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This study sought to report the degree to which postgraduate trainees in radiation oncology perceive their education has been impacted by the COVID-19 pandemic. A cross-sectional online survey was administered from June to July 2020 to trainee members of the Canadian Association of Radiation Oncology (CARO) (n = 203). Thirty-four trainees responded with a 17% response rate. Just under half of participants indicated that COVID-19 had a negative/very negative impact on training (n = 15; 46%). The majority agreed/strongly agreed that they feared family/loved ones would contract COVID-19 (n = 29, 88%), felt socially isolated from friends and family because of COVID-19 (n = 23, 70%), and had difficulty concentrating on tasks because of concerns about COVID-19 (n = 17, 52%). Changes that had a negative/very negative impact on learning included limitations to travel and networking (n = 31; 91%) and limited patient contact (n = 19; 58%). Virtual follow-ups (n = 25: 76%) and in-patient care activities (n = 12; 36%) increased. Electives were cancelled in province (n = 10; 30%), out-of-province (n = 16; 49%), and internationally (n = 15; 46%). Teaching from staff was moderately reduced to completely suppressed (n = 23, 70%) and teaching to medical students was moderately reduced to completely suppressed (n = 27, 82%). Significant changes to radiation oncology training were wrought by the pandemic, and roughly half of trainees perceive that these changes had a negative impact on training. Innovations in training delivery are needed to adapt to these new changes.

The rapidly increasing number of prostate cancer survivors in tandem with a forthcoming shortage of oncology specialists in our health system poses a barrier to ensuring that high-quality survivorship care is available to support this population. As such, there is a need to consider ways to optimize survivorship care, while taking health system constraints into account. The purpose of this study is to explore the perceptions of survivorship self-management between oncology specialists, primary care providers (PCPs), and survivors themselves.A single cross-sectional survey, relating to how prostate cancer survivorship care could be improved, was administered to each group.Two hundred forty-three participants (N = 206 survivors, N = 10 oncology specialists, N = 27 PCPs) completed the study survey. Most PCPs (90%) and oncology specialists (84%) perceived that an opportunity for prostate cancer survivors to have an expanded role in their care would be beneficial. Nearly half (49%) of survivors reported that it would be beneficial to have an expanded role in their survivorship care with only 11% indicating that it would not be beneficial at all.Barriers to developing this model involve limited oncology specialist time to execute survivorship plans, limited communication between oncology specialists and PCPs, and a lack of primary care and survivor education targeted specifically to prostate cancer survivorship.

The development of patient education (PE) materials is costly and resource-intensive, and no mechanisms exist for sharing materials across cancer centers/hospitals to limit duplicated effort. The aim of this study was to explore the incidence and cost implication of duplicated PE efforts.PE leaders from all (14) cancer centers in Ontario, Canada, submitted their collections of systemic therapy PE materials. Materials were categorized by topic and were coded as duplicate (more than one other material exists on the same topic and there was significant content and/or textual overlap), adapted (material was adapted from an existing material) or unique (no other material addresses the topic).304 materials were included and50 % of materials had duplicate content (n = 166, 55 %), a small proportion were adapted (n = 27, 9%), and less than half were unique (n = 111, 37 %). The majority of materials were considered amenable to adaptation meaning that the content was not dependent on a specific institutional context (n = 283, 93 %). The opportunity for cost savings if duplication of effort could be avoided is approximately $800 K for systemic therapy materials produced in cancer centers.There is need to refine the process for developing PE materials. Creating mechanisms of sharing can help facilitate equal access to materials and can result in significant cost savings.Efforts are needed to better coordinate the development of PE materials among patient educators. Better coordination would allow patient education programs to focus on other important challenges.

Most patients diagnosed with cancer are administered systemic therapy and these patients are counselled and given printed education (PE) materials. High rates of low health literacy highlight the need to evaluate the quality of these PE materials. A current state assessment of the quality of PE materials was conducted in Ontario, Canada. Patient education leaders from 14 cancer centres submitted print materials on the topic of systemic cancer therapy to the assessment team. To report adherence to PE quality and health literacy best practices, the following validated measures were used: readability (FRY, SMOG and Flesch Reading Ease), understandability and actionability (Patient Education Materials Assessment Tool (PEMAT)). Materials at grade level 6 or lower and with PEMAT scores greater than 80% were considered to meet health literacy best practices. A total of 1146 materials were submitted; 366 met inclusion criteria and 83 were selected for assessment. Most materials scored below the 80% target for understandability (x = 73%, 31–100%) and actionability (x = 68%, 20–100%), and above the recommended grade 6 readability level (x = grade 9) meaning that the majority did not meet quality standards or best practices. Results suggest that there is significant opportunity to improve the quality of PE materials distributed by cancer centres. The quality of PE materials is a critical safety and equity consideration when these materials convey important safety and self-care directives.

The study aim was to evaluate the costs associated with developing and reviewing patient education materials (pamphlets) across Ontario cancer centers. While patient education often produces a positive return on investment, limited efforts have been dedicated to optimizing the personnel, time, and capital dedicated to this feat across healthcare systems. Patient education leaders at 14 cancer centers completed a survey measure, estimating the number of hours spent developing and reviewing pamphlets and identifying the personnel involved in each procedural step. The time expended per center in each step was then combined with average salary data for the identified personnel to derive total cost estimates. Cancer centers spend on average $5672 (SD = $3180) developing (M = $4560, SD = $2620) and reviewing (M = $1112, SD = $654) one pamphlet. This cumulates to an average per annum spending of $65,401 (SD = $75,494) for pamphlet development and $19,819 (SD = $28,524) for annual pamphlet review at each cancer center. The cost and number of hours spent developing and reviewing pamphlets varied substantially between cancer centers. While the security of budgets for patient education varies across cancer centers, opportunities to optimize human capital and monetary resources should be considered. Results of the study can be used to advocate for sustainable investment into cancer education programs, improve the coordination of educational materials production and review, and ensure that resource quality and access are consistent across the province.

Background The coronavirus disease 2019 (COVID‐19) pandemic has caused enormous strain on public health. Patients with cancer are particularly susceptible to the disease, and their treatment plans have been threatened by public health restrictions designed to contain the spread. Methods This study examined the effects of the pandemic on cancer patients' psychology, knowledge, attitudes, and practices concerning COVID‐19 as well as their perceptions of the impact of COVID‐19 on their cancer health care services. A survey was sent to 5800 patients at a cancer center in Toronto, Canada. Descriptive results were summarized. Qualitative feedback was coded and summarized. To examine for potential associations, regression models were tested for the outcomes of patient psychological well‐being, knowledge, attitudes, and practices, and they accounted for several demographic, health literacy, and disease variables. Results A total of 1631 surveys were completed. Most patients saw their appointments shifted to virtual visits, and for a substantial minority, there was no change. A majority of the patients (62%) expressed fears about contracting the virus. There were no independent predictors of COVID‐19–related knowledge. Fears were more pronounced among patients who did not speak English and those who used social media more often. Female participants, those who scored higher on knowledge questions, and those who used cancer center materials were more likely to take preventative measures against infection. Conclusions This study provides a snapshot of the state of cancer patient treatment and the knowledge, attitudes, and practices of patients between the first 2 waves of the pandemic. The study's results can inform our understanding of adaptation to conditions during and after the outbreak., The COVID‐19 pandemic has put patients with cancer at threat not only from the disease itself but also from its effects on their treatments. This study examines how the pandemic has affected patients as well as their knowledge, attitudes, and practices with respect to the disease.

Objectives The cancer system is experiencing a rise in cancer prevalence, a workforce shortage, and is resource-stretched. In this environment, informal caregivers (unpaid family caregivers of cancer patients) are required to take on expanded care roles and experience the debilitating effects of caregiver burden. Education programs are increasingly being developed to support caregivers. The aim of this review is to summarize what is known about these programs. Methods A scoping review was conducted from May 2019 to January 2020. The literature search yielded 34,906 articles. Results 119 articles were included, and ninety-two (77%) were focused on in-person psychoeducational programs. Conclusion Most caregiver programs have a unidimensional focus on psychoeducational training, demonstrating a need for more comprehensive programming to address the full spectrum of caregiver needs. Practice implications Clinicians and educators must collaborate to create accessible, equitable education programs that comprehensibly address the needs of unpaid family caregivers beyond addressing psychological aspects of cancer care. This will ensure that a broader range of patients and caregivers are equipped with the knowledge and skills needed to cope with a cancer diagnosis, navigate the health system and to maintain their quality of life.

The study aim was to evaluate the costs associated with developing and reviewing patient education materials (pamphlets) across Ontario cancer centers. While patient education often produces a positive return on investment, limited efforts have been dedicated to optimizing the personnel, time, and capital dedicated to this feat across healthcare systems. Patient education leaders at 14 cancer centers completed a survey measure, estimating the number of hours spent developing and reviewing pamphlets and identifying the personnel involved in each procedural step. The time expended per center in each step was then combined with average salary data for the identified personnel to derive total cost estimates. Cancer centers spend on average $5672 (SD = $3180) developing (M = $4560, SD = $2620) and reviewing (M = $1112, SD = $654) one pamphlet. This cumulates to an average per annum spending of $65,401 (SD = $75,494) for pamphlet development and $19,819 (SD = $28,524) for annual pamphlet review at each cancer center. The cost and number of hours spent developing and reviewing pamphlets varied substantially between cancer centers. While the security of budgets for patient education varies across cancer centers, opportunities to optimize human capital and monetary resources should be considered. Results of the study can be used to advocate for sustainable investment into cancer education programs, improve the coordination of educational materials production and review, and ensure that resource quality and access are consistent across the province.

Background: Increasing demands on Canada’s healthcare system require patients to take on more active roles in their health. Effective self-management has been linked to improved health outcomes; and there is evidence that effective behaviors, and subsequent healthcare utilization, are linked to self-efficacy and health literacy; however, this link has had minimal testing in the cancer context. Our aim is to examine the association between self-efficacy, health literacy, chemotherapy self-management behaviors, and health service utilization. Design and methods: A cross-sectional survey that included validated measures of self-efficacy, health literacy, chemotherapy self-management, and health service utilization was completed by participants (N = 213). Multivariable modeling using hierarchical linear regression was used to examine the association between variables. Results: Self-efficacy contributed significantly to explaining variation in chemotherapy self-management score. Health literacy was not significantly associated with any of the dependent variables. Conclusion: Participants with higher self-efficacy had higher chemotherapy self-management scores compared to participants with low self-efficacy. Contrary to evidence in the chronic disease self-management literature, this study demonstrated that health literacy was not associated with chemotherapy self-management behavior nor was it associated with self-efficacy. Building patient self-efficacy in the context of chemotherapy self-management could be particularly helpful both in the cancer center and in the domain of oral chemotherapy management at home where patients are required to take on significant responsibility for self-management.

The objective was to evaluate the effects of a pre-chemotherapy education class on chemotherapy-naïve patients diagnosed with gynecologic cancer and their informal caregivers.A prospective cohort study was conducted at a cancer centre in Toronto, Canada. All women diagnosed with gynecologic cancer, who were scheduled to receive chemotherapy treatment, and their caregivers were invited to attend the GyneChemo class, newly introduced as the centre's standard of care. Consenting attendees were asked to complete pre-and post-class survey measures assessing anxiety, self-efficacy, information needs, preparedness to begin chemotherapy treatment, and satisfaction with the class.Between September 2014 to September 2016, 642 individuals attended the GyneChemo class. 75 patients and 64 caregivers completed both pre- and post-class measures. Over 80% of participants agreed that the class was beneficial, specific to their needs, and administered in an appropriate setting. Significant increases in patient and caregiver self-efficacy (p 0.001) and preparedness to begin chemotherapy treatment (p 0.001) were found following class completion. Significant differences in patient's anxiety scores were found, with patients who reported an annual household income of$25,000 experiencing increased anxiety (MD = +5.33) and patients reporting an income of $25,000-$75,000 reporting decreased anxiety (MD = -4.75) following class completion (p = 0.034). No significant difference in the average pre-post caregiver anxiety score (p = 0.207) was found.This educational model provides patients and informal caregivers with information specific to their chemotherapy regimen and disease site. Integrating pre-treatment education into cancer care has the potential to improve the survivorship experience by increasing self-efficacy, treatment preparedness, and psychological well-being.

Purpose/Objective(s) To report the degree to which post-graduate trainees in radiation oncology perceive their education has been impacted by COVID-19. Materials/Methods A cross-sectional online survey was administered in June 2020 to trainee members of Canadian Association of Radiation Oncology (CARO). The 82-item survey was adapted from a similar survey administered during SARS and included the Stanford Acute Stress Reaction and Ways of Coping Questionnaires. The survey was developed using best practices including expert review and cognitive pre-testing. Frequency statistics are reported. Results Thirty-four trainees (10 fellows, 24 residents) responded. Nearly half of participants indicated that the overall impact of COVID-19 on training was negative/very negative (n = 15; 46%) or neutral (n = 15; 46%) with a small number indicating a positive/very positive (n = 3; 9%). Majority of trainees agreed/strongly agreed with the following statements: “I had difficulty concentrating on tasks because of concerns about COVID-19” (n = 17; 52%), “I had fears about contracting COVID-19” (n = 17; 52%), “I had fears of family/loved ones contracting COVID-19” (n = 29; 88%), “I felt socially isolated from friends and family because of COVID-19” (n = 23; 70%), “I felt safe from COVID-19 in the hospital during my clinical duties“ (n = 15; 46%), and “I was concerned that my personal safety was at risk if/when I was redeployed from my planned clinical duties” (n = 20; 61%). The changes that had a negative/very negative impact on learning included “the impact of limited patient contact” (n = 19; 58%), “the impact of virtual patient contact” (n = 11; 33%), and “limitations to travel and networking” (n = 31; 91%). Most reported reduced teaching from staff (n = 22; 66%). Two-thirds of trainees (n = 22, 67%) reported severe (> 50%) reduction in ambulatory clinical activities, 16 (49%) reported a moderate (< 50%) reduction in new patient consultations, while virtual follow-ups (n = 25: 76%) and in-patient clinical care activities (n = 12; 36%) increased. Nearly half of respondents reported no impact on contouring (n = 16; 49%), on-treatment management (n = 17; 52%) and tumor boards (n = 14; 42%) with the majority of other respondents reporting a decrease in these activities. Electives were cancelled in province (n = 10/20; 50%), out-of-province (n = 16/20; 80%) and internationally (n = 15/18; 83%). Conclusion Significant changes to radiation oncology training were wrought by the COVID-19 pandemic and roughly half of trainees perceive that these changes had a negative impact on their training. Safety concerns for self and family were significant and strategies to mitigate these concerns should be a priority.