PURPOSE: Many oncologists have relationships with industry. Previous work has shown that these payments are usually modest; however, there exist a subset of medical oncologists who receive more than $100,000 US dollars (USD) annually. Here, we describe the characteristics of these physicians. METHODS: This retrospective cohort study used the Open Payments data set to identify all US-based medical oncologists/hematologists who received $100,000+ USD in general payments linked to cancer medications in 2018. Open Payments and a web-based search were used to identify physician characteristics, demographics, research profile, and leadership positions. RESULTS: One hundred thirty-nine medical oncologists received > $100,000 USD in general payments. The median payment was $154,613 USD, and the total payment was $24.2 million USD. These high-payment physicians represent 1% of all US medical oncologists (N = 10,620) yet account for 37% of all industry payments in 2018. Sixty percent (84 of 139) and 21% (29 of 139) of these high-payment physicians hold hospital and specialty association leadership roles, respectively. One quarter (24%, 33 of 139) serve on journal editorial boards, and 10% (14 of 139) have authored clinical practice guidelines; 72% (100 of 139) hold faculty appointments. CONCLUSION: A small number of medical oncologists receive very high payments from the pharmaceutical industry. These physicians hold major leadership roles within oncology. Further work is needed to understand the extent to which these conflicts of interest may shape clinical practice and policy.

Background: The World Health Organization (WHO) Essential Medicines List (EML) and resource-stratified guidelines both prioritize high-value medicines. We compared the 2023 EML cancer medicines list with global cancer statistics, examined the proportion of EML therapies recommended by resource-stratified guidelines, and identified gaps that merit evaluation by the WHO EML Committee. Methods: We compared the 2023 EML medicines for adult cancers with cancer incidence and mortality data from GLOBOCAN 2022. We cross-referenced the EML with 2 resource-stratified guidelines (National Comprehensive Cancer Network [NCCN] and National Cancer Grid [NCG] of India) and evaluated preferred treatments in resource-stratified guidelines that were not recommended by the EML. Results: The 2023 EML included 64 cancer medicines for 219 tumor-specific indications. The greatest number of medicines are listed for leukemia (37/219 [17%]) and lymphoma (33/219 [15%]). Although some common cancers (eg, hepatocellular carcinoma) have no EML-listed medicines because of the low clinical benefit, we identified some cancers (eg, esophageal, gastric) with effective therapies that the EML Committee should evaluate for inclusion. Cancers with no listed medicines make up 34% of cancer deaths globally. Among EML indications with an NCCN resource-stratified guideline, 42% (35/84) and 73% (62/84) were recommended by the NCCN Basic and Core Guidelines, respectively. Among EML indications with an NCG resource-stratified guideline, 163 of 196 (83%) and 175 of 196 (89%) were recommended by the NCG Essential and Optimal guidelines, respectively. Conclusions: We identified some effective medicines that should be evaluated for inclusion in the WHO EML. Prioritization of cancer medicines was similar between the EML and NCG India but discordant between with NCCN resource-stratified guideline.

Cervical cancer is a largely preventable disease, with over 90% of cases caused by persistent infection with human papillomavirus (HPV). Despite the availability of HPV vaccination and cervical screening, incidence rates in Canada have been rising since 2015, particularly among underserved populations. This study investigates contributing factors behind cervical cancer diagnoses in Eastern Ontario over a two-year period to identify gaps leading to failures in prevention and screening. A retrospective chart review was conducted for cervical cancer cases diagnosed between January 2022 and December 2023 at two regional cancer centres in Eastern Ontario. Cases were categorized as screen-detected, inadequately screened, or system failure, based on prior screening history and care processes. Data was collected on patient, screening, and cancer characteristics. Of 132 cases, 22 (16.7%) were screen-detected, 73 (55.3%) were inadequately screened, and 37 (28.0%) were attributed to healthcare system failure. Later-stage disease was significantly more common in the latter two groups. Thirty-one (23.5%) cases presented with palliative diagnoses, and 18 (13.6%) individuals died within 2.5 years. Inadequate screening was associated with rurality, deprivation, and lack of a primary care provider. System failures included false-negative Pap tests, loss to follow-up, and misapplication of screening guidelines. This study evaluated failures in cervical cancer prevention, which led to cervical cancer diagnoses in Eastern Ontario. Gaps included suboptimal screening participation, lack of access to care, health care system breakdowns, and limitations of the Pap test. Findings provide concrete suggestions for eliminating cervical cancer in Canada.

PURPOSE: Electronic health record (EHR) systems aim to improve efficiency, care coordination, and patient safety, yet implementation often introduces workflow challenges and staff burden. In 2024, the Cancer Centre of Southeastern Ontario (CCSEO), a regional academic cancer center in Canada, transitioned from a hybrid paper-electronic system to a fully integrated regional EHR. Although hospital EHR adoption has been studied, limited research has examined its impact within ambulatory oncology care, particularly among nonphysician staff, or how institutions responded to the findings. Our study explored oncology healthcare worker perspectives on EHR implementation at CCSEO and identified resulting quality-improvement (QI) initiatives. METHODS: Using purposeful maximum variation sampling, we recruited clinical, administrative, and research staff. Semistructured interviews explored workflow efficiency, documentation burden, staff wellness, patient safety, communication, and training. Data were audio-recorded, transcribed, and analyzed thematically using MAXQDA. RESULTS: Nineteen interviews were conducted until thematic saturation. Three major themes emerged. (1) Efficiency and workflow: Staff valued consolidated records and regional connectivity but reported navigation complexity, time burden, duplicate orders, reliance on multiple programs, and frequent workarounds. (2) Staff and patient wellness: Staff noted limited training, increased workload, cognitive overload, and reliance on peer support contributed to burnout. (3) Patient safety: Identified risks included order and medication errors, communication breakdowns, poor system visualization, imaging delays, and wristband or labeling issues. Several QI initiatives were implemented in response, including education and navigation rounds, formation of working groups, and integration of artificial intelligence. CONCLUSION: EHR implementation introduced both benefits and challenges in oncology workflows. Findings informed multidisciplinary QI initiatives targeting role-specific training, workflow optimization, and safety, offering a framework for other cancer centers transitioning to new EHR systems.

Next-generation sequencing (NGS) is integral to colorectal cancer (CRC) care, but its value depends on results being available when treatment decisions are made. We conducted a qualitative study to identify quality gaps in CRC NGS pathways and assess perspectives on digital and artificial intelligence (AI)-enabled workflow support. Semi-structured interviews were conducted with 22 medical oncologists and pathologists from 14 Ontario hospitals, and transcripts were analyzed thematically. Five themes emerged: (1) clinical indications and test ordering, where initiation was inconsistent because of unclear reflex-testing criteria, reliance on upstream clinicians, staging uncertainty, evolving indications, and funding constraints; (2) tissue, pathology, and laboratory workflow, where participants attributed bottlenecks and turnaround variability to send-out testing, staffing, infrastructure, and capacity; (3) interdisciplinary communication and tracking, where informal communication, unclear ownership, and manual tracking highlighted the need for closed-loop confirmation and alerts; (4) reporting and clinical integration, where report clarity, interpretability, and timing affected use; and (5) electronic health record integration and AI integration, where fragmented systems and limited interoperability delayed result access. Participants supported clinician-supervised digital or AI-enabled tools for case identification, triage, tracking, and overdue-result alerts. CRC NGS optimization requires standardized reflex criteria, clearer ownership, closed-loop tracking, reliable routing, structured reporting, and interoperable infrastructure.