Immune checkpoint inhibitors have markedly improved outcomes in patients with multiple advanced malignancies.However,their widespread use has markedly increased the incidence of immune-related adverse events(irAEs).ir...Immune checkpoint inhibitors have markedly improved outcomes in patients with multiple advanced malignancies.However,their widespread use has markedly increased the incidence of immune-related adverse events(irAEs).irAEs can affect a wide range of organ systems and are characterized by heterogeneous onset,broad toxicity spectra,and complex management requirements,thus ultimately impairing treatment continuation and patient quality of life.This review systematically summarizes the epidemiological features,clinical progression,and current management of irAEs.Existing guidelines largely focus on acute toxicities but have not provided structured strategies for chronic,delayed-onset,or multisystem irAEs.Moreover,clinical practice is hampered by incomplete multidisciplinary collaboration,insufficient training of oncologists,and fragmented treatment pathways,all of which limit the efficacy of irAE management.We propose incorporating irAE management into core oncology training and call for the establishment of comprehensive interdisciplinary frameworks to ensure the standardized long-term use of immunotherapy.展开更多
Gastric cancer remains a major health issue and a leading cause of death worldwide.While the incidence is decreasing in western countries,there has been a shift to more proximal cancers of the diffuse type,which are u...Gastric cancer remains a major health issue and a leading cause of death worldwide.While the incidence is decreasing in western countries,there has been a shift to more proximal cancers of the diffuse type,which are usually more aggressive and associated with a worse prognosis.Radical surgery still offers the only chance of long term survival,but surgery has reached a plateau of effectiveness and more aggressive approaches like"ultraradical" lymphadenectomy have not improved prognosis.There are three options to improve the situation:Earlier detection,neoadjuvant chemotherapy and adjuvant therapy.Whilst systematic gastroscopic screening makes sense in countries with a high incidence of gastric cancer,in other regions targeted investigation of risk groups including first-degree relatives of cancer patients,patients with a chronic corpusdominant gastritis or with defined genetic abnormalities may help to detect cancer at an earlier stage.Neoadjuvant chemotherapy has meanwhile proved to significantly improve the prognosis not only in patients with a locally advanced cancer who cannot be resected for cure but but also in those who are potentially amenable to curative resection.In the largest randomised study so far reported,perioperative chemotherapy raised overall survival after 5 years from 23%to 36%.The role of adjuvant chemotherapy has been discussed for over 30 years.Meta-analyses demonstrate a small but significant effect which,however,seems to be restricted to Asian patients.In a large USstudy,adjuvant radiochemotherapy appeared to significantly improve outcomes.However,less than 50%of the study patients underwent a systematic lymphadenectomy and so the results of the therapy group were not better to those of"only resected"patients in two large European studies.Thus,the indication of adjuvant(radio-)chemotherapy in gastric cancer currently remains uncertain.Endoscopists have found a therapeutic role through endoscopic resection of early cancers,introduced mainly by Japanese authors.With the development of high resolution endoscopy,endosonography and adequate equipment,the endoscopic curative resection of T1a-tumors(restricted to the mucosal layer) has been established.展开更多
Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterol...Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterology (HGE)-curriculum. Therefore, a Digestive Oncology curriculum should be developed and this document might be a starting point for such a curriculum. HGE-specialists are increasingly resisting the paradigm in which they play only a diagnostic and technical role in the management of digestive tumors. We suggest minimum endpoints in the standard HGE-curriculum for oncology, and recommend a focus year in the Netherlands for Digestive Oncology in the HGE-curriculum. To produce welltrained digestive oncologists, an advanced Digestive Oncology training program with specific qualifications in Digestive Oncology (2 years) has been developed. The schedule in Belgium includes a period of at least 6 mo to be spent in a medical oncology department. The goal ofthese programs remains the production of well-trained digestive oncologists. HGE specialists are part of the multidisciplinary oncological teams, and some have been administering chemotherapy in their countries for years. In this article, we provide a road map for the organization of a proper training in Digestive Oncology. We hope that the World Gastroenterology Organisation and other (inter)national societies will support the necessary certifications for this specific training in the HGE-curriculum.展开更多
AIM:To examine the infuence of gynecologic oncolo-gists(GO)in the United States on surgical/chemothe-rapeutic standard of care(SOC),and how this translates into improved survival among women with ovarian cancer(OC).ME...AIM:To examine the infuence of gynecologic oncolo-gists(GO)in the United States on surgical/chemothe-rapeutic standard of care(SOC),and how this translates into improved survival among women with ovarian cancer(OC).METHODS:Surveillance,Epidemiology,and End Result(SEER)-Medicare data were used to identify 11688 OC patients(1992-2006).Only Medicare recipients with an initial surgical procedure code(n=6714)were included.Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile.SOC was defined by a panel of GOs.Mul-tivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOC and proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival.RESULTS:About 34%received surgery from a GO and 25%received the overall SOC.One-third of women had a GO involved sometime during their care.Women receiving surgery from a GO vs non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC(P〈0.01).Risk of mortality was greater among women not receiving surgical SOC compared to those who did[hazard ratio=1.22(95%CI:1.12-1.33),P〈0.01],and also was higher among women seen by non-GOs vs GOs(for surgical treatment)after adjusting for covariates.Median survival time was 14 mo longer for women receiving combined SOC.CONCLUSION:A survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported.Persistent survival differences,particularly among those not receiving the SOC,require further investigation.展开更多
Introduction: Placenta Accreta Spectrum (PAS) is associated with significant maternal and fetal morbidity and mortality. The ideal conservative management still does not exist. We aimed to compare the outcome of cesar...Introduction: Placenta Accreta Spectrum (PAS) is associated with significant maternal and fetal morbidity and mortality. The ideal conservative management still does not exist. We aimed to compare the outcome of cesarean section for PAS by a gynecologic oncologist-led team using the modified triple P approach and by a non-gynecologic oncologist-led team. Material and Methods: This is non-randomized controlled trial. Group A had Cesarean Section by gynecologic oncologist. Gynecologic oncologist-led team did all Cesarean Section following a modified triple P approach. The first P is for “Plan” the uterine incision. The second P for “Pelvic” devascularization by internal iliac artery ligation. The third P is for Placenta non-separation with resection of the myometrium. Group B had Cesarean Section by non-gynecologic oncologist-led team. The main outcome measures were the need for hysterectomy, amount of blood loss, and the management-related complications. Results: Group A had significantly less estimated blood loss, and received less number of backed RBCs units, and less operative time than group B. The uterus is preserved in all cases of group A and in 50% of cases of group B. The overall maternal morbidity rate was 17.5% in group A and 72.2% in group B. Conclusion: This study provides evidence that the modified triple P approach for PAS by gynecologic oncologist-led team presents lower maternal morbidity in comparison to surgery by non-gynecologic oncologist-led team.展开更多
Objective:This study aims to offer an update assessment of the knowledge of Chinese oncologists on female fertility preservation,and identify the determinants that influence the implementation of fertility preservatio...Objective:This study aims to offer an update assessment of the knowledge of Chinese oncologists on female fertility preservation,and identify the determinants that influence the implementation of fertility preservation.Methods:A total of 713 Chinese oncologists with different specialties completed the online self-report questionnaire to assess their understanding of fertility risks in cancer treatment,knowledge on female fertility preservation,and perceptions on the barriers in referring patients for fertility preservation.Results:Although most oncologists were familiar with fertility risk in cancer treatment,half of them lacked the knowledge for reproduction and preservation methods.In the multivariable model,oncologists in a hospital with a specialized reproductive institution,positive precaution for fertility risk,and fertility preservation discussion with patients were significantly correlated with the possibility of fertility preservation referral.Conclusions:The intervention targets based on the update evaluation and identified influencing determinants will be helpful for all the oncofertility researchers,oncologists and institutions in future efforts for well-established female fertility preservation services.展开更多
AIM： To investigate and test a causal model derivedfrom previous meta-analytic data of health provider be-haviors and patient satisfaction.METHODS： A literature search was conducted forrelevant manuscripts that met ...AIM： To investigate and test a causal model derivedfrom previous meta-analytic data of health provider be-haviors and patient satisfaction.METHODS： A literature search was conducted forrelevant manuscripts that met the following criteria：Reported an analysis of provider-patient interaction inthe context of an oncology interview; the study hadto measure at least two of the variables of interest tothe model （provider activity, provider patient-centeredcommunication, provider facilitative communication,patient activity, patient involvement, and patient satis-faction or reduced anxiety）; and the information had tobe reported in a manner that permitted the calculationof a zero-order correlation between at least two of thevariables under consideration. Data were transformedinto correlation coefficients and compiled to producethe correlation matrix used for data analysis. The test of the causal model is a comparison of the expected correlation matrix generated using an Ordinary Least Squares method of estimation. The expected matrix iscompared to the actual matrix of zero order correlation coeffcients. A model is considered a possible ft if the level of deviation is less than expected due to random sampling error as measured by a chi-square statistic. The signifcance of the path coeffcients was tested us-ing a z test. Lastly, the Sobel test provides a test of the level of mediation provided by a variable and provides an estimate of the level of mediation for each connec-tion. Such a test is warranted in models with multiple paths.RESULTS： A test of the original model indicated a lack of ft with the summary data. The largest discrepancy in the model was between the patient satisfaction and the provider patient-centered utterances. The observed correlation was far larger than expected given a medi-ated relationship. The test of a modifed model was un-dertaken to determine possible ft. The corrected model provides a fit to within tolerance as evaluated by the test statistic, χ2 （8, average n = 342） = 10.22. Each of the path coefficients for the model reveals that each one can be considered signifcant, P 〈 0.05. The Sobel test examining the impact of the mediating variables demonstrated that patient involvement is a signifcantmediator in the model, Sobel statistic = 3.56, P 〈 0.05. Patient active was also demonstrated to be a signifcant mediator in the model, Sobel statistic = 4.21, P 〈 0.05. The statistics indicate that patient behavior mediates the relationship between provider behavior and patient satisfaction with the interaction.CONCLUSION： The results demonstrate empirical support for the importance of patient-centered care and satisfy the need for empirical casual support of provider-patient behaviors on health outcomes.展开更多
BACKGROUND Understanding how patients choose a provider may improve the overall experience by identifying ways to tailor a clinical practice.AIM To identify factors that patients consider important when choosing an or...BACKGROUND Understanding how patients choose a provider may improve the overall experience by identifying ways to tailor a clinical practice.AIM To identify factors that patients consider important when choosing an orthopedic oncologist.METHODS New patients presenting to an orthopedic oncology clinic within a tertiary academic medical center from January 2019 to August 2020 were invited to complete an anonymous survey.The questionnaire consisted of 27 items including a Likert-type assessment of the importance of selection factors.RESULTS A total of 101 new patients with a median age of 66 years(range,14 years to 91 years)responded.Most were referred by another doctor(n=63,62.4%),and of the referring providers,the most frequent specialty was orthopedic surgery(n=32,51%).Using a Likert-type scale with 1 representing‘least important’and 5 representing‘most important’,the most important factor was the hospital reputation(mean,4.65;SD,0.85).Additional factors of importance were the number of years in practice(3.87±1.3)and a primary care provider referral(3.71±1.6).Patients younger than 40 years old found social media(P=0.016)and internet presence(P=0.035)of their surgeon to be more important than older patients.In contrast,older patients considered care within an academic center to be of greater importance than younger patients(P=0.014).CONCLUSION This investigation suggests a primary care referral,as well as hospital and physician reputation,are among the most important factors when selecting an orthopedic oncologist.Furthermore,social media utilization appears to be more important for younger patients.展开更多
Today I read a popular article about the management of cancers in China （1）. Although written by foreign doctors, it does utter some ＇unspeakable helplessness＇, as commented by a netizen. Many unique dilemmas do e...Today I read a popular article about the management of cancers in China （1）. Although written by foreign doctors, it does utter some ＇unspeakable helplessness＇, as commented by a netizen. Many unique dilemmas do exist, and must be honestly faced by government, industry, doctors, patients, and the society. I was born in a remote village, had spent a few years as a medical student in a big city, and now am a tumor surgeon and hospital manager in a tertiary hospital in Beijing. Many of my patients have become my friends. I think I have a deep knowledge and understanding of people involved in the oncology.展开更多
Professor SUN Yan, a famous medical oncologist, was graduated from Yenching University with a B. S. degree in 1951, and from Peking Union Medical College with a M.D. degree in 1956. He studied traditional Chinese medi...Professor SUN Yan, a famous medical oncologist, was graduated from Yenching University with a B. S. degree in 1951, and from Peking Union Medical College with a M.D. degree in 1956. He studied traditional Chinese medicine from 1960 to 1961, and worked, between 1979 and 1980, as a visiting professor in M. D. Anderson Cancer Center, USA. Since 1959, he has been working in the Department of Medical Oncology in Cancer Hospital of Chinese Academy of Medical Sciences （CAMS）, holding the post of professor ＆ director of Department of Medical Oncology during 1986-1994. He was honored as the ＂Outstanding Physician＂ by CAMS and Peking Union Medical College （PUMC） in 1993, designated as an ＂Advanced Worker＂ in national health care system by the Ministry of Human Affairs in 1994, and elected an academician of Chinese Academy of Engineering in 1999. Since 1991, he has been enjoying the governmental special stipend.展开更多
AIM:To determine the association between the distribution of gynecologic oncologist(GO)and populationbased ovarian cancer death rates.METHODS:Data on ovarian cancer incidence and mortality in the United States was sup...AIM:To determine the association between the distribution of gynecologic oncologist(GO)and populationbased ovarian cancer death rates.METHODS:Data on ovarian cancer incidence and mortality in the United States was supplemented with United States census data,and analyzed in relation to practicing GOs.GO locations were geocoded to link association between county variables and GO availability.Logistic regression was used to measure areas of high and low ovarian cancer mortality,adjusting for contextual variables.RESULTS:Practicing GOs were unevenly distributed in the United States,with the greatest numbers in metropolitan areas.Ovarian cancer incidence and death rates increased as distance to a practicing GO increased.A relatively small number(153)of counties within 24 miles of a GO had high ovarian cancer death rates compared to 577 counties located 50 or more miles away with high ovarian cancer death rates.Counties located 50 or more miles away from a GO practice had an almost 60%greater odds of high ovarian cancer mortality compared to those with closer practicing GOs(OR=1.59,95%CI:1.18-2.15).CONCLUSION:The distribution of GOs across the United States appears to be significantly associated with ovarian cancer mortality.Efforts that facilitate outreach of GOs to certain populations may increase geographic access.展开更多
At the start of 2025,DeepSeek sparked a global wave of general artificial intelligence(AI)applications in medicine.1-3 Currently,large language models(LLMs)such as GPT-4o,DeepSeek-R1,Gemini 2.0,Command-R,Claude 3,Qwen...At the start of 2025,DeepSeek sparked a global wave of general artificial intelligence(AI)applications in medicine.1-3 Currently,large language models(LLMs)such as GPT-4o,DeepSeek-R1,Gemini 2.0,Command-R,Claude 3,Qwen,and Grok 3 exhibit distinct character-istics but a shared strength in advanced logical reasoning.This strength has the potential to significantly impact medical decision-making models.展开更多
Importance:Pediatric palliative care(PPC)is an interdisciplinary collaboration that focuses on the prevention and relief of patient suffering.PPC has emerged as a critical field of medical expertise and practice.Howev...Importance:Pediatric palliative care(PPC)is an interdisciplinary collaboration that focuses on the prevention and relief of patient suffering.PPC has emerged as a critical field of medical expertise and practice.However,no information is available regarding the progress of PPC in the Chinese mainland.Objective:This study investigated the geographic distribution,team structure,and services of PPC teams in the Chinese mainland.It also investigated the level of understanding and implementation among pediatric oncologists regarding PPC.Methods:The PPC subspecialty group of the Pediatrics Society of the Chinese Medical Association included 45 PPC teams.The team structure and services were investigated using questionnaires mailed to the team leader of each PPC team.In addition,we sent questionnaires regarding the level of PPC understanding and implementation of PPC practices to 170 pediatric oncologists in 11 hospitals.Results:The geographical distribution of PPC teams is uneven in China.Most PPC teams are concentrated in the eastern provincial capital of China.Most PPC teams had limited staff and services.The level of PPC understanding was considerably limited across all demographics;most pediatric oncologists reported“some understanding”(n=71,41.8%)or“poor understanding”(n=50,29.4%).Only 62.9%of pediatric oncologists had experience providing advice to family members regarding PPC matters.Interpretation:China is currently experiencing a critical shortage of PPC resources.Most pediatric oncologists had a limited understanding of PPC and reported limited practical implementation of PPC,which leads to underutilization of PPC resources.展开更多
YU Ren-cun was born on August 1, 1934. After graduating from Jiangxi Medical College in 1955, he took part in the very first Western Doctors＇ Class for Learning Traditional Chinese Medicine （TCM） held in Beijing fr...YU Ren-cun was born on August 1, 1934. After graduating from Jiangxi Medical College in 1955, he took part in the very first Western Doctors＇ Class for Learning Traditional Chinese Medicine （TCM） held in Beijing from March 1959 to December 1961. Prof. YU systematically learned TCM while taking this class. Since 1962, he has been working in the Beijing Hospital of Traditional Chinese Medicine, eventually being promoted to a Chief Physician by the Beijing Municipal Government in May of 1981. In 1997, Prof. YU was selected as a well-known veteran for the National TCM Doctor Inheritance Work by the State Administration of Traditional Chinese Medicine （SATCM）. The State Council of China has awarded him a special subsidy every month for his excellent work.展开更多
In the past year,several advancements have been achieved in the treatment of advanced non-small cell lung cancer(NSCLC),particularly in the areas of immunotherapy and targeted therapy.These achievements have provided ...In the past year,several advancements have been achieved in the treatment of advanced non-small cell lung cancer(NSCLC),particularly in the areas of immunotherapy and targeted therapy.These achievements have provided additional options for improving patient outcomes.The 2024 Chinese Society of Clinical Oncology Guidelines for NSCLC(CSCO NSCLC),a key reference for clinical oncologists in China,have incorporated current global research and adapted recommendations for applicability in real-world scenarios in China.This update covers not only patient selection,efficacy,and safety,but also considers economics,and accessibility,with an aim to provide more precise and comprehensive treatment guidance for Chinese oncologists.展开更多
目的:调查临床肿瘤学医师对粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)使用的认识,以及放疗和化疗患者的G-CSF使用现状,以评估临床G-CSF使用的规范性。方法:根据美国临床肿瘤学会(American Society of Clinical ...目的:调查临床肿瘤学医师对粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)使用的认识,以及放疗和化疗患者的G-CSF使用现状,以评估临床G-CSF使用的规范性。方法:根据美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)2006年白细胞生长因子使用指南和美国国家综合癌症网(National Comprehensive Cancer Network,NCCN)2012年髓细胞生长因子指南的定义,采用自行设计的调查问卷,于2012年6月-2012年11月,对国内31家二级或三级医院的临床肿瘤学医师进行有关临床G-CSF使用认识的抽样调查,并对其中一家三级甲等医院的放疗和化疗患者使用G-CSF的现状进行调查。结果:共218名医师完成了有效问卷,其中205名完成化疗问卷,85名完成放疗问卷。对初次化疗患者进行中性粒细胞减少性发热(febrileneutropenia,FN)风险评估方面,71.4%的医师知道如何进行FN风险评估,此外分别有50.0%、62.7%和2.9%的医师明确G-CSF的一级预防性使用、二级预防性使用和治疗性使用。80.0%的医师在接受联合放化疗的患者发生中性粒细胞减少时会使用G-CSF,而不考虑放疗部位的影响。本次研究共对222名化疗患者的724次化疗进行了调查。259次(35.8%)化疗在指南未推荐预防性使用G-CSF时预防性使用了G-CSF(属于使用过度),占预防性使用G-CSF总剂量的59.7%。按照指南推荐应使用G-CSF的105次(14.5%)化疗,实际却未使用G-CSF(属于使用不足)。在治疗性使用G-CSF中,只有11次(3.1%)规范使用G-CSF,占总使用剂量的7.4%,剩余92.6%为使用过度。在35名放疗患者中,97.1%的患者在发生中性粒细胞减少时使用G-CSF;3名放疗部位包括纵隔的同步放化疗患者在发生中性粒细胞减少时均治疗性使用G-CSF,与ASCO2006年白细胞生长因子使用指南的推荐不符。绝大部分患者的G-CSF使用剂量与指南推荐的不符。结论:目前国内临床肿瘤学医师不规范使用G-CSF的比例较高,临床实践与指南推荐之间存在较大差异。临床肿瘤学医师要提高对G-CSF使用规范的认识,促进G-CSF的规范使用。展开更多
Objective To investigate doctors'feelings when providing medical care to end-stage patients,and their understanding as well as reflection about theoretical concepts of palliative medicine.Methods Questionnaires we...Objective To investigate doctors'feelings when providing medical care to end-stage patients,and their understanding as well as reflection about theoretical concepts of palliative medicine.Methods Questionnaires were delivered through a social networking platform to1500clinicians of different specialties in10proviences of China.It covered issues of background information,self-assessment of familiarity to palliative care,prior training history,emotional attitude toward end-stage patients,and the reflections on clinical practice.Logistic regression analysis and chi-square test were used to analyse the categorical variables.Results There were379clinicians who completed the questionnaires and submitted successfully.Among them,66.8%(253/379)had attended palliative care training courses more than twice;66.8%(253/379)clinicians percieved powerless feeling when facing end-stage patients.We found that the education on palliative medicine was significantly associated to doctors'better comprehension on the concept of palliative care(OR=6.923,P=0.002).Doctors who were more familiar with palliative medicine were less likely to perceive powerless feelings(χ^2=13.015,P<0.001),and would be more likely to concern about patients and their family members in their clinical work(χ^2=28.754,P<0.001,χ^2=24.406,P<0.001).Conclusion The powerless feeling is prevalent in Chinese doctors when facing end-stage patients.Palliative care help them overcome the negative feelings and act more caring in clinic.More careful designed educational strategies that adapt to Chinese actual situation are needed to improve doctors'cognition on palliative care.展开更多
基金supported by grants from the Beijing Natural Science Foundation,Beijing Economic and Technological Development Zone Innovation Joint Fund(Grant no.L248072).
文摘Immune checkpoint inhibitors have markedly improved outcomes in patients with multiple advanced malignancies.However,their widespread use has markedly increased the incidence of immune-related adverse events(irAEs).irAEs can affect a wide range of organ systems and are characterized by heterogeneous onset,broad toxicity spectra,and complex management requirements,thus ultimately impairing treatment continuation and patient quality of life.This review systematically summarizes the epidemiological features,clinical progression,and current management of irAEs.Existing guidelines largely focus on acute toxicities but have not provided structured strategies for chronic,delayed-onset,or multisystem irAEs.Moreover,clinical practice is hampered by incomplete multidisciplinary collaboration,insufficient training of oncologists,and fragmented treatment pathways,all of which limit the efficacy of irAE management.We propose incorporating irAE management into core oncology training and call for the establishment of comprehensive interdisciplinary frameworks to ensure the standardized long-term use of immunotherapy.
文摘Gastric cancer remains a major health issue and a leading cause of death worldwide.While the incidence is decreasing in western countries,there has been a shift to more proximal cancers of the diffuse type,which are usually more aggressive and associated with a worse prognosis.Radical surgery still offers the only chance of long term survival,but surgery has reached a plateau of effectiveness and more aggressive approaches like"ultraradical" lymphadenectomy have not improved prognosis.There are three options to improve the situation:Earlier detection,neoadjuvant chemotherapy and adjuvant therapy.Whilst systematic gastroscopic screening makes sense in countries with a high incidence of gastric cancer,in other regions targeted investigation of risk groups including first-degree relatives of cancer patients,patients with a chronic corpusdominant gastritis or with defined genetic abnormalities may help to detect cancer at an earlier stage.Neoadjuvant chemotherapy has meanwhile proved to significantly improve the prognosis not only in patients with a locally advanced cancer who cannot be resected for cure but but also in those who are potentially amenable to curative resection.In the largest randomised study so far reported,perioperative chemotherapy raised overall survival after 5 years from 23%to 36%.The role of adjuvant chemotherapy has been discussed for over 30 years.Meta-analyses demonstrate a small but significant effect which,however,seems to be restricted to Asian patients.In a large USstudy,adjuvant radiochemotherapy appeared to significantly improve outcomes.However,less than 50%of the study patients underwent a systematic lymphadenectomy and so the results of the therapy group were not better to those of"only resected"patients in two large European studies.Thus,the indication of adjuvant(radio-)chemotherapy in gastric cancer currently remains uncertain.Endoscopists have found a therapeutic role through endoscopic resection of early cancers,introduced mainly by Japanese authors.With the development of high resolution endoscopy,endosonography and adequate equipment,the endoscopic curative resection of T1a-tumors(restricted to the mucosal layer) has been established.
文摘Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterology (HGE)-curriculum. Therefore, a Digestive Oncology curriculum should be developed and this document might be a starting point for such a curriculum. HGE-specialists are increasingly resisting the paradigm in which they play only a diagnostic and technical role in the management of digestive tumors. We suggest minimum endpoints in the standard HGE-curriculum for oncology, and recommend a focus year in the Netherlands for Digestive Oncology in the HGE-curriculum. To produce welltrained digestive oncologists, an advanced Digestive Oncology training program with specific qualifications in Digestive Oncology (2 years) has been developed. The schedule in Belgium includes a period of at least 6 mo to be spent in a medical oncology department. The goal ofthese programs remains the production of well-trained digestive oncologists. HGE specialists are part of the multidisciplinary oncological teams, and some have been administering chemotherapy in their countries for years. In this article, we provide a road map for the organization of a proper training in Digestive Oncology. We hope that the World Gastroenterology Organisation and other (inter)national societies will support the necessary certifications for this specific training in the HGE-curriculum.
基金Supported by The United States Federal Government,Centers for Disease Control and Prevention,Atlanta,GA,United States
文摘AIM:To examine the infuence of gynecologic oncolo-gists(GO)in the United States on surgical/chemothe-rapeutic standard of care(SOC),and how this translates into improved survival among women with ovarian cancer(OC).METHODS:Surveillance,Epidemiology,and End Result(SEER)-Medicare data were used to identify 11688 OC patients(1992-2006).Only Medicare recipients with an initial surgical procedure code(n=6714)were included.Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile.SOC was defined by a panel of GOs.Mul-tivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOC and proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival.RESULTS:About 34%received surgery from a GO and 25%received the overall SOC.One-third of women had a GO involved sometime during their care.Women receiving surgery from a GO vs non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC(P〈0.01).Risk of mortality was greater among women not receiving surgical SOC compared to those who did[hazard ratio=1.22(95%CI:1.12-1.33),P〈0.01],and also was higher among women seen by non-GOs vs GOs(for surgical treatment)after adjusting for covariates.Median survival time was 14 mo longer for women receiving combined SOC.CONCLUSION:A survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported.Persistent survival differences,particularly among those not receiving the SOC,require further investigation.
文摘Introduction: Placenta Accreta Spectrum (PAS) is associated with significant maternal and fetal morbidity and mortality. The ideal conservative management still does not exist. We aimed to compare the outcome of cesarean section for PAS by a gynecologic oncologist-led team using the modified triple P approach and by a non-gynecologic oncologist-led team. Material and Methods: This is non-randomized controlled trial. Group A had Cesarean Section by gynecologic oncologist. Gynecologic oncologist-led team did all Cesarean Section following a modified triple P approach. The first P is for “Plan” the uterine incision. The second P for “Pelvic” devascularization by internal iliac artery ligation. The third P is for Placenta non-separation with resection of the myometrium. Group B had Cesarean Section by non-gynecologic oncologist-led team. The main outcome measures were the need for hysterectomy, amount of blood loss, and the management-related complications. Results: Group A had significantly less estimated blood loss, and received less number of backed RBCs units, and less operative time than group B. The uterus is preserved in all cases of group A and in 50% of cases of group B. The overall maternal morbidity rate was 17.5% in group A and 72.2% in group B. Conclusion: This study provides evidence that the modified triple P approach for PAS by gynecologic oncologist-led team presents lower maternal morbidity in comparison to surgery by non-gynecologic oncologist-led team.
基金supported by grants from the National Key Research and Development Program(No.2018YFC1002103)The Chinese Medical Association(No.16020520668)+1 种基金the Natural Science Foundation of Hubei Province(No.2017CFB752)Key Projects of Science and Technology Research and Development Plan of Jingmen City(No.2019YFZD044).
文摘Objective:This study aims to offer an update assessment of the knowledge of Chinese oncologists on female fertility preservation,and identify the determinants that influence the implementation of fertility preservation.Methods:A total of 713 Chinese oncologists with different specialties completed the online self-report questionnaire to assess their understanding of fertility risks in cancer treatment,knowledge on female fertility preservation,and perceptions on the barriers in referring patients for fertility preservation.Results:Although most oncologists were familiar with fertility risk in cancer treatment,half of them lacked the knowledge for reproduction and preservation methods.In the multivariable model,oncologists in a hospital with a specialized reproductive institution,positive precaution for fertility risk,and fertility preservation discussion with patients were significantly correlated with the possibility of fertility preservation referral.Conclusions:The intervention targets based on the update evaluation and identified influencing determinants will be helpful for all the oncofertility researchers,oncologists and institutions in future efforts for well-established female fertility preservation services.
文摘AIM： To investigate and test a causal model derivedfrom previous meta-analytic data of health provider be-haviors and patient satisfaction.METHODS： A literature search was conducted forrelevant manuscripts that met the following criteria：Reported an analysis of provider-patient interaction inthe context of an oncology interview; the study hadto measure at least two of the variables of interest tothe model （provider activity, provider patient-centeredcommunication, provider facilitative communication,patient activity, patient involvement, and patient satis-faction or reduced anxiety）; and the information had tobe reported in a manner that permitted the calculationof a zero-order correlation between at least two of thevariables under consideration. Data were transformedinto correlation coefficients and compiled to producethe correlation matrix used for data analysis. The test of the causal model is a comparison of the expected correlation matrix generated using an Ordinary Least Squares method of estimation. The expected matrix iscompared to the actual matrix of zero order correlation coeffcients. A model is considered a possible ft if the level of deviation is less than expected due to random sampling error as measured by a chi-square statistic. The signifcance of the path coeffcients was tested us-ing a z test. Lastly, the Sobel test provides a test of the level of mediation provided by a variable and provides an estimate of the level of mediation for each connec-tion. Such a test is warranted in models with multiple paths.RESULTS： A test of the original model indicated a lack of ft with the summary data. The largest discrepancy in the model was between the patient satisfaction and the provider patient-centered utterances. The observed correlation was far larger than expected given a medi-ated relationship. The test of a modifed model was un-dertaken to determine possible ft. The corrected model provides a fit to within tolerance as evaluated by the test statistic, χ2 （8, average n = 342） = 10.22. Each of the path coefficients for the model reveals that each one can be considered signifcant, P 〈 0.05. The Sobel test examining the impact of the mediating variables demonstrated that patient involvement is a signifcantmediator in the model, Sobel statistic = 3.56, P 〈 0.05. Patient active was also demonstrated to be a signifcant mediator in the model, Sobel statistic = 4.21, P 〈 0.05. The statistics indicate that patient behavior mediates the relationship between provider behavior and patient satisfaction with the interaction.CONCLUSION： The results demonstrate empirical support for the importance of patient-centered care and satisfy the need for empirical casual support of provider-patient behaviors on health outcomes.
文摘BACKGROUND Understanding how patients choose a provider may improve the overall experience by identifying ways to tailor a clinical practice.AIM To identify factors that patients consider important when choosing an orthopedic oncologist.METHODS New patients presenting to an orthopedic oncology clinic within a tertiary academic medical center from January 2019 to August 2020 were invited to complete an anonymous survey.The questionnaire consisted of 27 items including a Likert-type assessment of the importance of selection factors.RESULTS A total of 101 new patients with a median age of 66 years(range,14 years to 91 years)responded.Most were referred by another doctor(n=63,62.4%),and of the referring providers,the most frequent specialty was orthopedic surgery(n=32,51%).Using a Likert-type scale with 1 representing‘least important’and 5 representing‘most important’,the most important factor was the hospital reputation(mean,4.65;SD,0.85).Additional factors of importance were the number of years in practice(3.87±1.3)and a primary care provider referral(3.71±1.6).Patients younger than 40 years old found social media(P=0.016)and internet presence(P=0.035)of their surgeon to be more important than older patients.In contrast,older patients considered care within an academic center to be of greater importance than younger patients(P=0.014).CONCLUSION This investigation suggests a primary care referral,as well as hospital and physician reputation,are among the most important factors when selecting an orthopedic oncologist.Furthermore,social media utilization appears to be more important for younger patients.
文摘Today I read a popular article about the management of cancers in China （1）. Although written by foreign doctors, it does utter some ＇unspeakable helplessness＇, as commented by a netizen. Many unique dilemmas do exist, and must be honestly faced by government, industry, doctors, patients, and the society. I was born in a remote village, had spent a few years as a medical student in a big city, and now am a tumor surgeon and hospital manager in a tertiary hospital in Beijing. Many of my patients have become my friends. I think I have a deep knowledge and understanding of people involved in the oncology.
文摘Professor SUN Yan, a famous medical oncologist, was graduated from Yenching University with a B. S. degree in 1951, and from Peking Union Medical College with a M.D. degree in 1956. He studied traditional Chinese medicine from 1960 to 1961, and worked, between 1979 and 1980, as a visiting professor in M. D. Anderson Cancer Center, USA. Since 1959, he has been working in the Department of Medical Oncology in Cancer Hospital of Chinese Academy of Medical Sciences （CAMS）, holding the post of professor ＆ director of Department of Medical Oncology during 1986-1994. He was honored as the ＂Outstanding Physician＂ by CAMS and Peking Union Medical College （PUMC） in 1993, designated as an ＂Advanced Worker＂ in national health care system by the Ministry of Human Affairs in 1994, and elected an academician of Chinese Academy of Engineering in 1999. Since 1991, he has been enjoying the governmental special stipend.
基金Supported by The Centers of Disease Control and Prevention,Atlanta,GA,USA,contracted to Sci Metrika,LLC,No.200-2008-27889 TO 5
文摘AIM:To determine the association between the distribution of gynecologic oncologist(GO)and populationbased ovarian cancer death rates.METHODS:Data on ovarian cancer incidence and mortality in the United States was supplemented with United States census data,and analyzed in relation to practicing GOs.GO locations were geocoded to link association between county variables and GO availability.Logistic regression was used to measure areas of high and low ovarian cancer mortality,adjusting for contextual variables.RESULTS:Practicing GOs were unevenly distributed in the United States,with the greatest numbers in metropolitan areas.Ovarian cancer incidence and death rates increased as distance to a practicing GO increased.A relatively small number(153)of counties within 24 miles of a GO had high ovarian cancer death rates compared to 577 counties located 50 or more miles away with high ovarian cancer death rates.Counties located 50 or more miles away from a GO practice had an almost 60%greater odds of high ovarian cancer mortality compared to those with closer practicing GOs(OR=1.59,95%CI:1.18-2.15).CONCLUSION:The distribution of GOs across the United States appears to be significantly associated with ovarian cancer mortality.Efforts that facilitate outreach of GOs to certain populations may increase geographic access.
文摘At the start of 2025,DeepSeek sparked a global wave of general artificial intelligence(AI)applications in medicine.1-3 Currently,large language models(LLMs)such as GPT-4o,DeepSeek-R1,Gemini 2.0,Command-R,Claude 3,Qwen,and Grok 3 exhibit distinct character-istics but a shared strength in advanced logical reasoning.This strength has the potential to significantly impact medical decision-making models.
基金The Special Fund of the Pediatric Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals(No.XTCX201812)Management Research Project of Beijing Children’s Hospital,Capital Medical University(No.YGLQ202001)。
文摘Importance:Pediatric palliative care(PPC)is an interdisciplinary collaboration that focuses on the prevention and relief of patient suffering.PPC has emerged as a critical field of medical expertise and practice.However,no information is available regarding the progress of PPC in the Chinese mainland.Objective:This study investigated the geographic distribution,team structure,and services of PPC teams in the Chinese mainland.It also investigated the level of understanding and implementation among pediatric oncologists regarding PPC.Methods:The PPC subspecialty group of the Pediatrics Society of the Chinese Medical Association included 45 PPC teams.The team structure and services were investigated using questionnaires mailed to the team leader of each PPC team.In addition,we sent questionnaires regarding the level of PPC understanding and implementation of PPC practices to 170 pediatric oncologists in 11 hospitals.Results:The geographical distribution of PPC teams is uneven in China.Most PPC teams are concentrated in the eastern provincial capital of China.Most PPC teams had limited staff and services.The level of PPC understanding was considerably limited across all demographics;most pediatric oncologists reported“some understanding”(n=71,41.8%)or“poor understanding”(n=50,29.4%).Only 62.9%of pediatric oncologists had experience providing advice to family members regarding PPC matters.Interpretation:China is currently experiencing a critical shortage of PPC resources.Most pediatric oncologists had a limited understanding of PPC and reported limited practical implementation of PPC,which leads to underutilization of PPC resources.
文摘YU Ren-cun was born on August 1, 1934. After graduating from Jiangxi Medical College in 1955, he took part in the very first Western Doctors＇ Class for Learning Traditional Chinese Medicine （TCM） held in Beijing from March 1959 to December 1961. Prof. YU systematically learned TCM while taking this class. Since 1962, he has been working in the Beijing Hospital of Traditional Chinese Medicine, eventually being promoted to a Chief Physician by the Beijing Municipal Government in May of 1981. In 1997, Prof. YU was selected as a well-known veteran for the National TCM Doctor Inheritance Work by the State Administration of Traditional Chinese Medicine （SATCM）. The State Council of China has awarded him a special subsidy every month for his excellent work.
基金supported by the Shanghai Excellent Academic Leader(Grant No.21XD1423200)。
文摘In the past year,several advancements have been achieved in the treatment of advanced non-small cell lung cancer(NSCLC),particularly in the areas of immunotherapy and targeted therapy.These achievements have provided additional options for improving patient outcomes.The 2024 Chinese Society of Clinical Oncology Guidelines for NSCLC(CSCO NSCLC),a key reference for clinical oncologists in China,have incorporated current global research and adapted recommendations for applicability in real-world scenarios in China.This update covers not only patient selection,efficacy,and safety,but also considers economics,and accessibility,with an aim to provide more precise and comprehensive treatment guidance for Chinese oncologists.
文摘目的:调查临床肿瘤学医师对粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)使用的认识,以及放疗和化疗患者的G-CSF使用现状,以评估临床G-CSF使用的规范性。方法:根据美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)2006年白细胞生长因子使用指南和美国国家综合癌症网(National Comprehensive Cancer Network,NCCN)2012年髓细胞生长因子指南的定义,采用自行设计的调查问卷,于2012年6月-2012年11月,对国内31家二级或三级医院的临床肿瘤学医师进行有关临床G-CSF使用认识的抽样调查,并对其中一家三级甲等医院的放疗和化疗患者使用G-CSF的现状进行调查。结果:共218名医师完成了有效问卷,其中205名完成化疗问卷,85名完成放疗问卷。对初次化疗患者进行中性粒细胞减少性发热(febrileneutropenia,FN)风险评估方面,71.4%的医师知道如何进行FN风险评估,此外分别有50.0%、62.7%和2.9%的医师明确G-CSF的一级预防性使用、二级预防性使用和治疗性使用。80.0%的医师在接受联合放化疗的患者发生中性粒细胞减少时会使用G-CSF,而不考虑放疗部位的影响。本次研究共对222名化疗患者的724次化疗进行了调查。259次(35.8%)化疗在指南未推荐预防性使用G-CSF时预防性使用了G-CSF(属于使用过度),占预防性使用G-CSF总剂量的59.7%。按照指南推荐应使用G-CSF的105次(14.5%)化疗,实际却未使用G-CSF(属于使用不足)。在治疗性使用G-CSF中,只有11次(3.1%)规范使用G-CSF,占总使用剂量的7.4%,剩余92.6%为使用过度。在35名放疗患者中,97.1%的患者在发生中性粒细胞减少时使用G-CSF;3名放疗部位包括纵隔的同步放化疗患者在发生中性粒细胞减少时均治疗性使用G-CSF,与ASCO2006年白细胞生长因子使用指南的推荐不符。绝大部分患者的G-CSF使用剂量与指南推荐的不符。结论:目前国内临床肿瘤学医师不规范使用G-CSF的比例较高,临床实践与指南推荐之间存在较大差异。临床肿瘤学医师要提高对G-CSF使用规范的认识,促进G-CSF的规范使用。
基金supported by the Educational Reform Project of Peking Union Medical College(2015zlgc0120)~~
文摘Objective To investigate doctors'feelings when providing medical care to end-stage patients,and their understanding as well as reflection about theoretical concepts of palliative medicine.Methods Questionnaires were delivered through a social networking platform to1500clinicians of different specialties in10proviences of China.It covered issues of background information,self-assessment of familiarity to palliative care,prior training history,emotional attitude toward end-stage patients,and the reflections on clinical practice.Logistic regression analysis and chi-square test were used to analyse the categorical variables.Results There were379clinicians who completed the questionnaires and submitted successfully.Among them,66.8%(253/379)had attended palliative care training courses more than twice;66.8%(253/379)clinicians percieved powerless feeling when facing end-stage patients.We found that the education on palliative medicine was significantly associated to doctors'better comprehension on the concept of palliative care(OR=6.923,P=0.002).Doctors who were more familiar with palliative medicine were less likely to perceive powerless feelings(χ^2=13.015,P<0.001),and would be more likely to concern about patients and their family members in their clinical work(χ^2=28.754,P<0.001,χ^2=24.406,P<0.001).Conclusion The powerless feeling is prevalent in Chinese doctors when facing end-stage patients.Palliative care help them overcome the negative feelings and act more caring in clinic.More careful designed educational strategies that adapt to Chinese actual situation are needed to improve doctors'cognition on palliative care.
