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Highlights • Risk of distress/burnout amongst oncology professionals continues to worsen since COVID-19 despite improved job performance. • Female and younger (≤40 years old) colleagues continue to be at higher risk of poor well-being and feeling burnout. • Job demands have increased, with nearly half now feeling overwhelmed with workload. • Concerns regarding career development/training, job security, and international fellowship opportunities remain high. • A quarter of oncology professionals reported considering changing their career, including leaving the oncology profession. Background COVID-19 has had a significant impact on the well-being and job performance of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration set out to investigate and monitor well-being since COVID-19 in relation to work, lifestyle and support factors in oncology professionals 1 year on since the start of the pandemic. Methods An online, anonymous survey was conducted in February/March 2021 (Survey III). Key outcome variables included risk of poor well-being or distress (expanded Well-Being Index), feeling burnout (single item from expanded Well-Being Index), and job performance since COVID-19. Longitudinal analysis of responses to the series of three surveys since COVID-19 was carried out, and responses to job demands and resources questions were interrogated. SPSS V.26.0/V.27.0 and GraphPad Prism V9.0 were used for statistical analyses. Results Responses from 1269 participants from 104 countries were analysed in Survey III: 55% (n = 699/1269) female, 54% (n = 686/1269) >40 years, and 69% (n = 852/1230) of white ethnicity. There continues to be an increased risk of poor well-being or distress (n = 464/1169, 40%) and feeling burnout (n = 660/1169, 57%) compared with Survey I (25% and 38% respectively, P < 0.0001), despite improved job performance. Compared with the initial period of the pandemic, more participants report feeling overwhelmed with workload (45% versus 29%, P < 0.0001). There remain concerns about the negative impact of the pandemic on career development/training (43%), job security (37%). and international fellowship opportunities (76%). Alarmingly, 25% (n = 266/1086) are considering changing their future career with 38% (n = 100/266) contemplating leaving the profession. Conclusion Oncology professionals continue to face increased job demands. There is now significant concern regarding potential attrition in the oncology workforce. National and international stakeholders must act immediately and work closely with oncology professionals to draw up future-proof recovery plans.

Purpose: To estimate cancer screening coverage among a large sample of Greek individuals. Methods: 7012 adults from 30 Hellenic areas were surveyed. Tests included: faecal occult blood test, sigmoidoscopy, chest X-ray, urine test, testicular examination, trans-rectal ultrasound, full blood count, skin examination, digital rectal examination, PSA, Pap test, mammography, clinical breast examination (CBE), self breast examination and breast ultrasound. Results: Eighty-eight percent of males and 93% of females declared being interested in cancer screening; 37.8% of men and 37.9% of women had had a medical consultation for screening purpose in the previous 2 years. Less than 2% reported having received screening for colorectal cancer or skin malignancies. Screening for cervical cancer, mammography and CBE was reported by 39.6%, 22.8% and 27.9% of females respectively. Twenty percent of males reported screening for prostate cancer. Conclusion: The actual opportunistic screening approach presents important deficiencies with displaced priorities in test performance and a low proportion of individuals undergoing recommended tests. © Feseo 2009. 11 4 228 236

Background: Early stage Non-Small Cell Lung Cancer (NSCLC) is potentially curable with surgery. ESMO guidelines recommend cisplatin-based adjuvant chemotherapy (CT) for completely resected stage II-III NSCLC. There is limited evidence for the use of adjuvant CT and/or radiotherapy (RT) in incompletely resected (R1) early stage NSCLC. Materials and methods: A European survey of thoracic oncologists was conducted to evaluate use of adjuvant CT and RT for R1-resected NSCLC and to identify factors influencing treatment decisions. Demographics and information on clinical stage, regimens, cycles planned, radiotherapy sites, multidisciplinary management and discussion about inconclusive evidence with the patient were collected. Univariate and multivariate analyses were performed. Results: 768 surveys were collected from 41 European countries. 82.9% of participants were medical oncologists; 49.3% ESMO members; 37.1% based in University Hospitals; 32.6% practicing oncology for over 15 years and 81.4% active in research. 91.4% of participants prescribed adjuvant CT and mostly cisplatin/vinorelbine (81.2%) or cisplatin/gemcitabine (42.9%). 85% discussed limited clinical evidence with the patient. In the univariate analysis, a statistically significant association with CT prescription was found for medical oncology specialty (p

Background: Cancer of unknown primary (CUP) ranks among the ten most common malignancies worldwide. Cancer of unknown primary presents as disseminated disease, has a dismal prognosis and remains a diagnosis of exclusion. The natural history and biology of the disease is poorly understood, and efforts are focused on identifying the specific 'CUP signature'. Materials and methods: We collected and analysed all published research in the biology of CUP from 1974 till present (Medline, Embase, ASCO and ESMO Congresses). Results: Current scientific evidence suggests that aneuploidy and karyotype changes are frequent, while more subtle molecular aberrations, such as epidermal growth factor receptor family proteins, cKit/PDGFR are frequently overexpressed, although without prognostic significance. Loss of function of tumour suppressor genes, active angiogenesis, a hypoxic genetic programme and a mesenchymal transitory phenotype have been reported in CUP and may be indicative of unfavourable prognosis. Molecular pathway analyses have identified various biomolecules impacting on survival (pAKT, pMAPK, c-Met, p21 and pPRS6). Finally, circulating tumour cells have recently been reported as a frequent phenomenon in CUP. Conclusions: Overall, advances in understanding CUP biology have been weak and the application of gene expression profiling failed to identify an as yet elusive 'CUP molecular signature'. MicroRNA, epigenetic and proteomic studies are warranted to better characterize the biological profile of CUP and unravel its mystery. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. 43 5 491 500

Background: Conflicting results exist concerning disease knowledge and patients’ quality of life (QOL) while there is very limited information concerning the impact of awareness on caregivers’ health-related quality of life. The aim of this study was to explore the influence of disease awareness on both cancer patients and their caregivers during the period of chemotherapy. Materials and Methods: Two hundred and twelve cancer patient-caregiver dyads completed the QOL SF-36 instrument on the day of chemotherapy. Hierarchical multiple linear regression analysis was performed. Results: Physical component parameters were significantly higher in the family members (p

Objective: The efficacy and tolerability of M-TIP was evaluated as first-line treatment for patients with poor-risk germ cell tumors (GCT), according to International Germ Cell Cancer Collaborative Group (IGCCCG) criteria. Patients and methods: Thirty patients with poor-risk GCT were treated with M-TIP (methotrexate 250 mg/m2 given as a 4-hour infusion with folinic acid rescue on day 1, paclitaxel 175 mg/m2 given as a 3-hour infusion on day 1, followed by ifosfamide 1.2 g/m2 given as a 2-hour infusion and cisplatin 20 mg/m2 given as a 2-hour infusion on days 2 to 6) regimen for four cycles. Results: Five (16.6%, 95% confidence interval [CI]: 2%-31%) patients achieved clinical complete response (cCR) with chemotherapy only, 15 (50%, 95% CI: 31-69%) patients pathologic complete response (pCR) (11 had necrosis/fibrosis and 4 had mature teratoma) and 3 (10%) patients surgical complete response (sCR) for an overall favorable response of 76.6%. Twenty-one patients are continuously disease-free at a median follow-up of 5.3 years (range 0.9-8.4+ years), resulting in a 5-year progression-free survival (PFS) rate of 66.6% (95% CI = 49%-85%) and a 5-year survival rate of 70% (95% CI = 53%-87%). Toxicity was generally mild except for myelotoxicity. Patients with febrile neutropenia were successfully treated with broad spectrum antibiotics and G-CSF support. Hematologic toxicity in this trial was ameliorated with the use of G-CSF. Neurotoxicity and nephrotoxicity were not a problem, since only 6.6% and 3.3% of patients developed sensory neuropathy and renal toxicity, respectively. Conclusion: M-TIP is a highly effective (high proportion of patients achieved long-term disease-free status, lack of relapses) and well tolerated regimen for first-line treatment of poor-risk GCT patients. These results have to be compared with the standard BEP chemotherapy or more intensive regimens in multicentre randomized trials. © 2010 Elsevier Inc.

Aim: To describe potential beneficial effects of tyrosine kinase inhibitor in the treatment of unresectable/metastatic fibrous histiocytoma. Methods: We report a case of advanced stage fibrous histiocytoma with locally recurrent disease plus lung and bone metastatic deposits. Patient was treated with the tyrosine kinase inhibitor sunitinib. Results: Treatment with Sunitinib resulted in disease stabilization in the regional lesion and in good partial response for metastatic foci (reduction in number and size). After 13 months of treatment the patient is doing well with no tumor progression. Conclusions: This case appears to be one of the first documentations of beneficial effect and potential long-term benefit of TKIs in the treatment of fibrous histiocytoma.

Purpose: Cervical cancer is the second most common cancer of women worldwide and one of the leading cause of death in relative young women. This review gives an outline of chemotherapy of advanced, persistent or recurrent cervical cancer. Methods: We performed a literature search in the PubMed of almost all relevant articles concerning chemotherapy of advanced, persistent or recurrent cervical cancer. Results: The available data from the literature is mainly composed of most recent reviews, phase II and randomized phase III clinical trials. Conclusion: Single-agent cisplatin remains the current standard therapy for advanced, persistent or recurrent cervical cancer. Several single-agents have been tested, but none has been found to be superior compared to cisplatin. Both topotecan and paclitaxel in combination with cisplatin, have yielded superior response rates and progression-free survival without diminishing patient quality of life. However, only the combination of cisplatin and topotecan has improved overall survival. It is important to identify clinical and tumor-related factors predictive of response to cisplatin-based chemotherapy. Future trials are necessary, not only to compare combinations of existing agents, but to incorporate biological agents (monoclonal antibodies or small molecules) to chemotherapy in order to improve the treatment results of advanced, persistent or recurrent cervix cancer. © 2008 Elsevier Ltd. All rights reserved.

We report on a small-cell lung cancer case that was heralded by the presence of CENP-B specific anti-centromere autoantibodies (ACA) detected well before the diagnosis of cancer. The patient received chemotherapy plus radiotherapy, which resulted in complete remission of the tumor. Serum ACA levels were zeroed at the time of radiological documentation of tumor response and remained undetected at serial follow-up assessments until they rose again along with documentation of tumor recurrence which occurred 12 months later. We review in brief published research and discuss anti-centromere autoantibodies as potential biomarkers in small-cell lung cancer, a highly proliferative tumor which lacks sensitive serum markers. © 2007 Elsevier Ireland Ltd. All rights reserved. 60 2 302 306

We report on a small-cell lung cancer case that was heralded by the presence of CENP-B specific anti-centromere autoantibodies (ACA) detected well before the diagnosis of cancer. The patient received chemotherapy plus radiotherapy, which resulted in complete remission of the tumor. Serum ACA levels were zeroed at the time of radiological documentation of tumor response and remained undetected at serial follow-up assessments until they rose again along with documentation of tumor recurrence which occurred 12 months later. We review in brief published research and discuss anti-centromere autoantibodies as potential biomarkers in small-cell lung cancer, a highly proliferative tumor which lacks sensitive serum markers. Lung Cancer

Urine cytology has been a useful tool for the diagnosis of urinary tract malignancies. However, the presence of tumor cells in the urine sediment without an obvious urothelial metastatic deposit is a rare phenomenon and in patients with lung cancer has never been reported. We present five cases with metastatic lung cancer and positive urine cytology. The possible mechanisms underlining this phenomenon and its implications are discussed. Lung Cancer

Objective: To assess whether the use of chest radiography for screening changes over time. Design: Systematic review. Data Sources: MEDLINE, ISI, Cochrane Central Register of Controlled Trials, and handsearching of selected journals. Review Methods: We evaluated whether the proportion of primary care physicians using chest radiography to screen for (1) malignancy in the general asymptomatic population, (2) malignancy in a high-risk subgroup, (3) any disease in the general population, and (4) any disease in a high-risk subgroup changed over time, using random-effects meta-regression analysis. Adjustments for the availability of national guidelines were also performed. Results: Overall, 10% to 90% of primary care physicians reported using chest x-ray for screening. In unadjusted analyses, the proportion of physicians using chest radiography for cancer screening in the general population tended to increase by 0.9% per year (8 studies, n = 4313). The corresponding annual changes were -2.9% for cancer screening in high-risk subgroups (8 studies, n = 2784) and -0.4% regarding screening for any disease in the population (7 studies, n = 2627). No meta-regressions were run for outcome (4) (only 1 study). In the adjusted analyses, there was a decreasing nonsignificant trend for all outcomes. Conclusions: Despite formal recommendations, many physicians still use chest x-ray for screening, with their number decreasing slowly over time. This practice may be harmful because the positive predictive value of chest radiography is low, and further evaluation of false-positive findings might be associated with increased cost and risk from additional diagnostic or therapeutic interventions. 12 11 650 656