Search

The Internet is a readily available source of information, and patients in North America frequently access it. Esophageal cancer is the 7th most common cancer worldwide, but there is a lack of studies examining esophageal cancer website quality. This current study looks to systematically analyze the quality of websites accessed by patients with esophageal cancer. A previously validated website evaluation tool was used to analyze the quality of online esophageal cancer resources for patients. The term "esophagus cancer" was used to retrieve hits from the search engine Google and the meta-search engines Dogpile and Yippy. A 100 website list was compiled using pre-specified inclusion and exclusion criteria. Websites were evaluated regarding administration, accountability, authorship, organization, readability, content, and accuracy. The term "esophagus cancer" returned over 500 websites from the search engines. Of the 100 websites included for analysis, 97% disclosed ownership, sponsorship, and advertising. Only 35% identified an author and even fewer (31%) gave the author's credentials. Only 31% declared updates to their information within the past 2 years. Readability scores revealed only 9%, and 12% of sites scored at an elementary level, according to the Flesch-Kincaid (FK) and SMOG scoring scales, respectively. The average FK and SMOG scores were 12.6 and 11.0, respectively. Detection was the most accurately described (70%). However, few websites provided accurate incidence/prevalence (28%), stage-specific prognosis (27%), or preventative information (17%). The quality of websites offering information on esophageal cancer is variable. While they overwhelmingly disclose website ownership interests, most do not identify authors, poorly describe important domains of esophageal cancer, and overall readability exceeds the commonly accepted level for non-healthcare professionals.

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.

Cancer patients may face difficulty evaluating web-based COVID-19 resources in context with their cancer diagnosis. The purpose of this study is to systematically evaluate educational resources available for cancer patients seeking online information on COVID-19 and cancer. The term "COVID-19 and Cancer" was searched in Google and metasearch engines Yippy and Dogpile. After applying inclusion and exclusion criteria, the results from the 3 lists were systematically combined for a final ranked list. This list was analyzed using a validated structured rating tool with respect to accountability, interactivity, organization, readability, and content coverage and accuracy. Three hundred ninety-eight websites were identified, and 37 websites were included for analysis. Only 43% of sites disclosed authorship, 24% cited sources, and 32% were updated within 3 months of the search date. Fifty-four percent of websites had high school readability (8.0-12.0), 43% were at university level or above, and no websites demonstrated the recommended reading level for health information for the public ( 6.0). Topics most discussed were special considerations for cancer patients during COVID-19 (84%) and COVID-19 risk factors (73%). Topics least covered were COVID-19 incidence/prevalence (5%) and prognosis (8%). There is some COVID-19 information for cancer patients available online, but quality is variable. Healthcare professionals may direct cancer patients to the most reliable COVID-19 and cancer websites shown in this study and results may be helpful when designing future online health information resources.

The internet is a common source of health information for patients with cancer. Despite research surrounding the quality of online resources for individual types of cancer, these results may not necessarily be easily extrapolated to cancer resources as a whole. Thus, we aim to use a standardized tool to produce generalizable results by analyzing the quality of online resources for the most common cancers. Educational websites pertaining to breast, lung, prostate, and colorectal cancers were searched using multiple search engines. After screening against pre-specified inclusion criteria, the most visible 100 websites for each cancer were extracted for analysis. A validated tool was then used to assess their quality. Pooled results were evaluated using descriptive and inferential statistics. Of the 400 analyzed websites, 43% were commercially affiliated, and these were significantly associated with greater use of biased language. Thirty percent of websites disclosed authorship, 47% cited at least one reliable source, and 43% were updated within the last 2 years. The average Flesch-Kincaid readability was determined to be at a grade 10.9 level, which is significantly more difficult than the recommended grade 6 level. Risk factors, symptoms, and detection were the most accurately covered topics. However, most websites did not cover prognosis. This study comprehensively examines the quality of online cancer resources for the four most common cancers. Our results could help guide the development of future resources, support patient education endeavors, and raise awareness among healthcare providers about the limitations of online cancer resources.

Background and objective The internet has become a major resource of information for cancer patients. However, the quality of these resources is variable, and a better understanding is needed to guide physicians as to how to best support patients in their online searches. We previously evaluated the quality of online breast cancer resources in 2011. Nearly a decade later, we aimed to assess the present quality of online breast cancer-related information and to compare our current analysis with data collected in 2011. Methods A list of 100 breast cancer websites was systematically compiled using meta-search engines Yippy and Dogpile and the search engine Google using the search term "breast cancer". Content accuracy and quality markers, including authorship, attribu-tion, currency, site organization, and readability were assessed by using a previously validated standardized rating tool. Results were analyzed using descriptive statistics and Fisher's exact test. The same strategy was used in both 2011 and 2019. Results When comparing 2011 data to the current one, 27% of websites had been updated in the previous two years in 2011 compared to 65% in 2019 (p0.00001). Both data sets remained similar in terms of website disclosures and objectivity. Only 30% of websites analyzed in 2019 used two or more reliable sources, while 63% had no reliable sources or no sources cited. From 2011 to 2019, resources with readability above grade 12 increased from 4% to 30% (p0.0001), while websites offering educational support rose from 8% to 35% (p0.0001). In 2019, treatment and etiology/risk factors were the most accurately covered areas (64% and 63% of websites, respectively). In 2011, 63% of websites were found to be globally accurate. Prognosis coverage increased from 18% to 33% from 2011 to 2019 (p=0.02). In 2019, survivorship was also evaluated and found to be covered in only 24% of resources. Conclusion Over the past eight years, there have been variable changes in the quality of online breast cancer resources. Promisingly, websites are being updated more frequently and the educational support offered is expanding. Furthermore, there has been significant improvement in the coverage of prognosis, although this requires further progress. Unfortunately, websites are becoming increasingly challenging to understand for the average patient, and coverage of survivorship is lacking. Our study provides vital information to healthcare providers on these trends in online breast cancer resources and how to best support patients in their internet searches.

The aim of this study is to assess the Internet usage pattern amongst glioma patients and to characterize its impact in their decision-making and clinical interactions. Glioma patients attending a tertiary cancer center between June and December 2019 were invited to participate in this study. A 26-item survey consisting of closed and open-ended questions was distributed with a unique identifier. Quantitative data were analyzed with descriptive statistics using SPSS Statistical package, and qualitative data with grounded theory approach. Thirty-two patients completed the survey. Demographics varied in age, time since diagnosis, glioma type, and level of education. Eighty-one percent were identified as “Internet users” who sought online glioma information. Google was the most popular search engine (96%), with “glioma” being the most frequent search term. The selection of websites often relied on perceived credibility and top search hits. The most searched topic was prognosis (73%). The majority of patients found that online information was easy to understand, and this did not vary significantly amongst age groups. Website quality was always assessed by 60% of patients. Only 62% patients found the Internet a useful resource, and 70% patients found it facilitated their understanding. Most patients discussed their Internet findings with a physician, largely regarding concerns about reliability. There is variable glioma information available online. Patients with glioma use the Internet as a resource, with variable impact on their interactions and decision-making. This information can be used by physicians, educators, and website developers to support glioma patients’ needs.

OBJECTIVE Psychiatric comorbidities are common among cancer patients. However, little is known about the quality of online information regarding these conditions. This study uses a validated tool to systematically determine the strengths and limitations of websites addressing depression in cancer patients. METHODS The term "depression in cancer patients" was searched online using the search engines Google, Yippy, and Dogpile. A set of predetermined inclusion/exclusion criteria was applied to all search results, which yielded 48 websites for inclusion. A validated rating tool was used to score the websites based on the six domains of Affiliation, Accountability, Interactivity, Structure & Organization, Readability, and Content Quality. The results were analyzed using descriptive statistics. RESULTS Of the 48 websites evaluated, 50% were commercial. 63% of websites identified authorship, 54% cited reliable sources, 37% provided links, and 38% were updated within the last 2 years. 94% of websites featured a search engine and 60% had at least four structural tools. Average readability was at a grade 12.3 level using the Flesch-Kincaid scale and 11.3 using the Simple Measure of Gobbledygook Index. The most completely and accurately covered topics of depression were symptoms and treatment-83% and 73% respectively. Its prevention and prognosis were not covered by any of the websites. CONCLUSIONS A validated rating tool was applied to evaluate the quality of online information for depression in cancer patients. Website accountability was poor, readability was often at a level that is too difficult for the lay audience, and the topics of prevention and prognosis were seldom covered.

Background Meningiomas are the most common primary central nervous system tumors and patients face difficulty evaluating resources available online. The purpose of this study is to systematically evaluate the educational resources available for patients seeking meningioma information on the Internet. Methods A total of 127 meningioma websites were identified by inputting the term “meningioma” on Google and two meta-search engines. A structured rating tool developed by our research group was applied to top 100 websites to evaluate with respect to accountability, interactivity, readability, and content quality. Responses to general and personal patient questions were evaluated for promptness, accuracy, and completeness. The frequency of various social media account types was analyzed. Results Of 100 websites, only 38% disclosed authorship, and 32% cited sources. Sixty-two percent did not state date of creation or modification, and 32% provided last update less than 2 years ago. Websites most often discussed the definition (99%), symptoms (97%), and treatment (96%). Prevention (8%) and prognosis (47%) were most often not covered. Only 3% of websites demonstrated recommended reading level for general population. Of 84 websites contacted, 42 responded, 32 within 1 day. Conclusions Meningioma information is readily available online, but quality varies. Sites often lack markers for accountability, and content may be difficult to comprehend. Information on specific topics are often not available for patients. Physicians can direct meningioma patients to appropriate reliable online resources depicted in this study. Furthermore, future web developers can address the current gaps to design reliable online resources.

To survey Canadian radiation oncology (RO) practice leaders to determine the effect of the COVID-19 pandemic on radiation services and patient and staff issues in the early phase of the pandemic and 1 year later.The RO leader (department or division head) from every Canadian cancer center with radiation services was identified. Two surveys were circulated to the identified leader via email from the Canadian Association of Radiation Oncology central office, using the SurveyMonkey survey tool: the first closed in June 2020 and the second (expanded) survey in June 2021, representing 2 points in time of the COVID-19 pandemic. Questions included patient volume, service interruptions and delays, and changes in scheduling and telemedicine use. Additional questions were included in the follow-up survey to determine further effects on disease presentation, volume, vaccination and access, and personnel issues.Telemedicine was widely adopted early in the pandemic and continued to be a common technique to communicate and connect with patients. Although many centers were deferring or delaying certain disease sites early in the pandemic, this was not as prevalent 1 year later. Reduced cancer screening and patients presenting with more advanced disease were concerns documented in the 2021 survey. A high level of concern regarding stress among health care professionals was identified.Canadian RO centers have faced numerous challenges during the COVID-19 pandemic but continued to provide timely and essential cancer care for patients with cancer. Future evaluation of RO center practices will be important to continue to document and address the effect of the COVID-19 pandemic on issues relevant to RO leaders, patients, and staff.

Introduction The internet has become a mainstay source of health information for cancer patients. Online patient education videos are common; however, there have been no studies examining the quality of publicly available videos on radiotherapy for lung cancer (one of the most common forms of cancer). To fill this knowledge gap, we aim to systematically map and objectively assess videos discussing radiotherapy for lung cancer on YouTube. Methods The terms "radiotherapy for lung cancer," "radiation for lung cancer," "radiation therapy for lung cancer," and "radiation treatment for lung cancer" were searched on YouTube using a clear-cache browser. Results were sorted by relevance and the top 50 English-language results for each search were recorded. After removing duplicates, each video was assessed for length, Video Power Index (VPI, which is the product of a video's average daily views and like and dislike ratio), source, content, comment moderation, and misinformation. Two raters were used to ensure consistency. Results were evaluated using descriptive and inferential statistics. Results A total of 88 unique videos resulted from the search. The median video length was 4 minutes and 5 seconds. The average VPI was 10.9 (95% CI: 1.5-20.4) and the median number of views was 954.5. All videos were published between July 8, 2009 and November 18, 2020. Of the videos, 44% were published within the past two years. A total of 61% of the videos were from the USA, 14% were from the UK, 6% from Australia, 5% each from Canada and India, and other countries make up the remaining 10%. Most of the videos were published by healthcare facilities (39%) and non-profit organizations (31%). Content-wise, 95% of videos contain information specific to lung cancer. A total of 46 videos (52%) were targeted toward patient education. Of which, 37 covered radiotherapy for lung cancer, 12 covered side effects for radiotherapy, and 11 covered both. The other 42 videos (48%) were designed for a professional audience. Stereotactic body radiation therapy (SBRT)/stereotactic ablative radiotherapy (SABR) was the most commonly described radiotherapy modality (42%), and the physician interview was the most common format, being used in 59% of videos. Out of the 38 videos with at least one comment, only two (5%) were moderated by the host channel. None of the videos featured misleading information. Conclusions This study comprehensively surveyed YouTube videos pertaining to radiotherapy for lung cancer to provide a high-level overview of the information that patients may find online. Although nearly half of the videos describe lung cancer radiotherapy for patients, only a small proportion comprehensively cover both radiotherapy and its side effects. The results of our study can help guide the development of patient education tools and encourage healthcare providers to recognize the limitations of online health information and proactively address patient questions regarding radiotherapy. Future research could examine videos on other lung cancer treatment options or radiotherapy for other cancers.

Summary Background Whole breast irradiation delivered once per day over 3–5 weeks after breast conserving surgery reduces local recurrence with good cosmetic results. Accelerated partial breast irradiation (APBI) delivered over 1 week to the tumour bed was developed to provide a more convenient treatment. In this trial, we investigated if external beam APBI was non-inferior to whole breast irradiation. Methods We did this multicentre, randomised, non-inferiority trial in 33 cancer centres in Canada, Australia and New Zealand. Women aged 40 years or older with ductal carcinoma in situ or node-negative breast cancer treated by breast conserving surgery were randomly assigned (1:1) to receive either external beam APBI (38·5 Gy in ten fractions delivered twice per day over 5–8 days) or whole breast irradiation (42·5 Gy in 16 fractions once per day over 21 days, or 50 Gy in 25 fractions once per day over 35 days). Patients and clinicans were not masked to treatment assignment. The primary outcome was ipsilateral breast tumour recurrence (IBTR), analysed by intention to treat. The trial was designed on the basis of an expected 5 year IBTR rate of 1·5% in the whole breast irradiation group with 85% power to exclude a 1·5% increase in the APBI group; non-inferiority was shown if the upper limit of the two-sided 90% CI for the IBTR hazard ratio (HR) was less than 2·02. This trial is registered with ClinicalTrials.gov , NCT00282035 . Findings Between Feb 7, 2006, and July 15, 2011, we enrolled 2135 women. 1070 were randomly assigned to receive APBI and 1065 were assigned to receive whole breast irradiation. Six patients in the APBI group withdrew before treatment, four more did not receive radiotherapy, and 16 patients received whole breast irradiation. In the whole breast irradiation group, 16 patients withdrew, and two more did not receive radiotherapy. In the APBI group, a further 14 patients were lost to follow-up and nine patients withdrew during the follow-up period. In the whole breast irradiation group, 20 patients were lost to follow-up and 35 withdrew during follow-up. Median follow-up was 8·6 years (IQR 7·3–9·9). The 8-year cumulative rates of IBTR were 3·0% (95% CI 1·9–4·0) in the APBI group and 2·8% (1·8–3·9) in the whole breast irradiation group. The HR for APBI versus whole breast radiation was 1·27 (90% CI 0·84–1·91). Acute radiation toxicity (grade ≥2, within 3 months of radiotherapy start) occurred less frequently in patients treated with APBI (300 [28%] of 1070 patients) than whole breast irradiation (484 [45%] of 1065 patients, p Interpretation External beam APBI was non-inferior to whole breast irradiation in preventing IBTR. Although less acute toxicity was observed, the regimen used was associated with an increase in moderate late toxicity and adverse cosmesis, which might be related to the twice per day treatment. Other approaches, such as treatment once per day, might not adversely affect cosmesis and should be studied. Funding Canadian Institutes for Health Research and Canadian Breast Cancer Research Alliance.

Objective: This study evaluated online thyroid cancer patient information quality. This is essential, given increasing patient use of online health information. Methods: A total of 100 thyroid cancer websites, representing those patients find first, were identified using Google and two meta-search engines. Content accuracy and patient-evaluable quality markers, including attribution, currency, structure, and content comprehensiveness and readability, were assessed with a previously validated standardized rating tool, developed using design-based methods. Accuracy was defined compared to standard, peer-reviewed medical resources, UpToDate and the National Comprehensive Cancer Network. Responses to general and personal "patient" questions were evaluated for promptness and accuracy. Results: Of 100 websites, only 26% stated authorship, and 56% cited sources. Seventy-four percent had dates of creation or last update, with only half of those dates occurring within the past 2 years. Websites most often discussed the definition (94%), diagnosis (92%), and treatment (94%) of thyroid cancer, but diagnosis and treatment were also most frequently incomplete or inaccurate: diagnosis information was complete and accurate 50% of the time, and treatment 47%. Only 2% of websites were comprehensible without high school education. Of 83 websites contacted with "patient" questions, 50 replied, 48 within 1 week. Conclusion: Thyroid cancer information is widely available online, but quality varies. Sites often lack markers for patients to assess quality, and content may be difficult to understand. Information is frequently incomplete, particularly on topics important to patients, such as diagnosis and treatment. Educational resource developers may fill these gaps, and healthcare providers can direct thyroid cancer patients to reliable online resources. Abbreviation: NCCN = National Comprehensive Cancer Network.

Thyroid cancer incidence rates and Internet use are both increasing. Thyroid cancer is common in young patients, who are likely to use the Internet. This study aims to characterize thyroid cancer patient Internet use and search patterns, usability of online resources, and effects on clinical care. From May to December 2017, inclusive, patients with thyroid cancer attending two tertiary cancer centers were invited to complete a survey about Internet use. Thirty-nine of 72 questionnaires were returned (54%). Ninety-seven percent of participants used the Internet, and 87% had looked for thyroid cancer information. The majority (94%) searched on Google. Patients most often looked for information about treatment (94%) and symptom management (76%). Many patients evaluated content quality by comparing several resources (71%), discussing with a physician (56%) or using a credible academic or government site (53%). Online information was somewhat hard to understand for 32%, but 91% found it useful. Over half (60%) of treatment decisions were affected by web resources, and information helped 50% of patients make decisions with their physicians. Respondents highlighted a lack of resources on survivorship and uncommon tumors such as medullary or anaplastic cancer. Physicians should recognize that patients overwhelmingly access online information, which often impacts patients' decision-making. Clinicians can guide thyroid cancer patients through abundant web-based information and assist in interpreting this information. Educators can use this information to guide resource development, tailoring content and design to thyroid cancer patients' needs.

Purpose Interprofessional education (IPE) is demonstrated to improve patient outcomes in a variety of health care fields and clinical settings. However, the extent and effectiveness of IPE in radiation oncology is undefined. This systematic literature review identifies reports of radiation oncology IPE and summarizes the outcomes of those initiatives. Methods The literature was queried through PubMed using search terms focusing on IPE targeted toward radiation oncologists, radiation therapists, nurses, medical physicists, and medical dosimetrists in the undergraduate medical education, graduate medical education, and continuing medical education settings. IPE was defined as any educational initiative designed to improve understanding or teamwork efficiency between the learners of interest. Because of the lack of published material pertaining to IPE in radiation oncology, noninterventional, descriptive studies were included. Results Of 1,306 articles screened, 4 were included in the qualitative analysis. Radiation therapists were included in IPE most frequently (four articles), followed by radiation oncologists, nurses, physicists, and dosimetrists (one article each). IPE initiatives identified ranged from descriptive surveys and written source review to IPE workshops and longitudinal IPE curricula with quantified outcomes. Descriptive studies viewed IPE positively, and all studies collecting quantitative data demonstrated positive outcomes. Undergraduate health profession students were included most frequently (three articles), followed by practicing professionals (one article). No articles reported IPE in the graduate medical education setting. Conclusions This systematic review demonstrates that despite the general association of IPE with improved outcomes, radiation oncology IPE initiatives are lacking. There is a significant opportunity to further develop radiation oncology IPE.

The internet is a common source of health information for patients with cancer. Despite research surrounding the quality of online resources for individual types of cancer, these results may not necessarily be easily extrapolated to cancer resources as a whole. Thus, we aim to use a standardized tool to produce generalizable results by analyzing the quality of online resources for the most common cancers. Educational websites pertaining to breast, lung, prostate, and colorectal cancers were searched using multiple search engines. After screening against pre-specified inclusion criteria, the most visible 100 websites for each cancer were extracted for analysis. A validated tool was then used to assess their quality. Pooled results were evaluated using descriptive and inferential statistics. Of the 400 analyzed websites, 43% were commercially affiliated, and these were significantly associated with greater use of biased language. Thirty percent of websites disclosed authorship, 47% cited at least one reliable source, and 43% were updated within the last 2 years. The average Flesch-Kincaid readability was determined to be at a grade 10.9 level, which is significantly more difficult than the recommended grade 6 level. Risk factors, symptoms, and detection were the most accurately covered topics. However, most websites did not cover prognosis. This study comprehensively examines the quality of online cancer resources for the four most common cancers. Our results could help guide the development of future resources, support patient education endeavors, and raise awareness among healthcare providers about the limitations of online cancer resources.

Purpose Approximately one quarter of cancer patients are parents to young children. One unique challenge faced by this patient group is the difficulty of accessing childcare support during medical appointments. Hospital-based childcare options could represent a solution to this problem, but to this point, no comprehensive scans have described existing on-site childcare centres. The purpose of this study is to identify and characterize on-site childcare services available to patients at North American hospitals. This information could inform the development of similar programs for cancer patients. Methods Using publicly available information, an environmental scan of the grey literature was conducted to investigate Canadian and American hospitals for the presence of childcare services. A standardized data collection tool was used to extract centre characteristics. Results Twenty-six childcare centres were identified across 161 hospitals. The majority of the centres were associated with pediatric hospitals (77%) and were located in the United States (69%). Only a single childcare centre was associated with a cancer hospital. All centres accommodated children between the ages of 3 and 8. Most centres were open for over 30 hours per week (77%) and were free of charge to users (89%). Other characteristics, including capacity and staffing, varied widely. Conclusions These results represent an inventory of patient-accessible, on-site childcare services currently available at North American hospitals. Cancer patients who are also parents may especially need this kind of support, as they are at high risk for financial toxicity.

Glioblastoma multiforme (GBM) carries a poor prognosis, and patients often have trouble accessing high-quality resources. The purpose of this study is to systematically evaluate the information available to GBM patients on the Internet. An Internet search using the term "Glioblastoma Multiforme" was performed using three different search engines: Google, Yippy, and Dogpile. A structured rating tool, validated and developed by our research group, was applied to evaluate the top 100 websites with respect to accuracy, coverage, readability, currency, structure, attribution, and interactivity. Among the 100 websites evaluated, definition and treatment were the most accurately written sections (98% and 78% of websites). Etiology/risk factors and diagnosis were the least accurately written sections (40% and 52% of websites). Half of the websites did not cover etiology/risk factors, and 47% did not cover diagnosis. Only 21% of websites provided complete authorship information, and almost half of websites (46%) were affiliated with commercial websites (.com). Sixty three percent of websites were at a post-secondary reading level. The majority of online GBM websites contains accurate but incomplete information. Many websites do not provide authorship information, last modification dates, and reference materials. Readability was generally inappropriate for GBM patients. This research can be useful for clinicians to guide GBM patients to quality online resources.

11009 Background: Medical oncology and medical education have both expanded exponentially over the past 50 years; as such, it is important to understand the current status of postgraduate medical oncology education and develop ways to advance this field. This study undertakes a scoping review of medical education literature in medical oncology to inform future scholarship in this area. Methods: MEDLINE (Ovid), Embase (Ovid), ERIC (EBSCO), and Web of Science (UBC Core Collection) were searched to find peer-reviewed English language articles on Postgraduate Medical Education in Medical Oncology published between 2009 and 2020. The review was designed in accordance with updated methodological guidance for the conduct of scoping review. Articles were classified by learning specialty, learner training level, region of authorship, single or multi-institution, year of publication, whether the journal was an education journal, quantitative vs qualitative design, study methodology, and category or topic. A modified Kerns framework for curriculum development was used to assess the type of curriculum intervention, Boyer’s definition of scholarship was used to classify the type of scholarship, and the CanMEDS Framework was used to map the domains of physician competency each study aims to address. Results were interpreted using descriptive statistics and collated and summarized utilizing predetermined conceptual frameworks. Results: 2959 references were initially found across the 4 databases. After title and abstract screening, 305 articles remained; after full text review, a total of 144 articles were included in our final analysis. These data showed that postgraduate medical oncology graduate medical education scholarship is increasing and most commonly observed in the United States. Quantitative studies were most common with surveys used as the most popular study approach. In terms of CanMEDS framework, Professional and Medical Expert comprised the large majority of education focuses, while very few articles addressed Leader or Health Advocate. Curriculum development, professional development, and attitudinal skills (communication skills, ethics) were the dominant research themes, while no articles discussed teacher training. Conclusions: By investigating the body of current literature, this research identifies areas of highest priority in postgraduate medical oncology graduate medical education and opportunities for growth. Whereas areas like professionalism and attitudinal skills are well-studied, research is lacking in leadership, health advocacy and teaching training. This study provides guidance for future medical education scholarship in medical oncology and establishes a benchmark to examine changes in medical oncology educational scholarship over time.

Purpose/Objective(s): Cancer patients are increasingly using the Internet to educate themselves about COVID-19. Recent studies have shown that cancer patients are at risk of more serious outcomes of COVID-19 compared to the general population. Some cancer treatments such as chemotherapy can impact the immune system, which may make COVID-19 infection more dangerous. This study looks to systematically examine the quality of web resources available for cancer patients about COVID-19. Materials/Methods: The term “COVID-19 Risk and Cancer” was searched in Google and metasearch engines Yippy and Dogpile. URLs were recorded from each search and inclusion and exclusion criteria were applied. The results from the 3 lists were combined to come up with a final list based on overall average rank order. This list was analyzed using a previously validated structured rating tool with respect to accountability, currency, interactivity, readability, and content coverage and accuracy. Results: 398 websites were identified prior (this includes overlap between the three search sites used), 37 websites were included for analysis. Out of 37 websites, only 43% disclosed authorship and 24% cited sources. Most websites (76%) revealed date of creation, and 32% were updated less than 3 months before the date of search. 68% of websites enabled questions to be sent to the author or webmaster regarding COVID-19 risk queries. 54% of websites had high school readability (8.0-12.0), 43% were at university level or above, and only one website demonstrated the recommended reading level for general public (below 8.0). Topics most commonly discussed were special consideration for cancer patients in COVID-19 (84%), COVID-19 risk factors (73%), and infection prevention (62%), while topics least covered were COVID-19 incidence/prevalence (5%), prognosis (8%), and treatment (16%). Conclusion: There is some COVID-19 in cancer risk information available online, but quality is variable. The total number of sites with relevant information related to COVID-19 and cancer was relatively low and many sites lacked markers for accountability. Some information may not be up to date and content may be difficult to comprehend. Healthcare professionals may direct cancer patients to the most reliable online resources about COVID-19 and cancer shown in this study. In addition, this may be helpful to consider when designing comprehensive web resources regarding COVID-19.

Purpose/objective(s) In 2018, the Canadian Medical Association acknowledged that physician health remains a significant threat to the viability of Canada's health care system. The prevalence of burnout among American oncologists was 44% in a 2014 survey. The purpose of this survey was to determine the national prevalence of burnout indicators and report work engagement among Canadian radiation oncologists. Materials/methods Between November 2019 and March 2020 (pre-COVID pandemic), an online questionnaire was distributed electronically to 333 Canadian radiation oncologists across 49 centers through the Stadt lander Canadian Association of Radiation Oncology mailing list. The survey included 62 questions assessing work engagement, and the validated Maslach Burnout Inventory (MBI) burnout scale (22 questions). Results 241 of the 333 surveyed Canadian radiation oncologists (72%) completed the questionnaire and were included in this analysis. Responses to the MBI showed that 15% of radiation oncologists met the strict criteria for burnout (i.e., negative scores in all 3 domains: exhaustion, depersonalization, and low accomplishment). Another 60% scored negative in at least one of the three burnout domains. Using the more commonly reported definition of burnout (negative scores in either exhaustion and/or depersonalization), 44% of Canadian radiation oncologists were burnt out. Only 25% had positive scores in all 3 domains and were fully engaged in their work. The full burnout syndrome varied between provinces and was the highest in British Columbia (22%) and lowest in Quebec (3%). The responses to work engagement questions revealed significant concerns regarding inefficiency in workflow (50%), heavy workloads (> 50%), poor work life balance (68%), lack of control over the work environment (47%) and lack of recognition from administrators (45%). 48% perceive the atmosphere at their primary work area as "chaotic and hectic". Within the last 3 years, 41% had considered leaving their institution to work elsewhere and 51% were considering reducing their full-time equivalent (FTE). Reassuringly, 80% reported a sense of overall ability to provide high quality care and a 59% feel they have a supportive network of colleagues and 80% are willing to try something new. The top 4 strategies identified by respondents aimed to improve work-life quality were (1) more support staff at work, (2) more efficient care models, (3) more resources for patients, and (4) lighter workloads for physicians. Conclusion Our survey showed that only 25% of Canadian radiation oncologists are fully engaged in their work, whereas 15% met the strict criteria for burnout and 44% met the commonly used burnout criteria. With the rising incidence of cancer and complexity of care, there is an urgent need for system change, leverage enthusiasm to "try something new", and develop appropriate strategies to improve the well-being of the Canadian radiation oncologist workforce.

Introduction: Over 70% of Canadians who use the internet search for healthcare information online. This is especially true regarding the young adult population. Testicular cancer is the most commonly diagnosed cancer in men aged 15–29. This study characterizes how testicular cancer patients access healthcare information online, and how this influences their clinical encounters and treatment decisions. Methods: From June 2018 to January 2019, a survey consisting of 24 open and close-ended questions was distributed to testicular cancer patients at a tertiary cancer center. Survey results were evaluated using mixed methods analysis. Results: Fifty-nine surveys were distributed, and 44 responses were received. All respondents used the internet regularly and 82% used the internet as a source of information regarding their cancer. The majority followed top hits from Google when selecting websites to view. Frequent topics searched included treatment details and survivorship concerns. Eighty-nine percent of users found online information easy to understand and 94% found it increased their understanding. For 47% of users, the internet did not influence their clinical consultation nor their treatment decision (53%). Conclusions: Most testicular cancer patients in this study are regular internet users and use the internet to search for testicular cancer information. Healthcare providers should recognize this and can play important roles in discussing online findings with patients to assess their background knowledge and expectations, as well as providing guidance on selecting credible online resources. The results of this study can be used to improve patient-physician communication and education.

The aim of this study is to assess the Internet usage pattern amongst glioma patients and to characterize its impact in their decision-making and clinical interactions. Glioma patients attending a tertiary cancer center between June and December 2019 were invited to participate in this study. A 26-item survey consisting of closed and open-ended questions was distributed with a unique identifier. Quantitative data were analyzed with descriptive statistics using SPSS Statistical package, and qualitative data with grounded theory approach. Thirty-two patients completed the survey. Demographics varied in age, time since diagnosis, glioma type, and level of education. Eighty-one percent were identified as "Internet users" who sought online glioma information. Google was the most popular search engine (96%), with "glioma" being the most frequent search term. The selection of websites often relied on perceived credibility and top search hits. The most searched topic was prognosis (73%). The majority of patients found that online information was easy to understand, and this did not vary significantly amongst age groups. Website quality was always assessed by 60% of patients. Only 62% patients found the Internet a useful resource, and 70% patients found it facilitated their understanding. Most patients discussed their Internet findings with a physician, largely regarding concerns about reliability. There is variable glioma information available online. Patients with glioma use the Internet as a resource, with variable impact on their interactions and decision-making. This information can be used by physicians, educators, and website developers to support glioma patients' needs.

Online educational resources have an impact on patient understanding, opinion, and behavior. More colorectal cancer patients are being diagnosed and using the internet to search for information. This study aims to provide the most in-depth and comprehensive examination of online colorectal resources to date. An internet search using the terms “colorectal cancer,” “colon cancer,” and “rectal cancer” were performed, with meta-search engines “Dogpile,” “Yippy,” and “Google.” A total of 741, 759, and 703 websites were returned by the search engines respectively. A list of the “top 100 websites” was compiled by placing the sites in average rank order. The websites were evaluated using a validated structured rating tool. Inter-rater reliability was evaluated using kappa statistics, and the results were analyzed using descriptive statistics. Website affiliations were 40% commercial and 35% from non-profit organizations. Most websites disclosed ownership (93%) and had no apparent bias (94%). Authorship disclosure was poor (17%). Most sites were interactive (84%) and organized (70% with at least 4/5 features). Readability was at a senior high school level on average. Content coverage and accuracy were the highest in the areas of etiology (96% coverage) and symptoms (95% coverage) and lowest in areas of treatment (72% coverage) and prognosis (43% coverage). Colorectal cancer online information can be improved in accountability, readability, content accuracy, and completeness. Author disclosure, more accurate and updated citations, and a lower grade level of readability are needed. More complete and accurate information are needed, especially in the areas of treatment and prognosis.

Introduction The internet is an important source of health information, and yet the quality of the resources that patients’ access can vary widely. Previous research has evaluated the quality of information for several types of cancer; however, this has not yet been done for cervical cancer beyond treatment information. The goal of this project was to systematically evaluate the quality of resources for cervical cancer information available against a range of metrics, including content breadth and accuracy, readability, and accountability. Methods An internet search was performed using the term “cervical cancer” using Google and two meta-search engines, Dogpile and Yippy. The top-100 websites returned across all three engines were evaluated using a validated structured rating tool. Results Only 32% of websites disclosed their author and only 38% used citations, while 64% of websites had been updated in the last two years. Readability was at university-level or higher for 19% of websites, and high-school level for 78%. Coverage was highest for etiology and risk factors (93% of websites) and prevention strategies such as pap smears and vaccines (92%); coverage was lowest for prognosis (49%), staging (52%), side effects (47%), and follow-up (25%). When a topic was covered the information was predominantly accurate, and few websites had inaccurate information. At least one social-media platform was linked to by 79% of websites. Conclusions This project highlights the strengths and limitations in the quality of the top-100 informational cervical cancer websites. These findings can inform the dialogue between health care providers and patients around selecting and evaluating information resources. These findings can also inform specific improvements to make online resources for cervical cancer more accessible, comprehensive, and relevant to patients.

Goal This study aims to evaluate the quality of online hepatocellular carcinoma (primary liver cancer) resources by using a validated tool to determine the strengths and limitations of hepatocellular carcinoma Web sites designed for patient education. Background In recent years, online health information-seeking behavior has become more prevalent. Meanwhile, hepatocellular carcinoma incidence rates have also increased. However, there is currently limited literature assessing the quality of online hepatocellular carcinoma information. Materials and methods The term "hepatocellular carcinoma" was searched using the search engine Google and the meta-search engines Dogpile and Yippy. A validated rating tool was used to assign quality scores to 100 Web sites based on the domains of Web site affiliation, accountability, interactivity, structure and organization, readability, and content quality. Overall quality scores were tallied for all Web sites. Results Noncommercial hepatocellular carcinoma Web sites received significantly higher overall quality scores compared with their commercial counterparts. Overall, 30% of the Web sites identified their author(s), 42% cited sources, and 33% were updated within the past 2 years. The majority of Web sites utilized at least 1 interactive feature and 4 structural tools. Average readability was at a grade 11.8 level using the Flesch-Kincaid grading system, which is significantly higher than the recommended grade 6 level. Definition and treatment were the most commonly covered topics, while prevention and prognosis were the least commonly covered. Conclusions The quality of online hepatocellular carcinoma information is highly variable. Health care professionals should be aware of its limitations and be proactive in guiding patients to reliable resources.

Background Radiation oncology graduates occasionally experience difficulties obtaining employment. The purpose of this study was to explore the perceptions of radiation oncology residents (RORs) and program directors (PDs) about the job market and the potential impact on their well-being. Methods RORs and PDs from 13 Canadian training programs were invited to participate. Semi-structured interviews were conducted from March 2014 to January 2015. Knowledge/perception of the job market, impact on personal/professional life, as well as opinions regarding possible contributing factors/solutions to the job market were assessed. A conventional content analysis of each transcript was performed with the clustering of conceptually similar expressions into themes. Demographic information was summarized with descriptive statistics. Results Twenty RORs and four PDs participated. All the participants described delayed retirement and over-training as contributors to the job shortage. The majority of trainees interviewed were concerned about the job market (60%) and reported that it impacted their personal (60%) and professional (55%) relationships. PDs described the job market as negatively impacting their job satisfaction. Resident morale was ranked as poor by both groups. Conclusions Job market shortages can negatively impact the personal and professional well-being of trainees and PDs. Attention to manpower planning is important to maintaining a high-quality workforce. The cyclical undersupply and oversupply of residents occur in several countries, which makes our findings potentially relevant to residency training programs internationally.

An electrical Impedance based tool is designed and developed to aid physicians performing clinical exams focusing on cancer detection. Current research envisions improvement in sensor-based measurement technology to differentiate malignant and benign lesions in human subjects. The tool differentiates malignant anomalies from nonmalignant anomalies using Electrical Impedance Spectroscopy (EIS). This method exploits cancerous tissue behavior by using EIS technique to aid early detection of cancerous tissue. The correlation between tissue electrical properties and tissue pathologies is identified by offering an analysis technique based on the Cole model. Additional classification and decision-making algorithm is further developed for cancer detection. This research suggests that the sensitivity of tumor detection will increase when supplementary information from EIS and built-in intelligence are provided to the physician.

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.

PURPOSE/OBJECTIVE(S) 2020 marked the first ever administration of a national in-training radiation oncology examination coordinated through the collaborative effort of radiation oncology program directors across Canada. The primary aim of this project is to see if a national written examination in radiation oncology is perceived as useful by residents and program directors (PDs) and if so, how can it be improved for future years. MATERIALS/METHODS A written examination including both short answer questions and clinical cases addressing exam subjects covered as per the Royal College was designed for radiation-oncology residents from years 2 to 5 (PGY2-5). An anonymous electronic survey was distributed to residents and program directors of the 13 programs in Canada immediately following the completion of the examination and again after examination results were released. Likert scale and free text questions regarding their preparation and overall impression of the examination were asked. RESULTS Of all PGY2-5s, 33 of 102 completed a pre-examination survey and 9 a post one. There was a greater amount of participation from senior residents, about 60% of responses were from PGY4 and 5. Pre- and post- answers were very similar with less than 10% difference for almost all questions. Overall, more than 95% agreed that the examination should be administered again in future years and that results would highlight areas that needed reviewing prior to the Royal College examination. Of the 12 eligible PDs, 9 responded to the pre-examination survey. Over 75% agreed that this standardized national exam was more efficient than the local examination and that the results would help refine teaching topics. 33% of residents expressed a need for more radiation biology questions on the examination. Other recurrent recommendations included more physics questions, increased question clarity and consideration for transitioning to an online platform. CONCLUSION The first ever national written examination for radiation-oncology residents was administered in 2020. It was viewed positively by both residents and program directors. The PD survey feedback indicated that it was an efficient method to prepare residents for their Royal College examinations. Resident feedback indicated that some subjects were lacking. This information will be used to improve the quality of the examination for future years.