Oncology trainees speaking at MOGA ASM 2022 flagged the future of the discipline with wide-ranging research across topics including advanced care planning, the use of medical cannabis in oncology, cancer referrals to rehabilitation and trainee burnout.
Advanced trainee Dr Nancy Huang, from Liverpool Hospital, emphasised the importance of initiating advanced care planning (ACP) early to better support end-of-life care in patients with advanced cancers.
A retrospective study of 173 patients referred to early phase clinical trials found the median time from a diagnosis of metastatic disease to ACP discussion was 23.5 months.
The majority of ACP discussions were held late in the disease trajectory – 74% during the patient’s final 12 months, 61% during their final six months and 51% during their final three months.
Yet there would have been many opportunities for earlier ACP discussion given patients had received multiple lines of treatment, she said.
Most ACP discussions were with medical oncologists (43%) or palliative care (38%) and were mostly precipitated by disease progression or a hospital admission.
Dr Huang noted documentation of the ACP discussion was inconsistent – mostly in the electronic medical record (60%), MOSAIQ (>40%) or in a clinic letter (21.6%) – and communication with the patient’s GP was patchy.
Dr Joseph Taylor, from the Mater Hospital Newcastle, said doctors should also step up conversations with their patients about the efficacy and safety of medicinal cannabis.
In a prospective study comprising 350 oncology outpatients, 81% were non-users of medicinal cannabis and 19% were users. Males and smokers were more likely to be users.
When asked whether they believed there was high quality evidence for medicinal cannabis in cancer, about half of the users disagreed.
They weren’t sure medical cannabis was effective on physical symptoms, emotional symptoms or could slow or prevent cancer progression.
More than half of medicinal cannabis users also disagreed that there was high quality evidence on the risks of its use.
Dr Taylor, a dual medical oncology and palliative care trainee, said the fact that 28.8% of users believed medicinal cannabis could affect their cancer progression was concerning.
He said proactive discussion was warranted with patients to highlight the lack of evidence for medicinal cannabis and educate patients about other treatments which do have evidence.
Dr Alexander Murphy from Nepean Hospital told the meeting that solid cancer patients with metastatic disease referred and selected for rehabilitation have improved function and survival.
A retrospective study of 289 referrals for rehabilitation found overall survival (OS) higher in those accepted to rehabilitation compared to those excluded (7.5 v 5.3 months; aHR 0.45).
The study also found the functional independence measure (FIM) score improved by 18.3 points in patients between entry and discharge from rehabilitation (mean duration 11 days), while a higher FIM score on discharge was associated with survival.
Dr Udit Nindra, from Liverpool Hospital, flagged concerning rates of burnout in both medical oncology trainees and their mentors in the early stages of an ongoing pilot of a formal mentorship program.
Baseline scores using the Maslach Burnout Inventory found 93% of trainees and 54% of the mentors demonstrated some form of burnout in the previous 12 months.
Trainees had higher rates of burnout in two of three domains – depersonalisation and perceived personal achievement. Emotional exhaustion was similar in the two groups.
“Post-mentorship surveys will be conducted in November to assess the efficiency of a mentorship program to help support trainees and reduce burnout.”