The abscopal effect is a rare phenomenon in the treatment of metastatic cancer where tumor regression occurs distant from the irradiated volume. It is thought that local radiation induces immunogenic cell death by systemically enhancing the host’s antitumor immune system. We present a rare case of the abscopal effect in esophageal adenocarcinoma. After palliative radiation therapy to the primary tumor and adjacent lymph nodes, a complete response was observed not only in the irradiated tissues, but also in non-irradiated metastatic lymph nodes. The patient remains cancer-free one year later. A better understanding of the abscopal effect may lead to novel research to improve patient outcome in the often dismal case of esophageal adenocarcinoma.

ObjectiveTo review and summarise the available literature regarding breastfeeding experiences of medical students, residents and physicians.Eligibility criteriaArticles of any design, including non-peer reviewed data that examine the experiences of breast feeding of medical students, residents and staff physicians.Information sourcesOvid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid EMBASE, Scopus and Web of Science.Risk of biasAll peer-reviewed studies underwent risk-of-bias assessment using relevant tools, depending on the study design.Included studiesWe included 71 citations; 51 surveys, 3 narrative descriptions, 9 editorials or letters to the editor, and 3 reviews.Synthesis of resultsIncluded articles were heterogeneous with respect to their study design, target population and outcomes reported. Most articles had a high risk of bias. Only five articles reported the impact of an intervention.Description of effectDespite heterogeneity, the majority of articles described important barriers to breast feeding for physicians, residents and medical students. These barriers were similar across studies, and included inadequate and inaccessible space, time constraints and inflexible scheduling, and lack of colleague support. The consequences of these barriers included low milk supply and early discontinuation of breast feeding.Strengths and limitations of evidenceDue to the observed heterogeneity of articles identified in this review, we are unable to assess trends in barriers or duration of breastfeeding over time.InterpretationInterventions to overcome systemic and cultural barriers to breast feeding are needed to meet legal obligations of workplaces for physicians and trainees. These interventions should be formally evaluated using implementation science or quality improvement methods.

Abstract:The abscopal effect is a rare phenomenon in the setting of radiation therapy (RT) for metastatic cancer where tumor regression occurs distant from the site of treatment. A proposed mechanism of the abscopal effect is the activation of a systemic antitumor immune response by localized RT. We report the first case, to our knowledge, of the abscopal effect in squamous carcinoma of the anal canal with metastases to pelvic lymph nodes, liver and bone. After palliative RT to the pelvis with sensitizing chemotherapy, complete response was observed not only in the primary tumor but also in bone and multiple liver metastases at 4 months after treatment, an effect that remained durable at 4-year follow-up. Understanding of the abscopal effect and the immune mechanisms associated with anal cancer may lead to new avenues of research to improve outcome for patients with this rare disease.

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Background Mentorship during residency training is correlated with improved outcomes. Many residency programs have implemented formal mentorship programs; however, reported data for these programs have not been previously synthesized. Thus, existing programs may fall short on delivering effective mentorship. Objective To synthesize current literature on formal mentorship programs in residency training in Canada and the United States, including program structure, outcomes, and evaluation. Methods In December 2019, the authors performed a scoping review of the literature in Ovid MEDLINE and Embase. The search strategy included keywords relevant to mentorship and residency training. Eligibility criteria included any study describing a formal mentorship program for resident physicians within Canada or the United States. Data from each study were extracted in parallel by 2 team members and reconciled. Results A total of 6567 articles were identified through the database search, and 55 studies met inclusion criteria and underwent data extraction and analysis. Though reported program characteristics were heterogenous, programs most commonly assigned a staff physician mentor to a resident mentee with meetings occurring every 3 to 6 months. The most common evaluation strategy was a satisfaction survey at a single time point. Few studies performed qualitative evaluations or used evaluation tools appropriate to the stated objectives. Analysis of data from qualitative studies allowed us to identify key barriers and facilitators for successful mentorship programs. Conclusions While most programs did not utilize rigorous evaluation strategies, data from qualitative studies provided insights into barriers and facilitators of successful mentorship programs, which can inform program design and improvement.