usefulness and acceptability of this session. In addition, informational distress levels pre- and post-education were evaluated. A prostate radiation therapy (RT) education session was developed and facilitated by an interprofessional team. Topics discussed included how RT works, side effects and management, and support services available. Prior to the education session, participants reported their informational RT distress levels using the validated Distress Thermometer (DT). Post-education session, the DT was readministered. In addition, participants completed an acceptability survey to assess format, structure, and usefulness of the education session. Participants agreed that the session contained valuable and useful information helping them understand expectations during treatment, including resource availability, side effects and management, as well as procedural expectation during treatment. All stated they would recommend the session to other patients. The interprofessional nature of the sessions was deemed useful. Suggested areas for improvement included addition of a dietitian, information on long-term side effects, statistics of radiotherapy side effects, impact of radiotherapy on sexual function, and overall quality of life. The group education session significantly improved informational distress levels ( p  = 0.04). Educating prostate cancer patients utilizing an interprofessional group format can decrease anxiety and stress related to their RT treatment. Future development of group education sessions for other disease site groups may be valuable.

The treatment of breast cancer presents specifc concerns that are unique to the needs of older female patients. While treatment of early breast cancer does not vary greatly with age, the optimal management of older women with breast cancer often requires complex interdisciplinary supportive care due to multiple comorbidities. This article reviews optimal approaches to breast cancer in women 65 years and older from an interdisciplinary perspective. A literature review was conducted using MEDLINE and EMBASE, choosing articles concentrated on the management of older breast cancer patients from the point of view of several disciplines, including geriatrics, radiation oncology, medical oncology, surgical oncology, psychooncology, palliative care, nursing, and social work. This patient population requires interprofessional collaboration from the time of diagnosis, throughout treatment and into the recovery period. Thus, we recommend an interdisciplinary program dedicated to the treat ment of older women with breast cancer to optimize their cancer care.

Le traitement du cancer du sein soulève des préoccupations précises qui sont uniques aux besoins des patientes plus âgées. Bien que le traitement du cancer du sein au stade précoce de la maladie ne varie que très peu avec l'âge, la prise en charge optimale des patientes plus âgées atteintes de cette maladie exige souvent des soins de soutien interdisciplinaires complexes en raison des multiples comorbidités. Le présent article fait le point sur la conduite thérapeutique optimale pour le cancer du sein chez les femmes de 65 ans et plus dans une perspective interdisciplinaire. Une recension des écrits concernant la prise en charge des patientes plus âgées atteintes d'un cancer du sein a été effectuée dans les bases de données MEDLINE et EMBASE. Le point de vue de plusieurs spécialités a été retenu : gériatrie, radio-oncologie, oncologie médicale, oncologie chirurgicale, psycho-oncologie, soins palliatifs, soins infirmiers et travail social. Ce groupe de patientes nécessite une collaboration interprofessionnelle dès le diagnostic puis pour toute la durée du traitement, jusqu'à la période de rétablissement. Par conséquent, nous recommandons un programme interdisciplinaire spécifique au traitement des patientes plus âgées atteintes d'un cancer du sein pour l'optimisation de leurs soins de santé.

BACKGROUNDSexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can lead to adverse pregnancy and neonatal outcomes. The prevalence of STIs and its association with HIV mother-to-child transmission (MTCT) were evaluated in a substudy analysis from a randomized, multicenter clinical trial. METHODOLOGYUrine samples from HIV-infected pregnant women collected at the time of labor and delivery were tested using polymerase chain reaction testing for the detection of CT and NG (Xpert CT/NG; Cepheid, Sunnyvale, CA). Infant HIV infection was determined by HIV DNA polymerase chain reaction at 3 months. RESULTSOf the 1373 urine specimens, 249 (18.1%) were positive for CT and 63 (4.6%) for NG; 35 (2.5%) had both CT and NG detected. Among 117 cases of HIV MTCT (8.5% transmission), the lowest transmission rate occurred among infants born to CT- and NG-uninfected mothers (8.1%) as compared with those infected with only CT (10.7%) and both CT and NG (14.3%; P = 0.04). Infants born to CT-infected mothers had almost a 1.5-fold increased risk for HIV acquisition (odds ratio, 1.47; 95% confidence interval, 0.9–2.3; P = 0.09). CONCLUSIONSThis cohort of HIV-infected pregnant women is at high risk for infection with CT and NG. Analysis suggests that STIs may predispose to an increased HIV MTCT risk in this high-risk cohort of HIV-infected women.