Faculty Bibliography

BACKGROUND:Palliative care skills are essential in surgical practice, but time constraints and lack of faculty expertise are barriers to implementing palliative care education in surgical training. This study describes and assesses a 5-hour palliative care curriculum designed to fit within demanding residency programs. METHODS:The palliative care curriculum was delivered to general surgery residents at a single institution by faculty surgeons over the course of five 1-hour sessions. Palliative care competence was assessed by a palliative care competence survey completed by residents at baseline and after completion of the palliative care curriculum. The palliative care curriculum survey assessed 3 domains (attitudes, knowledge, and behavior) on a 5-point Likert scale to create a composite score and domain subscores reported as mean (standard deviation). RESULTS:The study included 62 survey respondents, most of whom were in their first year of training (n = 32, 59.7%). Overall survey scores were significantly higher after palliative care curriculum participation (3.92 [0.43]) when compared with baseline (3.56 [0.61]), P = .008; this was also demonstrated in the knowledge domain (3.73 [0.55] vs 3.32 [0.69], P = .011) and the behavior domain (3.44 [0.7] vs 3.28 [0.78], P = .023). The improvement in scores was demonstrated in both univariate and multivariate analyses (P < .05). CONCLUSION/CONCLUSIONS:Participation in this 5-hour palliative care curriculum for surgical residents is associated with improved attitudes, knowledge, and behaviors in palliative care. This palliative care curriculum provides a framework for palliative care education across a variety of residency programs based on available time and faculty resources.

BackgroundMalignant bowel obstruction (MBO) is a complex clinical entity and there remains a relative lack of high-quality comparative trials on surgical management, in part due to a heterogeneous patient population and different treatment modalities which contribute to challenges in trial design and completion. SWOG S1316 is the only prospective randomized trial evaluating surgical vs non-surgical management of MBO and involved a trial framework in which patients were recruited for a randomization pathway as well as a patient choice pathway. Importantly, successful completion of S1316 required numerous amendment modifications to the trial during its course. We aimed to highlight aspects of S1316 trial design, execution, and modification that potentially contributed to trial completion.MethodsIterative qualitative content analysis of trial modification amendments through the course of the trial from 2015 to 2020.Results133 unique amendments were made to S1316 from 2015 to 2020. We found four dominant domains for the amendments: Accrual Barriers, Study Design Changes, Data Collection Issues, and Clarifications. Accrual amendments were essential to completing the trial and included increasing participating sites from six to 30 (including international sites) and the inclusion of Spanish-speaking participants (11% of final study population).ConclusionsContent analysis of S1316 trial amendments highlighted that Accrual amendments were important in trial completion. Future investigators may benefit from better anticipating trial modifications as they design their studies. It is likely that rapid initiation of trial amendments can lead to improved accrual and study completion.

BACKGROUND:Neoadjuvant chemotherapy (NC) for early pancreatic ductal adenocarcinoma (PDAC) remains controversial. We investigate the adoption of NC and its impact on survival in clinical T1 (cT1) PDAC. METHODS:National Cancer Database (2006-2017) was reviewed for cT1 PDAC. Patients receiving NC and surgery were compared with patients undergoing upfront surgery (US). RESULTS:A total of 5886 patients were included. NC use increased from 4.8% in 2006 to 18.8% in 2017. The NC group (n = 618) versus the US group (n = 5268) had: younger age (66 years vs. 68 years), smaller tumor size (2 cm vs. 2.2 cm), more pancreas head tumors (77% vs. 70.6%), lower lymph-vascular invasion (25.9% vs. 40.6%), and less lymph node positivity (43.6% vs. 54.5%), p < 0.001. Factors associated with receipt of NC were: younger age, recent year of diagnosis, and treatment at an academic program. In the NC group versus the US group, median OS was 35.2 months versus 28.3 months, p < 0.001. Factors associated with improved survival included: well differentiated pathology, R0 surgical margins, and receipt of chemotherapy. CONCLUSION/CONCLUSIONS:In cT1 PDAC, chemotherapy is associated with improved survival. In a surgery-first approach, only 59% of patients receive adjuvant chemotherapy. These data suggest consideration of neoadjuvant therapy for early pancreatic cancer.