Publications by authors named "Reshma Jagsi"

424 Publications

Comparative Effectiveness Analysis of 3D-Conformal Radiotherapy versus Intensity Modulated Radiotherapy (IMRT) in a Prospective Multicenter Cohort of Breast Cancer Patients.

Int J Radiat Oncol Biol Phys 2021 Oct 8. Epub 2021 Oct 8.

University of Michigan, Ann Arbor, MI.

Purpose: Simple intensity modulation of radiation therapy reduces acute toxicity compared to two-dimensional techniques in adjuvant breast cancer treatment, but it remains unknown whether more complex or inverse-planned intensity modulated radiotherapy (IMRT) offers an advantage over forward-planned, three-dimensional conformal radiotherapy (3DCRT).

Methods And Materials: Using prospective data regarding patients receiving adjuvant whole breast RT without nodal irradiation at 23 institutions from 2011-2018, we compared incidence of acute toxicity (moderate-severe pain or moist desquamation) in patients receiving 3DCRT versus IMRT (either inverse planned or, if forward-planned, using ≥5 segments per gantry angle).  We evaluated associations between technique and toxicity using multivariable models with inverse-probability-of-treatment weighting (IPTW), adjusting for treatment facility as a random effect.

Results: Of 1,185 patients treated with 3DCRT and conventional fractionation, 650 (54.9%) experienced acute toxicity; of 774 treated with highly-segmented forward-planned IMRT, 458 (59.2%) did; of 580 treated with inverse-planned IMRT, 245 (42.2%) did.  Of 1,296 patients treated with hypofractionation and 3DCRT 432 (33.3%) experienced acute toxicity; of 709 treated with highly-segmented forward-planned IMRT, 227 (32.0%) did; of 623 treated with inverse-planned IMRT, 164 (26.3%) did. On multivariable analysis with IPTW, the odds ratio for acute toxicity after inverse-planned IMRT versus 3DCRT was 0.64 (95% CI, 0.45-0.91) with conventional fractionation and 0.41 (95% CI, 0.26-0.65) with hypofractionation.

Conclusions: This large, prospective, multicenter comparative effectiveness study found a significant benefit from inverse-planned IMRT compared to 3DCRT in reducing acute toxicity of breast radiotherapy. Future research should identify the dosimetric differences that mediate this association and evaluate cost-effectiveness.
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http://dx.doi.org/10.1016/j.ijrobp.2021.09.053DOI Listing
October 2021

A Delphi study and International Consensus Recommendations: The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer.

Radiother Oncol 2021 Sep 24;164:115-121. Epub 2021 Sep 24.

Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.

Bolus serves as a tissue equivalent material that shifts the 95-100% isodose line towards the skin and subcutaneous tissue. The need for bolus for all breast cancer patients planned for postmastectomy radiation therapy (PMRT) has been questioned. The work was initiated by the faculty of the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer courses and represents a multidisciplinary international breast cancer expert collaboration to optimize PMRT. Due to the lack of randomised trials evaluating the benefits of bolus, we designed a stepwise project to evaluate the existing evidence about the use of bolus in the setting of PMRT to achieve an international consensus for the indications of bolus in PMRT, based on the Delphi method.
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http://dx.doi.org/10.1016/j.radonc.2021.09.012DOI Listing
September 2021

NCCN Guidelines® Insights: Older Adult Oncology, Version 1.2021.

J Natl Compr Canc Netw 2021 09 20;19(9):1006-1019. Epub 2021 Sep 20.

National Comprehensive Cancer Network.

The NCCN Guidelines for Older Adult Oncology address specific issues related to the management of cancer in older adults, including screening and comprehensive geriatric assessment (CGA), assessing the risks and benefits of treatment, preventing or decreasing complications from therapy, and managing patients deemed to be at high risk for treatment-related toxicity. CGA is a multidisciplinary, in-depth evaluation that assesses the objective health of the older adult while evaluating multiple domains, which may affect cancer prognosis and treatment choices. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines providing specific practical framework for the use of CGA when evaluating older adults with cancer.
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http://dx.doi.org/10.6004/jnccn.2021.0043DOI Listing
September 2021

Cardiac Magnetic Resonance Imaging and Blood Biomarkers for Evaluation of Radiation-Induced Cardiotoxicity in Patients With Breast Cancer: Results of a Phase 2 Clinical Trial.

Int J Radiat Oncol Biol Phys 2021 Sep 9. Epub 2021 Sep 9.

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan. Electronic address:

Purpose: Radiation therapy (RT) can increase the risk of cardiac events in patients with breast cancer (BC), but biomarkers predicting risk for developing RT-induced cardiac disease are currently lacking. We report results from a prospective clinical trial evaluating early magnetic resonance imaging (MRI) and serum biomarker changes as predictors of cardiac injury and risk of subsequent cardiac events after RT for left-sided disease.

Methods: Women with node-negative and node-positive (N-/+) left-sided BC were enrolled on 2 institutional review board (IRB)-approved protocols at 2 institutions. MRI was conducted pretreatment (within 1 week of starting radiation), at the end of treatment (last day of treatment ±1 week), and 3 months after the last day of treatment (±2 weeks) to quantify left and right ventricular volumes and function, myocardial fibrosis, and edema. Perfusion changes during regadenoson stress perfusion were also assessed on a subset of patients (n = 28). Serum was collected at the same time points. Whole heart and cardiac substructures were contoured using CT and MRI. Models were constructed using baseline cardiac and clinical risk factors. Associations between MRI-measured changes and dose were evaluated.

Results: Among 51 women enrolled, mean heart dose ranged from 0.80 to 4.7 Gy and mean left ventricular (LV) dose from 1.1 to 8.2 Gy, with mean heart dose 2.0 Gy. T1 time, a marker of fibrosis, and right ventricular (RV) ejection fraction (EF) significantly changed with treatment; these were not dose dependent. T2 (marker of edema) and LV EF did not significantly change. No risk factors were associated with baseline global perfusion. Prior receipt of doxorubicin was marginally associated with decreased myocardial perfusion after RT (P = .059), and mean MHD was not associated with perfusion changes. A significant correlation between baseline IL-6 and mean heart dose (MHD) at the end of RT (ρ 0.44, P = .007) and a strong trend between troponin I and MHD at 3 months post-treatment (ρ 0.33, P = .07) were observed. No other significant correlations were identified.

Conclusions: In this prospective study of women with left-sided breast cancer treated with contemporary treatment planning, cardiac radiation doses were very low relative to historical doses reported by Darby et al. Although we observed significant changes in T1 and RV EF shortly after RT, these changes were not correlated with whole heart or substructure doses. Serum biomarker analysis of cardiac injury demonstrates an interesting trend between markers and MHD that warrants further investigation.
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http://dx.doi.org/10.1016/j.ijrobp.2021.08.039DOI Listing
September 2021

Mentoring Underrepresented Minority Physician-Scientists to Success.

Acad Med 2021 Sep 7. Epub 2021 Sep 7.

A. Kalet is professor and Stephen and Shelagh Roell Endowed Chair, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Wauwatosa, Wisconsin; ORCID: https://orcid.org/0000-0003-4855-0223. A.M. Libby is professor and vice chair for academic affairs, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-4564-9407. R. Jagsi is Newman Family Professor and deputy chair, Department of Radiation Oncology, and director, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-6562-1228. K. Brady is professor and vice president for research, Medical University of South Carolina, Charleston, South Carolina; ORCID: https://orcid.org/0000-0002-3944-8051. D. Chavis-Keeling is executive director, Administration, Finance, and Operations, Clinical and Translational Science Institute, and director, Administrative Core, Clinical and Translational Science Award, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-1528-8532. M.H. Pillinger is professor of medicine and director, Translational Research Education and Careers Unit, Clinical and Translational Science Institute, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0003-3168-1542. G.L. Daumit is Samsung Professor of Medicine and vice chair, Clinical and Translational Research, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-0717-0216. A.F. Drake is Newton D. Fischer Distinguished Professor of Otolaryngology/Head and Neck Surgery, director, University of North Carolina Craniofacial Center (School of Dentistry), and executive associate dean of academic programs, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. W.P. Drake is professor of medicine and pathology, microbiology, and immunology, Robert A. Goodwin Jr. Director in Medicine, and director, Sarcoidosis Center of Excellence, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0001-9406-3130. V. Fraser is Adolphus Busch Professor of Medicine and chair, Department of Medicine, Washington University School of Medicine, Washington University, St. Louis, Missouri; ORCID: https://orcid.org/0000-0001-6251-0733. D. Ford is professor of medicine and director, Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, Maryland. J.S. Hochman is Harold Snyder Family Professor of Cardiology, associate director, Leon H Charney Division of Cardiology, senior associate dean for clinical sciences, and codirector, Clinical and Translational Science Institute, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-5889-5981. R.D. Jones is a research area specialist intermediate, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan. C. Mangurian is professor of psychiatry, epidemiology, and biostatistics, and vice chair for diversity and health equity, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (UCSF), Weill Institute for Neurosciences, affiliate faculty, UCSF Philip R. Lee Institute for Health Policy Studies, director, UCSF Public Psychiatry Fellowship at Zuckerberg San Franciso General Hospital (ZSFG), and core faculty, UCSF Center for Vulnerable Populations at ZSFG, San Francisco, California; ORCID: https://orcid.org/0000-0002-9839-652X. E.A. Meagher is professor, medicine and pharmacology, and vice dean and chief clinical research officer, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-1841-4570. G. McGuinness is professor and vice chair of academic affairs, senior vice chair of radiology, associate dean for mentoring and professional development, and director, clinical faculty mentoring, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-5326-9180. J.G. Regensteiner is professor, Judith and Joseph Wagner Chair in Women's Health Research, director, Center for Women's Health Research, and director, Office of Women in Medicine and Science, University of Colorado School of Medicine, Aurora Colorado; ORCID: https://orcid.org/0000-0002-9331-3908. D.C. Rubin is William B. Kountz Professor of Medicine, professor of developmental biology, and associate director of faculty affairs, Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri; ORCID: https://orcid.org/0000-0002-4192-909X. K. Yaffe is professor of psychiatry, neurology, and epidemiology, University of California, San Franciso, Weill Institute for Neurosciences, and Roy and Marie Scola Endowed Chair and vice chair of research in psychiatry, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0003-0919-3825. J.E. Ravenell is associate professor, Departments of Population Health and Internal Medicine, associate dean for diversity affairs and inclusion, and director, Diversity in Research, Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0001-7024-3460.

As the nation seeks to recruit and retain physician-scientists, gaps remain in understanding and addressing mitigatable challenges to the success of faculty from underrepresented minority (URM) backgrounds. The Doris Duke Charitable Foundation Fund to Retain Clinical Scientists (FRCS) program, implemented in 2015 at 10 academic medical centers in the United States, seeks to retain physician-scientists at risk of leaving science because of periods of extraordinary family-caregiving needs, hardships that URM faculty-especially those who identify as female-are more likely to experience. At the annual FRCS program directors conference in 2018, program directors-21% of whom identify as URM individuals and 13% as male-addressed issues that affect URM physician-scientists in particular. Key issues that threaten the retention of URM physician-scientists were identified through focused literature reviews; institutional environmental scans; and structured small- and large-group discussions with program directors, staff, and participants. These issues include bias and discrimination, personal wealth differential, the minority tax (i.e., service burdens placed on URM faculty who represent URM perspectives on committees and at conferences), lack of mentorship training, intersectionality and isolation, concerns about confirming stereotypes, and institutional-level factors. The authors present recommendations for how to create an environment in which URM physician-scientists can expect equitable opportunities to thrive, as institutions demonstrate proactive allyship and removal of structural barriers to success. Recommendations include providing universal training to reduce interpersonal bias and discrimination, addressing the consequences of the personal wealth gap through financial counseling and benefits, measuring the service faculty members provide to the institution as advocates for URM faculty issues and compensating them appropriately, supporting URM faculty who wish to engage in national leadership programs, and sustaining institutional policies that address structural and interpersonal barriers to inclusive excellence.
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http://dx.doi.org/10.1097/ACM.0000000000004402DOI Listing
September 2021

Financial Toxicity in Breast Reconstruction: A National Survey of Women Who have Undergone Breast Reconstruction After Mastectomy.

Ann Surg Oncol 2021 Sep 3. Epub 2021 Sep 3.

Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.

Background: Despite awareness regarding financial toxicity in breast cancer care, little is known about the financial strain associated with breast reconstruction. This study aims to describe financial toxicity and identify factors independently associated with financial toxicity for women pursuing post-mastectomy breast reconstruction.

Methods: A 33-item electronic survey was distributed to members of the Love Research Army. Women over 18 years of age and at least 1 year after post-mastectomy breast reconstruction were invited to participate. The primary outcome of interest was self-reported financial toxicity due to breast reconstruction, while secondary outcomes of interest were patient-reported out-of-pocket expenses and impact of financial toxicity on surgical decision making.

Results: In total, 922 women were included (mean age 58.6 years, standard deviation 10.3 years); 216 women (23.8%) reported financial toxicity from reconstruction. These women had significantly greater out-of-pocket medical expenses. When compared with women who did not experience financial toxicity, those who did were more likely to have debt due to reconstruction (50.9% vs. 3.2%, p < 0.001). Younger age, lower annual household income, greater out-of-pocket expenses, and a postoperative major complication were independently associated with an increased risk for financial toxicity. If faced with the same decision, women experiencing financial toxicity were more likely to decide against reconstruction (p < 0.001) compared with women not experiencing financial toxicity.

Conclusions: Nearly one in four women experienced financial toxicity from breast reconstruction. Women who reported higher levels of financial toxicity were more likely to change their decisions about surgery. Identified factors predictive of financial toxicity could guide preoperative discussions to inform decision making that mitigates undesired financial decline.
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http://dx.doi.org/10.1245/s10434-021-10708-5DOI Listing
September 2021

Insights from an Intervention to Support Early Career Faculty with Extraprofessional Caregiving Responsibilities.

Womens Health Rep (New Rochelle) 2021 23;2(1):355-368. Epub 2021 Aug 23.

Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Insufficient support for balancing career and family responsibilities hinders retention of physician-scientists. Programs to improve retention of this important group of faculty are crucial. Understanding the experiences of program implementers is key to refining and improving program offerings. We conducted an interpretive, descriptive, and qualitative study as part of an ongoing evaluation of the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists (FRCS) awards. We conducted telephone interviews with 12 program directors representing all 10 US medical schools who received the Doris Duke funding in 2016. Of the 12 participants, 10 were women (83.3%). Participating program directors perceived the FRCS award as capable of producing paradigmatic changes regarding how responsibilities at home and work in academic medicine are viewed and integrated by early-career faculty members. The main qualitative themes that captured directors' experiences implementing the program were as follows: (1) championing a new paradigm of support, (2) lessons learned while implementing the new paradigm, (3) results of the new paradigm, and (4) sustaining the paradigm. These findings may help to inform development of similar programs to retain and support the career progress of physician-scientists with extraprofessional caregiving responsibilities. The interviews illuminate ways in which the Doris Duke FRCS award has driven institutional culture change by normalizing discussion and prompted reassessment of extraprofessional challenges and how best to aid early-career faculty members in overcoming these challenges.
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http://dx.doi.org/10.1089/whr.2021.0018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409229PMC
August 2021

ASO Visual Abstract: Financial Toxicity in Breast Reconstruction: A National Survey of Women Who Have Undergone Breast Reconstruction After Mastectomy.

Ann Surg Oncol 2021 Aug 30. Epub 2021 Aug 30.

Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.

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http://dx.doi.org/10.1245/s10434-021-10722-7DOI Listing
August 2021

Institutional imperatives for the advancement of women in medicine and science through the COVID-19 pandemic.

Lancet 2021 09 24;398(10304):937-939. Epub 2021 Aug 24.

Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.

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http://dx.doi.org/10.1016/S0140-6736(21)01912-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455349PMC
September 2021

Mitigating Implicit Bias in Radiation Oncology.

Adv Radiat Oncol 2021 Sep-Oct;6(5):100738. Epub 2021 Jun 24.

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.

Implicit bias is one of the most insidious and least recognizable mechanisms that can cause inequity and disparities. There is increasing evidence that both implicit and explicit biases have a negative effect on patient outcomes and patient-physician relationships. Given the impact of Implicit bias, a joint session between ASTROs Committee on Health Equity, Diversity, and Inclusion and the National Cancer Institute (the ASTRO-National Cancer Institute Diversity Symposium) was held during the American Society of Radiation Oncology (ASTRO) 2020 Annual Meeting, to address the effect of implicit bias in radiation oncology through real life and synthesized hypothetical scenario discussions. Given the value of this session to the radiation oncology community, the scenarios and discussion are summarized in this manuscript. Our goal is to heighten awareness of the multiple settings in which implicit bias can occur as well as discuss resources to address bias.
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http://dx.doi.org/10.1016/j.adro.2021.100738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339323PMC
June 2021

Disparities in older adult accrual to cancer trials: Analysis from the alliance for clinical trials in oncology (A151736).

J Geriatr Oncol 2021 Aug 4. Epub 2021 Aug 4.

Mayo Clinic, Rochester, MN, United States of America.

Background: Older adults are under-represented in cancer clinical trials. However, it remains unclear which types of trials under-enroll aging patients. We aimed to identify associations between trial characteristics and disparate enrollment of older adults onto trials sponsored by the Alliance for Clinical Trials in Oncology (Alliance).

Methods: Actual age ≥ 65 percentage and trial data were extracted from the Alliance closed study list. Each trial, based on its cancer type and years of enrollment, was assigned an expected age ≥ 65 percentage extracted from the Surveillance, Epidemiology, and End Results (SEER) US population-based database. Enrollment disparity difference (EDD), the difference between the expected age ≥ 65 percentage and the actual age ≥ 65 percentage, was calculated for each trial. Linear regression determined trial variables associated with larger EDDs and variables with an overall association p-value <0.20 were included in a multivariable fixed-effects linear model.

Results: The median age of 66,708 patients across 237 trials was 60 years (range 18-102). The average actual age ≥ 65 percentage enrolled per trial was lower than each trial's expected age ≥ 65 percentage average (39% vs. 58%; EDD 19, 95% CI 17.1-21.3%, p < 0.0001). In multivariable analyses, non-genitourinary (GU) cancer types (p < 0.001), trimodality+ trials (estimate 8.78, 95%CI 2.21-15.34, p = 0.009), and phase 2 trials (estimate 4.43 95% CI -0.06-8.91; p = 0.05) were all associated with larger EDDs.

Conclusions: Disparate enrollment of older adults is not equal across cancer trials. Future strategies to improve older adult inclusion should focus on trial types associated with the highest disparate enrollment.
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http://dx.doi.org/10.1016/j.jgo.2021.07.008DOI Listing
August 2021

"I'm Being Forced to Make Decisions I Have Never Had to Make Before": Oncologists' Experiences of Caring for Seriously Ill Persons With Poor Prognoses and the Dilemmas Created by COVID-19.

JCO Oncol Pract 2021 Jul 29:OP2100119. Epub 2021 Jul 29.

Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI.

Purpose: The COVID-19 pandemic has created a new set of problems for clinicians. This study examines the experiences of oncologists providing care to seriously ill persons near the end of life in the context of the COVID-19 pandemic.

Methods: Between January 2020 and August 2020, we conducted semistructured, in-depth individual interviews with 22 purposefully sampled oncologists from practices enrolled in the Michigan Oncology Quality Consortium. Deidentified transcripts of the interviews were examined using thematic analysis.

Results: Our respondents described several novel problems created by the COVID-19 pandemic, including: (1) ethical challenges, (2) the need to manage uncertainty-physically and emotionally-on the part of both patients and oncologists, and (3) the difficulty of integrating technology and communication for seriously ill persons. These problems were made more complex by features of the pandemic: resource scarcity (and the need to fairly allocate poor resources), delays in care, high levels of fear, and the increased importance of advance care planning. Nonabandonment served as a way to cope with increased stress, and the use of telemedicine became an increasingly important medium of communication.

Conclusion: This study offers an in-depth exploration of the problems faced by oncologists as a result of the COVID-19 pandemic and how they navigated them. Optimal decision making for seriously ill persons with cancer during the COVID-19 pandemic must include open acknowledgment of the ethical challenges involved, the emotions experienced by both patients and their oncologists, and the urgent need to integrate technology with compassionate communication in determining patient preferences.
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http://dx.doi.org/10.1200/OP.21.00119DOI Listing
July 2021

Gender Differences in Work-Life Integration Among Medical Physicists.

Adv Radiat Oncol 2021 Sep-Oct;6(5):100724. Epub 2021 May 28.

Department of Radiation Oncology, Michigan Medicine, Ann Arbor, Michigan.

Purpose: To generate an understanding of the primary concerns facing medical physicists regarding integration of a demanding technical career with their personal lives.

Methods And Materials: In 2019, we recruited 32 medical physics residents, faculty, and staff via emails to US medical physics residency program directors to participate in a 1-hour, semistructured interview that elicited their thoughts on several topics, including work-life integration. Standard techniques of qualitative thematic analysis were used to generate the research findings.

Results: Of the participants, 50% were women and 69% were non-Hispanic White individuals, with a mean (SD) age of 37.5 (7.4) years. They were evenly split between residents and faculty or staff. Participant responses centered around 5 primary themes: the gendered distribution of household responsibilities, the effect of career or work on home and family life, the effect of family on career or work, support and strategies for reconciling work-life conflicts, and the role of professional societies in addressing work-life integration. Participants expressed concern about the effect of heavy workloads on home life, with female respondents more likely to report carrying the majority of the household burden.

Conclusions: Medical physicists experience challenges in managing work-life conflict amid a diverse array of personal and professional responsibilities. Further investigations are needed to quantitatively assess the division of work and household labor by gender in medical physics, particularly after the outbreak of the COVID-19 pandemic, but this study's qualitative findings suggest that the profession should consider ways to address root causes of work-life conflict to promote the future success and well-being of all medical physicists, and perhaps women in particular.
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http://dx.doi.org/10.1016/j.adro.2021.100724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260998PMC
May 2021

Financial Toxicity During Breast Cancer Treatment: A Qualitative Analysis to Inform Strategies for Mitigation.

JCO Oncol Pract 2021 Oct 12;17(10):e1413-e1423. Epub 2021 Jul 12.

Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.

Purpose: Financial toxicity from cancer treatment is a growing concern. Its impact on patients requires refining our understanding of this phenomenon. We sought to characterize patients' experiences of financial toxicity in the context of an established framework to identify knowledge gaps and strategies for mitigation.

Methods: Semistructured interviews with patients with breast cancer who received financial aid from a philanthropic organization during treatment were conducted from February to May 2020. Interviews were transcribed and coded until thematic saturation was reached, and findings were contextualized within an existing financial toxicity framework.

Results: Thirty-two patients were interviewed, of whom 58% were non-Hispanic White. The mean age was 46 years. Diagnoses ranged from ductal carcinoma in situ to metastatic breast cancer. Concordant with an established framework, we found that direct and indirect costs determined objective financial burden and subjective financial distress stemmed from psychosocial, behavioral, and material impact of diagnosis and treatment. We identified expectations as a novel theme affecting financial toxicity. We identified knowledge gaps in treatment expectations, provider conversations, identification of resources, and support-finding and offer strategies for mitigating financial toxicity on the basis of participant responses, such as leveraging support from decision aids and allied providers.

Conclusion: This qualitative study confirms an existing framework for understanding financial toxicity and identifies treatment expectations as a novel theme affecting both objective financial burden and subjective financial distress. Four knowledge gaps are identified, and strategies for mitigating financial toxicity are offered. Mitigating patients' financial toxicity is an important unmet need in optimizing cancer treatment.
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http://dx.doi.org/10.1200/OP.21.00182DOI Listing
October 2021

Speaker Introductions at Grand Rounds: Differences in Formality of Address by Gender and Specialty.

J Womens Health (Larchmt) 2021 Jul 1. Epub 2021 Jul 1.

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.

Despite increasing representation of women in medicine, gender bias remains pervasive. The authors sought to evaluate speaker introductions by gender in the grand rounds of multiple specialties at a large academic institution to understand the cultural context of this behavior and identify predictors of formality. The authors reviewed grand rounds recordings of speakers with doctorates presenting to the departments of family medicine, general surgery, internal medicine, obstetrics and gynecology, and pediatrics at one institution from 2014 to 2019. The primary outcome was whether a speaker's professional title was used as the first form of address. The authors assessed factors correlated with professional introduction using multivariable logistic regression. Speakers were introduced professionally in 346/615 recordings (56.3%). Female introducers were more likely to introduce speakers professionally (odds ratio [OR]: 2.52). A significant interaction existed between speaker gender and home institution: female speakers visiting from an external institution were less likely than male external speakers to be introduced professionally (OR: 0.49), whereas female speakers internal to the institution were more likely to be introduced professionally than male internal speakers (OR: 1.75). Use of professional titles varied by specialty and was higher than average for family medicine (83.2%), surgery (75.8%), and pediatrics (64.0%) and lower for internal medicine (37.5%) and obstetrics and gynecology (50.7%). These findings suggest a complex relationship between gender and formality of introduction that merits further investigation. Understanding differences in culture across specialties is important to inform efforts to promote equity.
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http://dx.doi.org/10.1089/jwh.2021.0031DOI Listing
July 2021

Perception of Medical Student Mistreatment: Does Specialty Matter?

Acad Med 2021 Jun 29. Epub 2021 Jun 29.

K.E. O'Brien is a professor, Division of General Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida; ORCID: https://orcid.org/0000-0003-3293-7458. A.J. Mechaber is professor emeritus, University of Miami Leonard Miller School of Medicine, Miami, Florida. C.H. Ledford is a professor and associate dean, Undergraduate Clinical Education, Oakland University William Beaumont School of Medicine, Rochester, Michigan. F.A. Klocksieben is a statistical data analyst, Research Methodology and Biostatistics Core, University of South Florida Morsani College of Medicine, Tampa, Florida; ORCID: https://orcid.org/0000-0003-0576-3771. M.J. Fagan is a professor of medicine, emeritus, Alpert Medical School of Brown University, Providence, Rhode Island. H.E. Harrell is a professor of medicine, University of Florida College of Medicine, Gainesville, Florida. S. Kaib is an associate professor and associate dean, Student Affairs, Department of Family, Community, and Preventive Medicine, University of Arizona-Phoenix College of Medicine, Phoenix, Arizona. M. Elnicki is a professor of medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. R. Van Deusen is an associate professor of medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. S. Moerdler is an assistant professor, Department of Pediatrics, Division of Hematology/Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. R. Jagsi is a professor, deputy chair, Department of Radiation Oncology, and director, Center for Bioethics and Social Sciences in Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan. E. Frank is a professor and the Canada Research Chair in Preventive Medicine and Population Health, University of British Columbia, Vancouver, British Columbia, Canada.

Purpose: Medical student mistreatment is pervasive, yet whether all physicians have a shared understanding of the problem is unclear. The authors presented professionally designed trigger videos to physicians from six different specialties to determine if they perceive mistreatment and its severity similarly.

Method: From October 2016 to August 2018, resident and attending physicians from 10 U.S. medical schools viewed five trigger videos showing behaviors that could be perceived as mistreatment. They completed a survey exploring their perceptions. The authors compared perceptions of mistreatment across specialties and, for each scenario, evaluated the relationship between specialty and perception of mistreatment.

Results: Six-hundred and fifty resident and attending physicians participated. There were statistically significant differences in perception of mistreatment across specialties for three of the five scenarios: aggressive questioning (range 74.1%-91.2%), negative feedback (range 25.4%-63.7%), and assignment of inappropriate tasks (range 5.5%-25.5%) (P ≤ .001, for all). After adjusting for gender, race, professional role, and prior mistreatment, physicians in surgery viewed three scenarios (aggressive questioning, negative feedback, inappropriate tasks) as less likely to represent mistreatment compared to internal medicine physicians. Physicians from obstetrics and gynecology and from "other" specialties perceived less mistreatment in two scenarios (aggressive questioning, negative feedback) while family physicians perceived more mistreatment in one scenario (negative feedback) compared to internal medicine physicians. The mean severity of perceived mistreatment on a 1 to 7 scale (7 most serious) also varied statistically significantly across the specialties for three scenarios: aggressive questioning (range 4.4-5.4, P < .001), ethnic insensitivity (range 5.1-6.1, P = .001), and sexual harassment (range 5.5-6.3, P = .004).

Conclusions: Specialty was associated with differences in the perception of mistreatment and in the rating of its severity. Further investigation is needed to understand why these perceptions of mistreatment vary among specialties and how to address these differences.
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http://dx.doi.org/10.1097/ACM.0000000000004223DOI Listing
June 2021

Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine: A Systematic Review and Meta-analysis.

JAMA Netw Open 2021 Jun 1;4(6):e2112404. Epub 2021 Jun 1.

Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania.

Importance: Despite equal numbers of men and women entering medical school, women are underrepresented in the upper echelons of academic medicine and receive less compensation and research funding. Citation-related publication productivity metrics, such as the h-index, are increasingly used for hiring, salary, grants, retention, promotion, and tenure decisions. Exploring sex differences in these metrics across academic medicine provides deeper insight into why differences are observed in career outcomes.

Objective: To systematically examine the available literature on sex differences in h-index of academic faculty physicians across all medical specialties and all levels of academic rank.

Data Sources: Medical literature with the term h-index found in PubMed and published between January 1, 2009, and December 31, 2018, was used.

Study Selection: A PICOS (Population, Intervention, Comparison, and Outcomes), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and MOOSE (Meta-analysis of Observational Studies in Epidemiology) selection protocol was used to find observational studies that published h-indexes for faculty physicians that were stratified by sex. Studies were excluded if they were review articles, retracted, or unavailable online. Ultimately, 14 of 786 studies (1.78%) met the inclusion criteria.

Data Extraction And Synthesis: Data from 9 studies across 16 specialties were examined using weighted random-effects meta-analyses. Five studies were excluded because of overlapping specialties with another study or because they were missing appropriate statistics for the meta-analysis. Four of these studies were included in qualitative synthesis to bring the total to 13 studies.

Main Outcomes And Measures: The primary study outcome was the h-index.

Results: The meta-analysis included 10 665 North American unique academic physicians across 9 different studies from the years 2009 to 2018. Of the 10 665 physicians, 2655 (24.89%) were women. Summary effect sizes for mean h-indexes of men and women and mean h-index difference between men and women were determined for all faculty physicians and at each academic rank. Overall, female faculty had lower h-indexes than male faculty (mean difference, -4.09; 95% CI, -5.44 to -2.73; P < .001). When adjusting for academic rank, female faculty still had lower h-indexes than male faculty at the ranks of assistant professor (mean difference, -1.3; 95% CI, -1.90 to -0.72; P < .001), associate professor (mean difference, -2.09; 95% CI, -3.40 to -0.78; P = .002), and professor (mean difference, -3.41; 95% CI, -6.24 to -0.58; P = .02).

Conclusions And Relevance: In this systematic review and meta-analysis, women had lower h-indexes than men across most specialties and at all academic ranks, but it is unclear why these differences exist. These findings suggest that future investigation should be conducted regarding the causes of lower h-indexes in women and that interventions should be developed to provide a more equitable environment for all physicians regardless of sex.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.12404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243235PMC
June 2021

Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis.

J Patient Exp 2021 3;8:2374373521998847. Epub 2021 Mar 3.

Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA.

Comprehensive patient education is necessary for shared decision-making. While patient-provider conversations primarily drive patient education, patients also use published materials to enhance their understanding. In this investigation, we evaluated the readability of 2585 patient education materials published in high-impact medical journals from 1998 to 2018 and compared our findings to readability recommendations from national groups. For all materials, mean readability grade levels ranged from 11.2 to 13.8 by various metrics. Fifty-four (2.1%) materials met the American Medical Association recommendation of sixth grade reading level, and 215 (8.2%) met the National Institutes of Health recommendation of eighth grade level. When stratified by journal and material type, general medical education materials from were the most readable ( < .001), with 79.8% meeting the eighth grade level. Readability did not differ significantly over time. Efforts to standardize publication practice with the incorporation of readability evaluation during the review process may improve patients' understanding of their disease processes and treatment options.
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http://dx.doi.org/10.1177/2374373521998847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205335PMC
March 2021

A Health Systems Ethical Framework for De-Implementation in Health Care.

J Surg Res 2021 Jun 17;267:151-158. Epub 2021 Jun 17.

Center for Healthcare Outcomes and Policy, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address:

Introduction: Unnecessary health care not only drive up costs, but also contribute to avoidable patient harms, underscoring an ethical obligation to eliminate practices which are harmful, lack evidence, and prevent spending on more beneficial services. To date, de-implementation ethics discussions have been limited and focused on clinical ethics principles. An analysis of de-implementation ethics in the broader context of the health care system is lacking.

Methods: To better understand the ethical considerations of de-implementation, recognizing it as a health care systems issue, we applied Krubiner and Hyder's bioethical framework for health systems activity. We examine ethics principles relevant to de-implementation, which either call for or facilitate the reduction of low value surgery.

Results And Discussion: From 11 health systems principles proposed by Krubiner and Hyder, we identified the 5 principles most pertinent to the topic of de-implementation: evidence and effectiveness, transparency and public engagement, efficiency, responsiveness, and collaboration. An analysis of de-implementation through the lens of these principles not only supports de-implementation but proves an obligation at the health system level to eliminate low value care. Recognizing the challenge of defining "value," the proposed framework may increase the legitimacy and objectivity of de-implementation.

Conclusions: While there is no single ideal ethical framework from which to approach de-implementation, a health systems framework allows for consideration of the systems-level factors impacting de-implementation. Framing de-implementation as a health systems issue with systems-wide ethical implications empowers providers to think about new ways to approach potential roadblocks to reducing low-value care.
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http://dx.doi.org/10.1016/j.jss.2021.05.006DOI Listing
June 2021

Remote Mentorship in Radiation Oncology: Lessons to Share.

Adv Radiat Oncol 2021 Jul-Aug;6(4):100686. Epub 2021 Mar 14.

Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.

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http://dx.doi.org/10.1016/j.adro.2021.100686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188242PMC
March 2021

Promoting Equity for Women in Medicine - Seizing a Disruptive Opportunity.

N Engl J Med 2021 Jun 12;384(24):2265-2267. Epub 2021 Jun 12.

From the Department of Radiation Oncology and the Center for Bioethics and Social Sciences, University of Michigan, Ann Arbor (R.J.); the Department of Pediatrics, Zuckerberg San Francisco General Hospital, and the Dean's Office, University of California, San Francisco - both in San Francisco (E.F.-A.); and the Office of the Dean, the Leonard Davis Institute for Health Economics, and the Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.H.).

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http://dx.doi.org/10.1056/NEJMp2104228DOI Listing
June 2021

The use of bolus in postmastectomy radiation therapy for breast cancer: A systematic review.

Crit Rev Oncol Hematol 2021 Jul 5;163:103391. Epub 2021 Jun 5.

Sheba Medical Center, Ramat Gan, Israel GROW-School for Oncology and Developmental Biology or GROW (Maastro), Maastricht University, Maastricht, the Netherlands; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address:

Purpose: Post mastectomy radiation therapy (PMRT) reduces locoregional recurrence (LRR) and breast cancer mortality for selected patients. Bolus overcomes the skin-sparing effect of external-beam radiotherapy, ensuring adequate dose to superficial regions at risk of local recurrence (LR). This systematic review summarizes the current evidence regarding the impact of bolus on LR and acute toxicity in the setting of PMRT.

Results: 27 studies were included. The use of bolus led to higher rates of acute grade 3 radiation dermatitis (pooled rates of 9.6% with bolus vs. 1.2% without). Pooled crude LR rates from thirteen studies (n = 3756) were similar with (3.5%) and without (3.6%) bolus.

Conclusions: Bolus may be indicated in cases with a high risk of LR in the skin, but seems not to be necessary for all patients. Further work is needed to define the role of bolus in PMRT.
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http://dx.doi.org/10.1016/j.critrevonc.2021.103391DOI Listing
July 2021

Prevalence of cannabis use among individuals with a history of cancer in the United States.

Cancer 2021 Sep 3;127(18):3437-3444. Epub 2021 Jun 3.

Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.

Background: Patients with cancer have played a key role in advocating for legal access to cannabis, but little is known about links between cancer and cannabis use or cannabis-related beliefs. The authors used data from a national survey to study these relationships.

Methods: Nationally representative data collected by the National Survey on Drug Use and Health from 2015 to 2019 were acquired. Patterns of cannabis use and cancer history were examined and tested within age group subpopulations via domain analysis using survey weights.

Results: Data for 214,505 adults, including 4741 individuals (3.8%) with past (>1 year ago) cancer diagnosis and 1518 individuals (1.2%) with recent (≤1 year ago) cancer diagnosis, were examined. Cannabis use was less common in those with past (8.9%; 95% CI, 8.0%-9.8%) or recent (9.9%; 95% CI, 6.9%-11.1%) cancer diagnosis than in those without a history of cancer (15.9%; 95% CI, 15.7%-16.1%). However, when analyses were stratified by age group, those 18 to 34 years of age were more likely to report past cannabis use, and those 35 to 49 years of age were more likely to report past or recent cannabis use if they had a history of cancer. Younger patients felt that cannabis was more accessible and less risky if they had a history of cancer.

Conclusions: Patients with cancer were less likely to report cannabis use, but there were different cannabis perceptions and use patterns by age. Age should be considered in studies of cannabis and cancer, and policy initiatives may be needed to aid provision of quality information on cannabis risk to those with cancer.

Lay Summary: Cannabis (marijuana) use is increasing in the United States, but we do not have much information on the relationship between cannabis use and cancer. We studied information from a representative group of people and found that younger patients generally reported more past and/or recent cannabis use if they had been diagnosed with cancer whereas older individuals did not. Beliefs about cannabis risk and accessibility differed by age. Clinical trials to study cannabis should account for patient age, and accurate information about cannabis should be provided to help patients with cancer make decisions about cannabis use.
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http://dx.doi.org/10.1002/cncr.33646DOI Listing
September 2021

Sensitivity of Psychosocial Distress Screening to Identify Cancer Patients at Risk for Financial Hardship During Care Delivery.

JCO Oncol Pract 2021 May 27:OP2001009. Epub 2021 May 27.

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.

Purpose: Patients with cancer frequently encounter financial hardship, yet systematic strategies to identify at-risk patients are not established in care delivery. We assessed sensitivity of distress-based screening to identify patients with cancer-related financial hardship and associated care delivery outcomes.

Methods: A survey of 225 patients at a large cancer center assessed cancer-related financial hardship (0-10 Likert scale; highest quintile scores ≥ 5 defined severe hardship). Responses were linked to electronic medical records identifying patients' distress screening scores 6 months presurvey (0-10 scale) and outcomes of missed cancer care visits and bad debt charges (unrecovered patient charges) within 6 months postsurvey. A positive screen for distress was defined as score ≥ 4. We analyzed screening test characteristics for identifying severe financial hardship within 6 months and associations between financial hardship and outcomes using logistic models.

Results: Although patients with positive distress screens were more likely to report financial hardship (odds ratio [OR], 1.21; 1.08-1.37; < .001), a positive distress screen was only 48% sensitive and 70% specific for identifying severe financial hardship. Patients with worse financial hardship scores were more likely to miss oncology care visits within 6 months (for every additional point in financial hardship score from 0 to 10, OR, 1.28; 1.12-1.47; < .001). Of patients with severe hardship, 72% missed oncology visits versus 35% without severe hardship ( = .006). Patients with worse hardship were more likely to incur any bad debt charges within 6 months (OR, 1.32; 1.13-1.54; < .001).

Conclusion: Systematic financial hardship screening is needed to help mitigate adverse care delivery outcomes. Existing distress-based screening lacks sensitivity.
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http://dx.doi.org/10.1200/OP.20.01009DOI Listing
May 2021

Structural Factors, Power, and the Physician Sex Pay Gap-Reply.

JAMA Pediatr 2021 Aug;175(8):868-869

Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor.

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http://dx.doi.org/10.1001/jamapediatrics.2021.0873DOI Listing
August 2021

A Scoping Review of Behavioral Interventions Addressing Medical Financial Hardship.

Popul Health Manag 2021 May 14. Epub 2021 May 14.

Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.

Little information has been compiled across studies about existing interventions to mitigate issues of medical financial hardship, despite growing interest in health care delivery. The purpose of this qualitative systematic scoping review was to examine content and outcomes of interventions to address medical financial hardship. PRISMA guidelines were applied to present results using PubMed, Scopus, and CINAHL, published between January 1980 and August 2020. Additional studies were identified through reference lists of selected papers. Included studies focused on mitigating medical financial hardship from out-of-pocket (OOP) health care expenses as an intervention strategy with at least 1 evaluation component. Screening 2412 articles identified 339 articles for full-text review, 12 of which met inclusion criteria. Variation was found regarding targets and outcome measurement of intervention. Primary outcomes were in the following categories: financial outcomes (eg, OOP expenses), behavioral outcomes, psychosocial, health care utilization, and health status. No included studies reported significant reduction in OOP expenses, perceptions of financial burden/toxicity, or health status. However, changes were observed for behavioral outcomes (adherence to treatment, patient needs addressed), some psychosocial outcomes (mental health symptoms, perceived support, patient satisfaction), and care utilization such as routine health care. No patterns were observed in the achievement of outcomes across studies based on intensity of intervention. Few rigorous studies exist in this emerging field, and studies have not shown consistent positive effects. Future research should focus on conceptual clarity of the intervention, align outcome measurement and achieve consensus around outcomes, and employ rigorous study designs, measurement, and outcome follow-up.
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http://dx.doi.org/10.1089/pop.2021.0043DOI Listing
May 2021

Current Social Media Use Among Radiation Oncology Trainees.

Adv Radiat Oncol 2021 Mar-Apr;6(2):100642. Epub 2020 Dec 23.

Department of Radiation Oncology, Lowell General Hospital, Andover, Massachusetts.

Purpose: Resident physicians use social media (SM) for many reasons. We sought to characterize current SM use by radiation oncology (RO) trainees for education and professional development.

Methods And Materials: An anonymous 40-question survey was sent by e-mail to RO residents in the 2018 to 2019 academic year. SM platform use, time spent on SM, professional use, and opinions regarding SM use were assessed. Descriptive statistics and a univariate logistic regression analysis were performed to identify factors associated with perceptions of SM and spending >25% of SM time for academic or professional purposes.

Results: Of the 615 residents surveyed, 149 responded (24% response rate). Facebook (73%), theMednet (62%), Instagram (59%), Twitter (57%), and Doximity (50%) were the top SM platforms used. Most respondents (53%) reported <25% of overall SM time on professional/academic purposes, and 21% reported using SM >60 minutes per day over the past week. Residents with an RO mentor on SM (n = 35; 24%; odds ratio [OR]: 2.79; 95% confidence interval [CI], 1.29-6.08; = .010), those participating in RO discussions on SM (n = 71; 48%; OR: 2.85; 95% CI, 1.42-5.72; = .003), and those interacting with professional societies (n = 69; 46%; OR: 7.11; 95% CI, 3.32-15.24; < .001) were more likely to spend >25% of their SM time on professional/academic purposes. The vast majority of respondents agreed that SM exposed them to novel educational content (82%) and was helpful for career development (65%). In addition, 69% agreed that SM can improve clinical skills and knowledge. A substantial minority agreed that SM distracts them from studying (38%) or they felt pressure to have a SM presence (29%).

Conclusions: Most RO residents reported that SM provides novel educational content and can help with career development. Potential disadvantages of SM for trainees may include distraction and pressure to maintain a SM presence. SM use by RO trainees merits further research to optimize its potential for education and professional development.
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http://dx.doi.org/10.1016/j.adro.2020.100642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022140PMC
December 2020

Family and Medical Leave for Diagnostic Radiology, Interventional Radiology, and Radiation Oncology Residents in the United States: A Policy Opportunity.

Radiology 2021 07 13;300(1):31-35. Epub 2021 Apr 13.

From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.).

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http://dx.doi.org/10.1148/radiol.2021210798DOI Listing
July 2021

Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV-Related Oropharyngeal Cancer.

Oncologist 2021 08 29;26(8):676-684. Epub 2021 Apr 29.

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.

Introduction: Optimal surveillance paradigms for survivors of early stage human papillomavirus (HPV)-related oropharyngeal cancer are not well defined. This study aimed to characterize patient interest in and factors associated with an altered surveillance paradigm.

Materials And Methods: We surveyed patients with Stage I or II HPV-related oropharyngeal cancer treated at a tertiary care institution from 2016 to 2019. Primary outcomes were descriptive assessment of patient knowledge, interest in altered surveillance, burdens of in-person appointments, and priorities for surveillance visits. Ordinal regression was used to identify correlates of interest in altered surveillance.

Results: Sixty-seven patients completed surveys from February to April 2020 at a median of 21 months since completing definitive treatment. A majority (61%) of patients were interested in a surveillance approach that decreased in-person clinic visits. Patients who self-identified as medical maximizers, had higher worry of cancer recurrence, or were in long-term relationships were less likely to be interested. Patients reported significant burdens associated with surveillance visits, including driving distance, time off work, and nonmedical costs. Patients were most concerned with discussing cancer recurrence (76%), physical quality of life (70%), mortality (61%), and mental quality of life (52%) with their providers at follow-up visits.

Conclusion: Patients with early stage HPV-related oropharyngeal cancers are interested in altered surveillance approaches, experience significant burdens related to surveillance visits, and have concerns that are not well addressed with current surveillance approaches, including physical and mental quality of life. Optimized surveillance approaches should incorporate patient priorities and minimize associated burdens.

Implications For Practice: The number of patients with HPV-related oropharyngeal cancers is increasing, and numerous clinical trials are investigating novel approaches to treating these good-prognosis patients. There has been limited work assessing optimal surveillance paradigms in these patients. Patients experience significant appointment-related burdens and have concerns such as physical and mental quality of life. Additionally, patients with early stage HPV-related oropharyngeal cancers express interest in altered surveillance approaches that decrease in-person clinic visits. Optimization of surveillance paradigms to promote broader survivorship care in clinical practice is needed.
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http://dx.doi.org/10.1002/onco.13784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8342565PMC
August 2021
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