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What do hematology residents know about caring for older adults with cancer? A national survey of Canadian hematology residents' knowledge and interests

Published:August 29, 2022DOI:https://doi.org/10.1016/j.jgo.2022.08.018

      Abstract

      Introduction

      As the Canadian population ages, older adults comprise an increasing proportion of those diagnosed and treated for hematologic malignancies. A geriatric oncology curriculum has been recognized as a top priority in the care of older patients with cancer. It is not clear, however, whether hematology trainees receive training in geriatric oncology. We sought to understand residents' views and needs for a geriatric oncology curriculum during hematology residency in Canada.

      Materials and Methods

      We conducted a cross-sectional needs assessment of hematology trainees enrolled in a Canadian residency or advanced fellowship training program within hematology. The survey, which was piloted with three non-hematology residents to ensure user-friendliness, used a combination of Likert scale, multiple-choice, and open-ended questions. The survey comprised three sections: (1) demographic data, (2) current state of geriatric oncology training (amount, content) and (3) attitudes towards learning about geriatric oncology and preferred curriculum components and identified needs. The survey was administered by the study team and distributed electronically to program directors in June 2020. The program directors were asked to forward the survey to trainees registered within their Division of Hematology. Data were analyzed descriptively.

      Results

      Twenty-nine hematology residents participated (41.4% estimated response rate). Most respondents had not received geriatric oncology teaching (58.6%, n = 17) and have never been taught about geriatric oncology assessment tools (72.4%, n = 21) during hematology residency. Most respondents felt that their program should deliver a geriatric oncology curriculum (96.6%, n = 28). Respondents were most interested in learning about use of geriatric assessment tools for pre-treatment chemotherapy decision-making (86.2%, n = 25), prediction of chemotherapy toxicity (82.8%, n = 24), and to facilitate conversations regarding treatment initiation, continuation, or termination (79.3%, n = 23).

      Discussion

      Our study highlights the paucity of geriatric oncology training in hematology residency training programs. Our results highlight both the need and interest for a future dedicated geriatric oncology curriculum integrated into hematology training and provide guidance about which topics are most valued by trainees.

      Keywords

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      References

        • Statistics Canada
        Population estimates.
        (Accessed February 26, 2020)
        • Statistics Canada
        Population projections for Canada.
        (Accessed February 26, 2020)
        • Canadian Cancer Society. Canadian cancer statistics
        Predictions of future burden of cancer in Canada.
        www.cancer.ca
        Date: 2015
        (Accessed February 26, 2020)
        • Bhatt V.R.
        Cancer in older adults: understanding cause and effects of chemotherapy-related toxicities.
        Future Oncol. 2019; 15: 2557-2560https://doi.org/10.2217/fon-2019-0159
      1. National Comprehensive Cancer Network. Clinical practice guidelines in oncology: senior adult, oncology, version 2.
        J Natl Compr Canc Netw. 2014; 12https://doi.org/10.6004/jnccn.2014.0009
        • Kennedy B.J.
        Aging and cancer.
        J Clin Oncol. 1988; 6: 1903-1911https://doi.org/10.1200/JCO.1988.6.12.1903
        • Hurria A.
        • Naylor M.
        • Cohen H.J.
        Improving the quality of cancer care in an aging population: recommendations from an IOM report.
        JAMA. 2013; 310: 1795-1796https://doi.org/10.1001/jama.2013.280416
        • Moy B.
        • Flaig T.W.
        • Muss H.B.
        • Clark B.
        • Tse W.
        • Windham T.C.
        Geriatric oncology for the 21st century: a call for action.
        J Oncol Pract. 2014; 10: 241-243https://doi.org/10.1200/JOP.2013.001333
        • Puts M.T.E.
        • Hsu T.
        • Szumacher E.
        • et al.
        Meeting the needs of the aging population: the Canadian network on aging and cancer—report on the first network meeting.
        Curr Oncol. 2017; 24: e163-e170https://doi.org/10.3747/co.24.3455
        • Maggiore R.J.
        • Gorawara-Bhat R.
        • Levine S.K.
        • Dale W.
        Perceptions, attitudes, and experiences of hematology/oncology fellows toward incorporating geriatrics in their training.
        J Geriatr Oncol. 2014; 5: 106-115https://doi.org/10.1016/j.jgo.2013.10.003
        • Eid A.
        • Hughes C.
        • Karuturi M.
        • Reyes C.
        • Yorio J.
        • Holmes H.
        An interprofessionally developed geriatric oncology curriculum for hematology-oncology fellows.
        J Geriatr Oncol. 2015; 6: 165-173https://doi.org/10.1016/j.jgo.2014.11.003
        • Maggiore R.J.
        • Dale W.
        • Hurria A.
        • et al.
        Hematology-oncology fellows’ training in geriatrics and geriatric oncology: findings from an american society of clinical oncology-sponsored national survey.
        J Oncol Pract. 2017; 13: e900-e908https://doi.org/10.1200/JOP.2017.022111
        • Leifer R.
        • Bristow B.
        • Puts M.
        • et al.
        National survey among radiation oncology residents related to their needs in geriatric oncology.
        J Cancer Educ. 2019; 34: 9-13https://doi.org/10.1007/s13187-017-1244-1
        • Hsu T.
        • Kessler E.R.
        • Parker I.R.
        • et al.
        Identifying geriatric oncology competencies for medical oncology trainees: a modified delphi consensus study.
        Oncologist. 2020; 25: 591-597https://doi.org/10.1634/theoncologist.2019-0950
        • Kalsi T.
        • Payne S.
        • Brodie H.
        • Mansi J.
        • Wang Y.
        • Harari D.
        Are the UK oncology trainees adequately informed about the needs of older people with cancer?.
        Br J Cancer. 2013; 108: 1936-1941https://doi.org/10.1038/bjc.2013.204
        • Morris L.
        • Thiruthaneeswaran N.
        • Lehman M.
        • Hasselburg G.
        • Turner S.
        Are future radiation oncologists equipped with the knowledge to manage elderly patients with cancer?.
        Int J Radiat Oncol Biol Phys. 2017; 98: 743-747https://doi.org/10.1016/j.ijrobp.2017.01.001
        • Leukemia and Lymphoma Society of Canada
        Facts and statistics.
        (Accessed April 22, 2019)
        • CaRMS
        Data and reports.
        (Accessed March 1, 2021)
        • Rahmani M.
        Medical trainees and the dunning-kruger effect: when they don’t know what they don’t know.
        J Grad Med Educ. 2020; 12: 532-534https://doi.org/10.4300/JGME-D-20-00134.1
        • Palumbo A.
        • Bringhen S.
        • Mateos M.V.
        • et al.
        Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an international myeloma working group report.
        Blood. 2015; 125: 2068-2074https://doi.org/10.1182/blood-2014-12-615187
        • Hallek M.
        • Fischer K.
        • Fingerle-Rowson G.
        • et al.
        Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial.
        Lancet. 2010; 376: 1164-1174https://doi.org/10.1016/S0140-6736(10)61381-5
        • Starkman R.
        • Alibhai S.
        • Wells R.A.
        • et al.
        An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical prognostic scoring.
        Leukemia. 2020; 34: 1394-1406https://doi.org/10.1038/s41375-019-0666-7 [doi]
        • Abel G.A.
        • Klepin H.D.
        Frailty and the management of hematologic malignancies.
        Blood. 2018; 131: 515-524https://doi.org/10.1182/blood-2017-09-746420
        • Puts M.
        • Hsu T.
        • Szumacher E.
        • et al.
        Never too old to learn new tricks: surveying Canadian health care professionals about learning needs in caring for older adults with cancer.
        Curr Oncol. 2019; 26: 71-72https://doi.org/10.3747/co.26.4833
        • Hegde A.
        • Murthy H.S.
        Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment?.
        Bone Marrow Transplant. 2018; 53: 3-10https://doi.org/10.1038/bmt.2017.192
        • Fitzgerald L.
        • Kittai A.
        • Nastoupil L.
        • et al.
        Real-world outcomes of elderly patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) treated with chimeric antigen receptor T-cell (CAR-T) therapy.
        J Clin Oncol. 2020; 38
        • Sorror M.L.
        How I assess comorbidities before hematopoietic cell transplantation.
        Blood. 2013; 121: 2854-2863https://doi.org/10.1182/blood-2012-09-455063 [doi]
        • Morris L.
        • Turner S.
        • Thiruthaneeswaran N.
        • et al.
        An international expert delphi consensus to develop dedicated geriatric radiation oncology curriculum learning outcomes.
        Int J Radiat Oncol Biol Phys. 2022; 113: 934-945https://doi.org/10.1016/j.ijrobp.2022.04.030
        • Cunningham C.T.
        • Quan H.
        • Hemmelgarn B.
        • et al.
        Exploring physician specialist response rates to web-based surveys.
        BMC Med Res Methodol. 2015; 15: 32-zhttps://doi.org/10.1186/s12874-015-0016-z