Health services articles within Nature Reviews Clinical Oncology

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  • Comment |

    Transgender patients are a marginalized group for whom current standards of oncology have yet to be optimized. In this Comment, we highlight opportunities for transgender-inclusive and transgender-specific practices across the cancer care continuum and identify evidence gaps that will need to be filled to attain optimal care for transgender populations.

    • Elle Lett
    • , Joannie M. Ivory
    •  & Mya L. Roberson

  • Viewpoint |

    In the past decade, oncologists worldwide have seen unprecedented advances in drug development and approvals but have also become increasingly cognizant of the rising costs of and increasing inequities in access to these therapies. These trends have resulted in the current problematic situation in which dramatic disparities in outcomes exist among patients with cancer worldwide owing, in part, to the lack of access to drugs that provide clinically meaningful benefits. In this Viewpoint, we have asked six oncologists working in different countries to describe how they perceive this issue in their region and propose potential solutions.

    • Carlos Barrios
    • , Gilberto de Lima Lopes
    •  & Manju Sengar

  • News & Views |

    A recent study not only confirms mounting evidence that technology-facilitated symptom monitoring improves care and should be considered for all patients with cancer, but also suggests that patient navigators can help to deliver such interventions. Herein we discuss how such an approach can minimize disparities and maximize access to culturally appropriate patient-centred care.

    • Gabrielle B. Rocque
    •  & Abby R. Rosenberg

  • News & Views |

    Surgical quality remains a priority for patients with cancer, payers and policymakers. Whether the risk-standardized mortality rate (RSMR) is a better metric than surgical volume to inform the regionalization of cancer surgery remains controversial. In particular, RSMR has been criticized on both theoretical and methodological grounds. Novel alternative means that incorporate surgical volume, as well as evidence-based process measures, are needed.

    • Karl Y. Bilimoria
    •  & Timothy M. Pawlik

  • Comment |

    The coronavirus disease 19 (COVID-19) pandemic has become the focus of attention worldwide, and herein we seek to highlight the potential problem of ‘collateral mortality’ from delayed or deferred treatments in patients with cancer. We propose potential solutions to ensure continuity of care in the field of surgical oncology.

    • Ker-Kan Tan
    • , Brendan J. Moran
    •  & Michael J. Solomon

  • News & Views |

    Evidence of quality of life improvements in patients with advanced-stage cancer has spurred a move towards early integration of palliative care into the outpatient setting. As discussed herein, meaningful and sustained improvements in timely access to palliative care requires commitments to funding, encouraging integration and routinizing referral across care settings. More palliative medicine training positions as well as broader education of clinicians and the public about the benefits of palliative care throughout the disease course are also needed.

    • Jean Mathews
    •  & Camilla Zimmermann

  • Comment |

    Health-care services are rapidly transforming their organization and workforce in response to the coronavirus disease 2019 (COVID-19) pandemic. These changes, and a desire to mitigate infection risk, are having profound effects on other vital aspects of care, including the care of patients with cancer. Difficult decisions are being made regarding the prioritization of both active treatments and palliative care, despite limited evidence that cancer is an independent risk factor for infection and mortality.

    • James Spicer
    • , Charlotte Chamberlain
    •  & Sophie Papa

  • Comment |

    The value of medical treatments is an issue that has been actively debated in recent years and is not unique to oncology. In this Comment, we discuss why we pursue treatments which might have limited benefit from the point of view of three parties: the patient, the physician, and the pharmaceutical industry.

    • Christopher M. Booth
    •  & Allan S. Detsky

  • Comment |

    Burnout is a substantial issue associated with the medical profession, with oncology being no exception. Increasing focus is being placed on implementing solutions to address physician burnout, and successful interventions have encompassed the following themes: the presence of an organizational mandate, data-driven and grassroots quality improvements, and a focus on systems change.

    • Krithika Murali
    •  & Susana Banerjee

  • News & Views |

    Despite the rising incidence of cancer in low-income and lower-middle-income countries, very few oncologists are present in these regions — or, in some areas, even none. However, limited evidence of the global oncology workload inequity is available in the literature. Herein, we summarize recent findings that shed some light on this problem and discuss potential oncology workforce solutions.

    • Temidayo Fadelu
    •  & Lawrence N. Shulman

  • News & Views |

    In 2016, results of an important randomized trial demonstrated that patients undergoing chemotherapy who reported symptoms electronically have a better quality of life than those receiving usual care. Now, a significant survival improvement for patients in the experimental arm of this study has been reported. The emphasis of this survival benefit is 'culturally' positive, promoting the adoption of patient-reported outcomes in clinical practice.

    • Elisa Sperti
    •  & Massimo Di Maio

  • Comment |

    Does a patient with advanced incurable disease have a right not to hear the bad news? We think not. Failing to disclose a poor prognosis undermines patient autonomy and increases the likelihood of poor end-of-life care.

    • Devan Stahl
    •  & Tom Tomlinson

  • Year in Review |

    In 2016, novel findings on the role of predisposing gene variants in sarcoma oncogenesis were published, as well as studies addressing novel molecular classifications and results from randomized controlled trials highlighting successful new treatments. Herein, we discuss these meaningful advances.

    • Jean-Yves Blay
    •  & Isabelle Ray-Coquard

  • Review Article |

    The PARP inhibitor olaparib has been approved for clinical use in patients with ovarian cancer withBRCA 1/2 mutations; however, this agent, which can confer substantial improvements in patient survival might also be effective in those without a BRCA mutation. Here, the authors describe the potential for expanding the use of BRCA-mutation testing and PARP inhibition beyond those who are likely to have a BRCAmutation.

    • Angela George
    • , Stan Kaye
    •  & Susana Banerjee

  • News & Views |

    The VOICE study addressed the oncologist–patient dyad by adding a two-sided intervention. The results of this ostensibly positive study are, at best, limited and, at worst, cosmetic because clinically relevant long-term outcomes were unaffected. VOICE is the first attempt at addressing complexity in this genre of studies and, even with its shortcomings, teaches us some important lessons.

    • Nathan Cherny

  • Review Article |

    Expediting the diagnosis of cancer is generally considered to result in improved patient outcomes, and much effort is applied to achieving this goal. Herein, the authors describe the various aspects of early diagnosis of cancer including the potential benefits, methods, most suitable patients and likely costs, in the context of the UK National Health Service.

    • Willie Hamilton
    • , Fiona M. Walter
    •  & Richard D. Neal

  • Opinion |

    Unwarranted variations, which cannot be attributed to patients' underlying illnesses or comorbidities, medical needs, or the dictates of evidence-based medicine, can account for substantial variations in patient outcomes. In this Perspectives, the authors describe possible approaches intended to address these variations in the context of colorectal cancer care.

    • Muralee Menon
    • , Chris Cunningham
    •  & David Kerr

  • Opinion |

    The Internet is a valuable tool that continues to revolutionize many aspects of our lives. Herein, the current trends in the use of online resources in oncology are described, using the findings from the National Cancer Institute's Health Information National Trends Survey (HINTS) as a foundation. Future opportunities and challenges relating to the use of the Internet to improve cancer prevention and care are discussed.

    • Bradford W. Hesse
    • , Alexandra J. Greenberg
    •  & Lila J. Finney Rutten

  • Review Article |

    The practice of palliative care for patients with cancer is continually improving, and an increasing evidence base indicates that early integration of oncological and palliative care can result in wide-ranging benefits for the patients, their loved ones, clinicians, and health-care payers. Herein, David Hui and Eduardo Bruera discuss optimization of clinical infrastructures, processes, and education to support this strategy, and provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. The authors emphasize the need for health-care systems and institutions to tailor integration based on their resources, size, and the level of primary palliative care available.

    • David Hui
    •  & Eduardo Bruera

  • Review Article |

    Cachexia, a syndrome where metabolic demands cannot be met by energy intake, can substantially reduce the quality of life and increase mortality of patients with oesophageal cancer. In this Review, authors describe the causes, and effects of cachexia in these patients throughout the disease trajectory, and during the survivorship period; suggestions are made on how best to manage the effects of, and minimize the occurrence of this syndrome.

    • Poorna Anandavadivelan
    •  & Pernilla Lagergren

  • Review Article |

    Adolescent or young adult (AYA) patients with cancer are a unique group, with unique clinical needs; these patients are not entirely suited to cancer treatment and managment strategies designed either for paediatric patients, or older adult patients. In this Review, issues associated with the treatment, management and long-term outcomes of AYA patients with cancer are described in the context of acute lymphoblastic leukaemia and melanoma.

    • Leonard Sender
    •  & Keri B. Zabokrtsky

  • News & Views |

    Debate continues regarding the benefit of primary tumour resection for patients with asymptomatic metastatic colorectal cancer; the largest observational study conducted to date has demonstrated prolonged survival, but was probably subject to biases, and data from previous meta-analyses of observational data are contradictory. The results of two ongoing randomized trials are eagerly awaited. In the meantime, treatment should be directed at symptom palliation.

    • Cornelis J. H. van de Velde

  • News & Views |

    The decision of patients with breast cancer to have contralateral mastectomies is often related to their genetic risk. However, the increasing frequency of this surgical approach is also associated with social and psychological issues such as celebrity experiences and fear of contralateral breast cancer. Appropriate counselling may better inform patients' surgical choices.

    • Aron Goldhirsch
    •  & Shari Gelber

  • Review Article |

    In this Review, Jeff Shrager and Marty Tenenbaum describe the latest generation of Precision Oncology, and the different ways to keep refining it. In Precision Oncology 3.0, each treatment event provides the chance to learn from it so that such treatment can be applied to other patients with similar characteristics without facing the difficult economic and structural challenges of a clinical trial.

    • Jeff Shrager
    •  & Jay M. Tenenbaum

  • Review Article |

    Is there such a thing as a 'good death'? Palliative care services alleviate the debilitating physical symptoms and psychological distress that patients with cancer frequently experience at the end of their lives. In this Review, Khan and colleagues discuss the preferences of these patients and how advance care planning can help in meeting these choices.

    • Shaheen A. Khan
    • , Barbara Gomes
    •  & Irene J. Higginson

  • Review Article |

    Primary care providers are pivotal in reducing diagnostic delay of cancer, particularly in health systems that have long waiting times for outpatient diagnostic services. In this Review, the authors discuss several aspects of primary care, from referrals to communication and follow-up care, focusing on the most common cancers managed at the GP office.

    • Jon D. Emery
    • , Katie Shaw
    •  & Lyndal J. Trevena

  • Review Article |

    The occurrence of second malignant neoplasms in survivors of cancer is one of the most serious complications of cancer and its treatment. Second and higher-order malignancies now comprise about 18% of all incident cancers in the USA, superseding first primary cancers of the breast, lung, and prostate. This Review article discusses the wide-range of factors that influence the occurrence of second malignant neoplasms and a review of modifiable behavioural and lifestyle factors.

    • Lois B. Travis
    • , Wendy Demark Wahnefried
    •  & Andrea K. Ng

  • Review Article |

    Palliative care is a crucial part of the treatment spectrum for patients with cancer because these patients frequently undergo aggressive therapy, sometimes in discordance with their wishes. This Review article outlines the different elements of palliative care, including communication, quality of life, symptom control, patient satisfaction and resource utilization, and shows how it can benefit patients.

    • Gabrielle B. Rocque
    •  & James F. Cleary

  • Science and Society |

    In this article, Ruth Rechis—a 20-year survivor of Hodgkin lymphoma—describes her personal account of surviving cancer and her experience as a researcher and advocate in the field of survivorship. She provides recommendations for engaging survivors as active participants in their post-treatment, long-term survivorship care and to ensure appropriate care is universally available as part of patient-centred comprehensive care.

    • Ruth Rechis
    • , Sarah R. Arvey
    •  & Ellen Burke Beckjord

  • News & Views |

    On 11 March 2011, a magnitude 9.0 earthquake and subsequent tsunami caused unprecedented devastation in Japan. Over 20,000 people lost their lives or went missing and more than 100,000 people had to evacuate their homes. Many victims are patients with chronic diseases, including cancer, who face interrupted or discontinued therapy.

    • Chiyo K. Imamura
    •  & Naoto T. Ueno

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