No abstract

Background Medical decisions made by oncology clinicians have serious implications, even when made collaboratively with the patient. Clinicians often use the Eastern Clinical Oncology Group (ECOG) performance status (PS) scores to help them make treatment-related decisions. Methods The current study explores the variability of the ECOG score when applied to 12 predetermined specially designed clinical case vignettes presented to a group of oncology clinicians ( n = 72). The quantitative analysis included evaluation of variability of ECOG PS scores and exploration of rater and patient-related factors which may influence the final ECOG rating. In-depth interviews were conducted with oncology clinicians to ascertain factors that they felt were important while making treatment-related decisions. Basic and global themes were generated following qualitative data analysis. Results Quantitative results showed that there was poor agreement in ECOG rating between raters. Overall concordance with the gold standard rating ranged between 19.4% and 56.9% for the vignettes. Moreover, patients deemed to have socially desirable qualities ( p < 0.004) were rated to have better PS and women patients ( p < 0.004) to have worse PS. Clinicians having international work experience had increased concordance with ECOG PS rating. Qualitative results showed that ‘perceived socio-economic background of the patient’, ‘age of the patient’, ‘patient’s and family’s preferences’ and ‘past treatment response’ were the major themes highlighted by respondents that influenced the treatment-related decisions made by clinicians. Conclusion There is considerable variability in ECOG PS determined by clinicians. Decision-making in oncology is complex, multifactorial and is influenced by rater and patient-related factors.

Rathke's cleft cyst is a non-neoplastic sellar cyst, which is increasingly reported on radiological investigation performed for unrelated intra-cranial pathology. When symptomatic, it is associated with headache, visual symptoms, and pituitary dysfunction. We report a case of an 18 year-old male patient with Rathke's cleft cyst, who presented with failing vision, headache, and hypocortisolism. After defaulting on planned surgery, the patient continued to take a replacement dose of prednisolone for a year. He reported significant improvement in vision and remarkable reduction in cyst size on repeat imaging after a year. Surgery was later performed in view of persisting severe headache. The authors discuss the reduction in cyst size in relation to long-term usage of replacement steroid. They postulate that selected patients with Rathke's cleft cyst with radiological evidence of inflammatory fluid can be given a trial of glucocorticoids and assessed for cyst shrinkage and changes in imaging characteristics.

Background Advances in cancer management have been associated with an increased incidence of emergency presentations with disease- or treatment-related complications. Objective This study aimed to measure the ability of patients and members of their social network to complete checklists for complications of systemic treatment for cancer and examine the impact on patient-centered and health-economic outcomes. Methods A prospective interventional cohort study was performed to assess the impact of a smartphone app used by patients undergoing systemic cancer therapy and members of their network to monitor for common complications. The app was used by patients, a nominated “safety buddy,” and acute oncology services. The control group was made up of patients from the same institution. Measures were based on process (completion of checklists over 60 days), patient experience outcomes (Hospital Anxiety and Depression Scale and the General version of the Functional Assessment of Cancer Therapy at baseline, 1 month, and 2 months) and health-economic outcomes (usage of appointments in primary care and elective and unscheduled hospital admissions). Results At the conclusion of the study, 50 patients had completed 2882 checklists, and their 50 “safety buddies” had completed 318 checklists. Near daily usage was maintained over the 60-day study period. When compared to a cohort of 50 patients with matching disease profiles from the same institution, patients in the intervention group had comparable changes in Hospital Anxiety and Depression Scale and General version of the Functional Assessment of Cancer Therapy. Patients in the Intervention Group required a third (32 vs 97 nights) of the hospital days with overnight stay compared to patients in the Control Group, though the difference was not significant. The question, “I feel safer with the checklist,” received a mean score of 4.27 (SD 0.87) on a Likert scale (1-5) for patients and 4.55 (SD 0.65) for family and friends. Conclusions Patients undergoing treatment for cancer and their close contacts can complete checklists for common complications of systemic treatments and take an active role in systems supporting their own safety. A larger sample size will be needed to assess the impact on clinical outcomes and health economics.

No abstract

No abstract

No abstract

No abstract