Zachary D. Epstein-Peterson

Predicting Life Expectancy in Patients With Metastatic Cancer Receiving Palliative Radiotherapy: The TEACHH Model

Predicting life expectancy (LE) in patients with metastatic cancer who are receiving palliative therapies is a difficult task. The purpose of the current study was to develop a LE prediction model among patients receiving palliative radiotherapy (RT) that identifies those patients with short (< 3 months) and long (> 1 year) LEs.

Examining Forms of Spiritual Care Provided in the Advanced Cancer Setting.

Spiritual care (SC) is important to the care of seriously ill patients. Few studies have examined types of SC provided and their perceived impact. This study surveyed patients with advanced cancer (N = 75, response rate [RR] = 73%) and oncology nurses and physicians (N = 339, RR = 63%). Frequency and perceived impact of 8 SC types were assessed. Spiritual care is infrequently provided, with encouraging or affirming beliefs the most common type (20%). Spiritual history taking and chaplaincy referrals comprised 10% and 16%, respectively. Most patients viewed each SC type positively, and SC training predicted provision of many SC types. In conclusion, SC is infrequent, and core elements of SC—spiritual history taking and chaplaincy referrals—represent a minority of SC. Spiritual care training predicts provision of SC, indicting its importance to advancing SC in the clinical setting.

Postoperative radiation therapy for osseous metastasis: Outcomes and predictors of local failure

PURPOSE To evaluate patterns and predictors of local failure in patients undergoing postoperative radiation therapy (RT) for osseous metastases. METHODS AND MATERIALS Patients undergoing postoperative RT for bone metastases between June 2008 and January 2012 were retrospectively reviewed. Patterns of local failure were assessed, and Fine and Grays univariable and multivariable analyses (MVA) were used to evaluate factors associated with local progression, including dose intensity of RT (biological equivalent dose, BED, Gy10) and percent coverage of the surgical hardware by the RT fields. Additional predictors were similarly assessed, including patient (eg, age, performance status), disease (eg, tumor type, metastasis site), and treatment (eg, interval from surgery to RT) characteristics. RESULTS A total of 82 cases were followed for a median of 4.3 months (11.5 months among living patients) after treatment completion. Median BED was 39 Gy10 (range, 14-60), and RT fields covered an average of 71% (standard deviation, 26%) of the hardware. Fourteen cases (17%) experienced local progression. Although most (71%) failures occurred within the RT fields, 29% occurred marginally or out of field, but adjacent to surgical hardware. Increasing coverage of the surgical hardware by RT fields was associated with a reduced risk of local failure in MVA (hazard ratio [HR], 0.10; 95% confidence interval [CI], 0.012-0.82; P = .03), whereas a greater risk of failure was seen with increasing time between surgery and RT (HR, 1.03; 95% CI, 1.01-1.06; P = .01). Extremity rather than spinal site trended toward a greater risk of failure but did not reach significance (HR, 3.79; 95% CI, 0.96-14.89; P = .057). BED ≥39 Gy10 did not predict local failure (P = .51) in MVA. CONCLUSIONS Current strategies achieve good outcomes after postoperative RT for osseous metastases. Greater coverage of the surgical hardware with RT fields and avoiding delays between surgery and postoperative RT should be considered to reduce recurrence risk for patients with bone metastases requiring surgical stabilization.

Student and Faculty Reflections of the Hidden Curriculum: How Does the Hidden Curriculum Shape Students' Medical Training and Professionalization?

The hidden curriculum, or the socialization process of medical training, plays a crucial role in the development of physicians, as they navigate the clinical learning environment. The purpose of this qualitative study was to examine medical faculty and students’ perceptions of psychological, moral, and spiritual challenges during medical training in caring for critically ill patients. Focus groups were conducted with 25 Harvard Medical School (HMS) students, and interviews were conducted with 8 HMS faculty members. Five major themes emerged as important in shaping students’ medical training experiences. First, students and faculty discussed the overall significance of the hidden curriculum in terms of the hierarchy of medicine, behavioral modeling, and the value placed on research versus clinical work. Second, respondents articulated values modeled in medicine. Third, students and faculty reflected on changes in student development during their training, particularly in terms of changes in empathy and compassion. Fourth, respondents discussed challenges faced in medical school including professional clinical education and the psychosocial aspects of medical training. Finally, students and faculty articulated a number of coping mechanisms to mitigate these challenges including reflection, prayer, repression, support systems, creative outlets, exercise, and separation from one’s work. The results from this study suggest the significance of the hidden curriculum on medical students throughout their training, as they learn to navigate challenging and emotional experiences. Furthermore, these results emphasize an increased focus toward the effect of the hidden curriculum on students’ development in medical school, particularly noting the ways in which self-reflection may benefit students.

Predicting life expectancy in patients with metastatic cancer receiving palliative radiotherapy

Predicting life expectancy (LE) in patients with metastatic cancer who are receiving palliative therapies is a difficult task. The purpose of the current study was to develop a LE prediction model among patients receiving palliative radiotherapy (RT) that identifies those patients with short (< 3 months) and long (> 1 year) LEs.

Predicting life expectancy in patients with metastatic cancer receiving palliative radiotherapy: The TEACHH model: Life Expectancy in Metastatic Cancer

Predicting life expectancy (LE) in patients with metastatic cancer who are receiving palliative therapies is a difficult task. The purpose of the current study was to develop a LE prediction model among patients receiving palliative radiotherapy (RT) that identifies those patients with short (< 3 months) and long (> 1 year) LEs.