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Choi Y, Huntley JH, Efron JE, Sato K, Marohn MR, Pollack CE. Survivorship care for early-stage colorectal cancer: a national survey of general surgeons and colorectal surgeons. Colorectal Dis 2018; 20:996-1003. [PMID: 29956455 DOI: 10.1111/codi.14321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/21/2018] [Indexed: 12/24/2022]
Abstract
AIM Few data are available on the optimal long-term care of early-stage colorectal cancer survivors, termed survivorship care. We aimed to investigate current practice in the management of patients following treatment for early-stage colorectal cancer. METHOD We performed an internet survey of members of the American Society for Colon and Rectal Surgeons about several aspects of long-term care, including allocation of clinician responsibility, challenges with transitions to primary care physicians (PCPs), long-term care plan provision and recommended surgical follow-up duration. RESULTS Overall, 251 surgeons responded. Surgeons reported taking primary responsibility for managing adverse surgical effects (93.2%) and surveillance testing (imaging and laboratories 68.6%, endoscopy 82.4%). Barriers to PCP handoffs included patient preference for surgical follow-up (endorsed by 76.6%) and inadequate communication with PCPs (endorsed by 36.9%). Approximately one-third of surgeons routinely provide survivorship care plans to PCPs; surgeons who received formal survivorship training were more likely to do so compared to those without such training (OR 3.29, 95% CI 1.57, 6.92). Although only 20.4% of surgeons follow their patients beyond 5 years, individuals in practice longer were more likely to continue long-term follow-up than those with ≤ 10 years of experience. CONCLUSIONS This is the largest survey of surgeons regarding long-term management for early-stage colorectal cancer and highlights the potential for improved coordination with PCPs and increased implementation of survivorship care plans.
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Affiliation(s)
- Y Choi
- Department of Medicine, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - J H Huntley
- Department of Medicine, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - J E Efron
- Department of Surgery, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - K Sato
- Department of Surgery, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - M R Marohn
- Department of Surgery, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - C E Pollack
- Department of Medicine, Johns Hopkins School of Medicine, Lutherville, MD, USA
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Denzen EM, Preussler JM, Murphy EA, Baker KS, Burns LJ, Foster J, Idossa L, Moore HK, Payton TJ, Haven D, Jahagirdar B, Kamani N, Rizzo JD, Salazar L, Schatz BA, Syrjala KL, Wingard JR, Majhail NS. Tailoring a Survivorship Care Plan: Patient and Provider Preferences for Recipients of Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 25:562-569. [PMID: 30315940 DOI: 10.1016/j.bbmt.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
This study aimed to develop a survivorship care plan (SCP) that can be individualized to facilitate long-term follow-up care of hematopoietic cell transplantation (HCT) survivors. A sample SCP was developed that included 2 documents: a treatment summary and preventive care recommendations that combined data on treatment exposures routinely submitted by HCT centers to the Center for International Blood and Marrow Transplant Research (CIBMTR) with long-term follow-up guidelines. Focus groups were conducted by phone to characterize the critical patient-centered elements of the SCP. Focus group eligibility criteria included (1) adult patients >1 year post-HCT and their caregivers (3 groups; n = 22), (2) HCT physicians and advanced practice providers (APPs) (2 groups; n = 14), (3) HCT nurses and social workers (4 groups; n = 17), and (4) community health care professionals (3 groups; n = 24). Transcripts were analyzed for saturation of key themes using NVivo 10 software. Patients and caregivers suggested combining the treatment summary and care guidelines into a single document. They also requested sections on sexual and emotional health and the immune system. Providers wanted the treatment summary to focus only on what they absolutely must know. Themes were similar across healthcare professionals, although screening for psychosocial issues was emphasized more by the nurses and social workers. All preferred to receive the SCP electronically; however, hardcopy was considered necessary for some patients. All felt that the SCP would facilitate appropriate post-HCT care. This study highlights the need for an SCP instrument to facilitate HCT survivorship care. Furthermore, it demonstrates the feasibility and value of engaging HCT recipients, caregivers, and providers in developing an SCP. Their feedback was incorporated into a final SCP that was subsequently tested in a randomized trial.
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Affiliation(s)
- Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, MN; Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Jaime M Preussler
- National Marrow Donor Program/Be The Match, Minneapolis, MN; Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | | | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, MN; Center for International Blood and Marrow Transplant Research, Minneapolis, MN.
| | - Jackie Foster
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Lensa Idossa
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | | | - Tammy J Payton
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Darlene Haven
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | | | | | - J Douglas Rizzo
- Medical College of Wisconsin, Milwaukee, WI; Center for International Blood and Marrow Transplant Research, Milwaukee, WI
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Effects of an Empowerment Program on Resilience and Posttraumatic Growth Levels of Cancer Survivors. Cancer Nurs 2018; 42:E1-E13. [DOI: 10.1097/ncc.0000000000000644] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Tevaarwerk AJ, Klemp JR, van Londen GJ, Hesse BW, Sesto ME. Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors. Cancer 2018; 124:4292-4300. [PMID: 30277575 DOI: 10.1002/cncr.31546] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/13/2018] [Accepted: 03/19/2018] [Indexed: 01/22/2023]
Abstract
The American cancer survivor population is ever-growing, with necessary follow-up primarily accomplished in a high-touch fashion-adding to unsustainability and fragmentation of care. Given the complexities of the health care system processes needed to support survivorship, engineering approaches may best address performance deficits and facilitate the provision of patient-centered care. Such collaboration between health care and engineering is recommended for redesigning health care delivery systems. By using Systems Engineering Initiative for Patient Safety (SEIPS), a systems engineering model widely used to improve health care quality and delivery, the authors examine the work system to identify the barriers and facilitators to necessary care in the presence of a survivorship care plan and visit. Recommendations for future improvement include ensuring that care-planning processes are dynamic, clearly assigned, resilient, and integrated with electronic health record systems.
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Affiliation(s)
- Amye J Tevaarwerk
- Department of Medicine, University of Wisconsin, Madison and Carbone Cancer Center, Madison, Wisconsin
| | - Jennifer R Klemp
- Department of Medicine, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, Kansas
| | - Gijsberta J van Londen
- University of Pittsburgh Cancer Institute and School/Department of Medicine, Pittsburgh, Pennsylvania
| | - Bradford W Hesse
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Mary E Sesto
- Department of Medicine, University of Wisconsin, Madison and Carbone Cancer Center, Madison, Wisconsin
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Advancing Uterine Cancer Survivorship Among African American Women. J Natl Med Assoc 2018; 110:391-395. [PMID: 30126566 DOI: 10.1016/j.jnma.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have examined health behavior interventions for African American women who are uterine cancer survivors. Black-white differences in uterine cancer survival suggest that there are unmet needs among these survivors. METHODS This article identifies opportunities to address disparities in uterine corpus cancer survival and quality of life, and thereby to increase uterine cancer survivorship among African American women. RESULTS For cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, lymphedema, and difficulty sleeping. A variety of interventions have been evaluated to address physical and mental health concerns, including exercise and dietary interventions. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among cancer survivors, but few studies have focused specifically on African American women with a uterine corpus cancer diagnosis. Research-tested culturally tailored lifestyle interventions are lacking. CONCLUSIONS There is a need for a better understanding of uterine cancer survivorship among African American women. Additional evaluations of interventions for improving the quality of life and survival of African American uterine cancer survivors are needed.
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Damlaj M, El Fakih R, Hashmi SK. Evolution of survivorship in lymphoma, myeloma and leukemia: Metamorphosis of the field into long term follow-up care. Blood Rev 2018; 33:63-73. [PMID: 30093158 DOI: 10.1016/j.blre.2018.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 12/18/2022]
Abstract
Recent advancements in cancer care, coupled with early detection and an aging population have resulted in significant growth of cancer survivors. Long term follow up of such survivors is essential given the heightened risk for development of late effects such as secondary neoplasms, cardiovascular disease or psychosocial dysfunction among others. As more patients with hematologic malignancies are cured or managed over protracted periods of time, awareness of such issues is paramount for the practicing clinicians for optimal patient management. In this review, we describe the genesis of the field of cancer survivorship, and then it's gentle metamorphosis into multiple sub-fields currently by presenting literature relevant to late effects commonly seen in Hodgkin lymphoma, non-Hodgkin lymphoma, chronic leukemia and multiple myeloma. We will discuss the strengths and pitfalls of the existing models of survivorship care in hematologic malignancies and conclude with expert perspective on how to move the field forward.
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Affiliation(s)
- Moussab Damlaj
- Division of Hematology & HSCT, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Riad El Fakih
- Division of Adult Hematology & Stem Cell Transplantation, Oncology Center, King Faisal Specialist Hospital and Research Center, s, Saudi Arabia
| | - Shahrukh K Hashmi
- Division of Adult Hematology & Stem Cell Transplantation, Oncology Center, King Faisal Specialist Hospital and Research Center, s, Saudi Arabia; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Jacobsen PB, DeRosa AP, Henderson TO, Mayer DK, Moskowitz CS, Paskett ED, Rowland JH. Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery. J Clin Oncol 2018; 36:2088-2100. [PMID: 29775389 PMCID: PMC6036622 DOI: 10.1200/jco.2018.77.7482] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Numerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers' concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors. Methods Randomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis. Results Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care. Conclusion Existing research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.
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Affiliation(s)
- Paul B. Jacobsen
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Antonio P. DeRosa
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Tara O. Henderson
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Deborah K. Mayer
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Chaya S. Moskowitz
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Electra D. Paskett
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Julia H. Rowland
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
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Weaver SJ, Jacobsen PB. Cancer care coordination: opportunities for healthcare delivery research. Transl Behav Med 2018; 8:503-508. [PMID: 29800404 PMCID: PMC6257019 DOI: 10.1093/tbm/ibx079] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In this commentary, we discuss opportunities to explore issues related to care coordination at three points on the cancer care continuum: (1) screening, particularly coordinating follow-up for abnormal findings, (2) active treatment, particularly challenges for patients with multiple chronic conditions, and (3) survivorship, particularly issues related to facilitating shared care between oncology and primary care. For each point on the continuum, we briefly summarize some of the important coordination issues and discuss potential avenues for future research in the context of existing evidence.
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Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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60
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Ke Y, Ng T, Chan A. Survivorship care models for breast cancer, colorectal cancer, and adolescent and young adult (AYA) cancer survivors: a systematic review. Support Care Cancer 2018; 26:2125-2141. [PMID: 29696424 DOI: 10.1007/s00520-018-4197-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/09/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Well-elucidated survivorship care models are pertinent in the long-term management of cancer survivors. This review aims to update existing literature and evaluate the key components of such models with a focus on breast, colorectal, and adolescent and young adult (AYA) cancer survivors. METHODS The PubMed electronic database were searched comprehensively for relevant publications in English through February 2017. Additional manual searches were conducted for reference lists and official guidelines published by oncology societies. Included studies addressed the correct cancer type, elaborated on each model's structure and provided patient-related outcome data to support its model's effectiveness if applicable. RESULTS Among the 25 included studies, six articles described survivorship models applicable to all cancer types, and the remaining focused on breast cancer (n = 10), colorectal cancer (n = 3), and AYA cancer survivors (n = 6). Shared-care model was largely described for all cancer types whereas multidisciplinary model predominated for AYA cancer survivors. Upon evaluation, these models described the essential components of survivorship care fairly well except for the care coordination component. Also, the definition of time points of care was vague and noncomprehensive. CONCLUSION The reviewed survivorship model studies were comprehensive but were limited by a lack of existing rigorous evaluation efforts to assess their effectiveness. This review further provided valuable recommendations for future methodological evaluation of such models. This review has highlighted care coordination as an area for improvement and emphasized the importance of obtaining data on the effectiveness of these survivorship models to ensure satisfactory quality of life and health outcomes.
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Affiliation(s)
- Yu Ke
- Department of Pharmacy, National University of Singapore, Blk S4A level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Terence Ng
- Department of Pharmacy, National University of Singapore, Blk S4A level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Blk S4A level 3, 18 Science Drive 4, Singapore, 117543, Singapore. .,Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. .,Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore, 169857, Singapore.
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Frick MA, Rosenthal SA, Vapiwala N, Monzon BT, Berman AT. The state of survivorship care in radiation oncology: Results from a nationally distributed survey. Cancer 2018; 124:2653-2660. [PMID: 29669165 DOI: 10.1002/cncr.31386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/29/2017] [Accepted: 12/13/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Survivorship care has become an increasingly critical component of oncologic care as well as a quality practice and reimbursement metric. To the authors' knowledge, the current climate of survivorship medicine in radiation oncology has not been investigated fully. METHODS An institutional review board-approved, Internet-based survey examining practices and preparedness in survivorship care was distributed to radiation oncology practices participating in the American College of Radiology Radiation Oncology Practice Accreditation program between November 2016 and January 2017. A total of 78 surveys were completed. Among these, 2 were nonphysicians, resulting in 76 evaluable responses. RESULTS Radiation oncologists (ROs) frequently reported that they are the primary provider in the evaluation of late toxicities and the recurrence of primary cancer. Although approximately 68% of ROs frequently discuss plans for future care with survivors, few provide a written survivorship care plan to their patients (18%) or the patients' primary care providers (24%). Patient prognosis, disease site, and reimbursement factors often influence the provision of survivorship care. Although ROs report that several platforms offer training in survivorship medicine, the quality of these resources is variable and extensive instruction is rare. Fewer than one-half of ROs believe they are expertly trained in survivorship care. CONCLUSIONS ROs play an active role within the multidisciplinary team in the cancer-related follow-up care of survivors. Investigation of barriers to the provision of survivorship care and optimization of service delivery should be pursued further. The development of high-quality, easily accessible educational programming is needed so that ROs can participate more effectively in the care of cancer survivors. Cancer 2018;124:2653-60. © 2018 American Cancer Society.
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Affiliation(s)
- Melissa A Frick
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seth A Rosenthal
- Sutter Medical Group and Sutter Cancer Center, Sacramento, California
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian T Monzon
- Radiation Oncology Practice Accreditation Program, American College of Radiology, Reston, Virginia
| | - Abigail T Berman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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Dang A, Miller S, Horvat D, Klassen-Ross T, Graveline M, Collins R, Olson R. Assessing post-radiotherapy handover notes from a family physician perspective. Curr Oncol 2018; 25:49-52. [PMID: 29507483 DOI: 10.3747/co.25.3728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Across our province, post-radiotherapy (rt) handover notes are sent to family physicians (fps) after rt. Based on previous fp feedback, we created a revised post-radiotherapy handover note with more information requested by fps. The purpose of this study was to determine whether the revised handover note improved the note as a communication aid. Methods Potential common and rare treatment side effects, oncologist contact information, and treatment intent were added to the revised handover note. Both versions were sent alongside a questionnaire to fps. Paired t-tests were carried out to compare satisfaction differences. Results There was a response rate of 37% for the questionnaires. Significantly greater clarity in the following categories was observed: responsibility for patient follow-up (mean score improvement of 1.2 on a 7-point Likert scale, p < 0.001), follow-up schedule (1.1, p < 0.001) as well as how and when to contact the oncologist (1.4, p = 0.001). Family physicians were also more content with how the institute transitioned care back to them (1.5, p = 0.012). Overall, fps were generally satisfied with the content of the revised post-rt handover note and noted improvement over the previous version. The frequency of investigations and institute supports initiated such as counselling services were suggested further additions. Conclusions The inclusion of potential treatment side effects, oncologist contact information, treatment intent and a well-laid out follow-up schedule were essential information needed by fps for an effective post-rt completion note. With these additions, the revised post-rt handover note showed significant improvement.
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Affiliation(s)
- A Dang
- University of British Columbia School of Medicine, Prince George, British Columbia
| | - S Miller
- Department of Radiation Oncology, British Columbia Cancer Agency-Centre for the North, Prince George, British Columbia.,Department of Surgery, University of British Columbia, Vancouver, British Columbia
| | - D Horvat
- University of British Columbia School of Medicine, Prince George, British Columbia.,Northern Health, Prince George, BC.,University of Northern British Columbia, Prince George, British Columbia.,Northern Partners in Care, Prince George, British Columbia
| | - T Klassen-Ross
- University of Northern British Columbia, Prince George, British Columbia
| | - M Graveline
- Northern Partners in Care, Prince George, British Columbia
| | - R Collins
- Northern Partners in Care, Prince George, British Columbia
| | - R Olson
- Department of Radiation Oncology, British Columbia Cancer Agency-Centre for the North, Prince George, British Columbia.,Department of Surgery, University of British Columbia, Vancouver, British Columbia
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Isaacson MJ, Hulme PA, Cowan J, Kerkvliet J. Cancer survivorship care plans: Processes, effective strategies, and challenges in a Northern Plains rural state. Public Health Nurs 2018; 35:291-298. [DOI: 10.1111/phn.12393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mary J. Isaacson
- College of Nursing; South Dakota State University; Sioux Falls SD USA
| | - Polly A. Hulme
- College of Nursing; South Dakota State University; Sioux Falls SD USA
| | - Jenna Cowan
- College of Nursing; South Dakota State University; Sioux Falls SD USA
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Ramsay JM, Mann K, Kaul S, Zamora ER, Smits-Seemann RR, Kirchhoff AC. Follow-Up Care Provider Preferences of Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2018; 7:204-209. [PMID: 29346008 DOI: 10.1089/jayao.2017.0083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To explore the experiences and perspectives of adolescent and young adult (AYA) cancer survivors regarding patient-provider relationships and their preferences surrounding type of healthcare provider for follow-up care. METHODS We recruited AYA cancer survivors who were diagnosed between the ages of 15 and 39 using the Utah Cancer Registry. Twenty-eight survivors participated in six focus groups held between March and May of 2015 in Salt Lake City and St. George, Utah. This analysis focuses on how survivors' preferences about type of healthcare provider may influence their transition into, and utilization of, follow-up care. RESULTS On average, survivors were 6.3 (standard deviation = 1.7) years from their cancer diagnosis. A majority of survivors expressed a desire not to transition to a new provider and preferred continuing to see their oncologist for follow-up care. For these survivors, this was due to already having a close relationship with their oncologist and because they trusted their provider's knowledge about cancer and how to handle late effects. However, survivors placed emphasis on being comfortable with their healthcare provider, regardless of provider type. CONCLUSIONS Our findings demonstrate the importance of formalizing provider transitions and roles after cancer therapy to improve patient comfort with new providers. By understanding the complexities of the transition from active cancer treatment to follow-up care for AYA survivors, these findings can inform programs undertaking post-care educational activities to ensure a seamless transition into survivorship care. Survivorship care plans can facilitate these transitions and improve patient confidence in follow-up care.
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Affiliation(s)
- Joemy M Ramsay
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Karely Mann
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Sapna Kaul
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Eduardo R Zamora
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Rochelle R Smits-Seemann
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anne C Kirchhoff
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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LaGrandeur W, Armin J, Howe CL, Ali-Akbarian L. Survivorship care plan outcomes for primary care physicians, cancer survivors, and systems: a scoping review. J Cancer Surviv 2018; 12:334-347. [PMID: 29332213 DOI: 10.1007/s11764-017-0673-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/22/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE With the focus on survivorship care-coordination between oncology and primary care providers (PCPs), there is a need to assess the research regarding the use of survivorship care plans (SCPs) and determine emerging research areas. We sought to find out how primary care physicians have been involved in the use of SCPs and determine SCP's effectiveness in improving care for cancer survivors. In this scoping review, we aimed to identify gaps in the current research and reveal opportunities for further research. METHODS We followed the methodology for scoping studies which consists of identifying the research question, locating relevant studies, selecting studies, charting the data, and collating, summarizing, and reporting the results. RESULTS Out of 5375 original articles identified in the literature search, 25 met the inclusion/exclusion criteria. Eight articles examined PCP-only related outcomes, eight examined survivor-only related outcomes, eight examined mixed outcomes between both groups, and one examined system-based outcomes. Findings highlighted several areas where SCPs may provide benefits, including increased confidence among PCPs in managing the care of survivors and increased quality of life and well-being for survivors. This research also highlighted the need for careful consideration of SCP mode of delivery and content in order to maximize their utility to patients and providers. CONCLUSIONS Based on the findings of this review, SCPs may benefit providers and health care systems, but the benefits to patients remain unclear. Further research on the potential benefits of SCPs to particular patient populations is warranted. IMPLICATIONS FOR CANCER SURVIVORS SCPs appear to be beneficial to PCPs in improving overall quality of care. However, more work needs to be done to understand the direct impact on cancer survivors.
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Affiliation(s)
- Weston LaGrandeur
- University of Arizona College of Medicine, 1733 E Silver Street, Tucson, AZ, 85719, USA.
| | - Julie Armin
- Department of Family & Community Medicine, University of Arizona, 1450 N. Cherry Ave, Tucson, AZ, 85719, USA
| | - Carol L Howe
- Department of Family & Community Medicine, University of Arizona Health Sciences Library, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ, 85724-5079, USA
| | - Leila Ali-Akbarian
- Department of Family & Community Medicine, University of Arizona Cancer Center, University of Arizona, 1450 N. Cherry Ave, Tucson, AZ, 85719, USA
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DeGuzman P, Colliton K, Nail C, Keim-Malpass J. Survivorship Care Plans: Rural, Low-Income Breast Cancer Survivor Perspectives. Clin J Oncol Nurs 2017; 21:692-698. [DOI: 10.1188/17.cjon.692-698] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Care coordination and effective transitions of care are essential for high-quality care in cancer survivors. Aspects of care that require coordination include cancer surveillance, managing the effects of cancer and its treatment, and preventive care, including screening for new cancers, with the clinician responsible for each aspect of care clearly defined. There are many barriers to transitioning and coordinating care across cancer specialists and primary care physicians; possible solutions include survivorship care plans and certain care models. Improving these areas, along with survivorship care training and education, may lead to more effective care coordination and transitions in the future.
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Affiliation(s)
- Youngjee Choi
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Baseman J, Revere D, Baldwin LM. A Mobile Breast Cancer Survivorship Care App: Pilot Study. JMIR Cancer 2017; 3:e14. [PMID: 28951383 PMCID: PMC5635232 DOI: 10.2196/cancer.8192] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 12/27/2022] Open
Abstract
Background Cancer survivors living in rural areas experience unique challenges due to additional burdens, such as travel and limited access to specialists. Rural survivors of breast cancer have reported poorer outcomes, poorer mental health and physical functioning, and lower-than-average quality of life compared to urban survivors. Objective To explore the feasibility and acceptability of developing a mobile health survivorship care app to facilitate care coordination; support medical, psychosocial, and practical needs; and improve survivors' long-term health outcomes. Methods An interactive prototype app, SmartSurvivor, was developed that included recommended survivorship care plan components. The prototype's feasibility and acceptability were tested by a sample of breast cancer survivors (n=6), primary care providers (n=4), and an oncologist (n=1). Results Overall, both survivors and providers felt that SmartSurvivor was a potentially valuable tool to support long-term survivorship care plan objectives. Portability, accessibility, and having one place for all contact, treatment, symptom tracking, and medication summaries was highly valued. Conclusions Our pilot study indicates that SmartSurvivor is a feasible and acceptable approach to meeting survivorship care objectives and the needs of both breast cancer survivors and their health care providers. Exploration of mobile health options for supporting survivorship care plan needs is a promising area of research.
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Affiliation(s)
- Janet Baseman
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Debra Revere
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, United States
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Abstract
Rehabilitation for cancer patients aims at reducing the impact of disabling and limiting conditions resulting from cancer and its treatment in order to enable patients to regain social integration and participation. Given current trends in cancer incidence and survival along with progress in medical treatment, cancer rehabilitation is becoming increasingly important in contemporary health care. Although not without limitations, the International Classification of Functioning, Disability and Health (ICF) provides a valuable perspective for cancer rehabilitation in understanding impairments in functioning and activity as the result of an interaction between a health condition and contextual factors. The structure of cancer rehabilitation varies across countries as a function of their healthcare systems and social security legislations, although there is a broad consensus with respect to its principal goals. Cancer rehabilitation requires a careful assessment of the individual patient's rehabilitation needs and a multidisciplinary team of health professionals. A variety of rehabilitation interventions exist, including psycho-oncological and psycho-educational approaches. Research on the effectiveness of cancer rehabilitation provides evidence of improvements in relevant outcome parameters, but faces some methodological challenges as well.
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Affiliation(s)
- Joachim Weis
- Universitätsklinikum Freiburg Medizinische Fakultät, Klinik Für Onkologische Rehabilitation UKF Reha GGmbH, Albert-Ludwigs-Universität Freiburg, Breisacher Str. 117, Freiburg, 79106, Deutschland, Germany.
| | - Jürgen M Giesler
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 49, Freiburg, 79106, Deutschland, Germany
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70
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Physical activity and advanced cancer: the views of oncology and palliative care physicians in Ireland. Ir J Med Sci 2017; 187:337-342. [DOI: 10.1007/s11845-017-1677-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
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Shliakhtsitsava K, Romero SAD, Whitcomb BW, Gorman JR, Roberts S, Su HI. Age and Cancer Treatment Are Related to Receiving Treatment Summaries and Survivorship Care Plans in Female Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:573-578. [PMID: 28731789 DOI: 10.1089/jayao.2017.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The study determined factors associated with patient-reported receipt of survivorship care plans and/or treatment summaries (SCP/TS). Two hundred forty female young adult cancer survivors ages 18-44 completed a web-based survey that included self-report on receiving SCP/TS. Mean age was 32.8 (standard deviation 5.8) years; 20% were diagnosed with cancer at age <21. Only 47% reported receipt of SCP/TS. Age <21 at diagnosis (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.0-3.9), chemotherapy (OR 2.3, 95% CI 1.2-4.6), central nervous system radiation (OR 2.5, 95% CI 1.1-5.6), and bone marrow transplantation (OR 7.2, 95% CI 1.5-33.3) were significantly associated with higher odds of SCP/TS receipt. Improved integration of TS and SCP into cancer survivorship care is needed.
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Affiliation(s)
- Ksenya Shliakhtsitsava
- 1 Department of Pediatric Hematology and Oncology, University of California , San Diego, San Diego, California
| | - Sally A D Romero
- 2 Department of Integrative Medicine, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Brian W Whitcomb
- 3 Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences , Amherst, Massachusetts
| | - Jessica R Gorman
- 4 Department of Health Promotion and Health Behavior, Oregon State University , Corvallis, Oregon
| | - Samantha Roberts
- 5 Moores Cancer Center, University of California , San Diego, San Diego, California
| | - H Irene Su
- 6 Department of Reproductive Medicine, Moores Cancer Center, University of California , San Diego, San Diego, California
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The Impact of Survivorship Care Planning on Patients, General Practitioners, and Hospital-Based Staff. Cancer Nurs 2017; 39:E26-E35. [PMID: 26720214 DOI: 10.1097/ncc.0000000000000329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In 2005, the Institute of Medicine recommended that all cancer patients receive a survivorship care plan (SCP). Despite widespread support, few centers have routinely implemented them. Understanding of their impact is limited. OBJECTIVES The aims of this study were to examine the impact of SCP delivery on patients and healthcare professionals at an Australian comprehensive cancer center and determine enablers and barriers to implementation. METHODS Six groups were surveyed: (1) patients who had received SCPs; (2) nurse coordinators using SCPs, (3) general practitioners (primary care, GPs) of patients who had received SCPs, (4) clinical service chairs, (5) heads of allied health, and (6) nurse coordinators not using SCPs (nonengaged nurse coordinators). Groups 1 to 3 completed written questionnaires. Groups 4 to 6 participated in semistructured interviews. RESULTS Fifty patients, 7 nurse coordinators, 18 GPs, 7 clinical service chairs, 4 heads of allied health, and 8 nonengaged nurse coordinators participated. Eighty-seven percent of patients considered the SCP to be very or somewhat useful; 50% felt it helped them understand their cancer experience. All engaged nurse coordinators reported SCPs to be very or somewhat useful, and 86% believed SCPs improved communication with GPs. General practitioners felt SCPs were very or somewhat useful (67%) and wished to receive SCPs for future patients (83%). Organizational and clinical leadership, multidisciplinary engagement, resourcing, and timing of SCP delivery were considered critical enablers. CONCLUSION Patients and healthcare professionals support the use of SCPs; however, they are resource intensive and require significant organizational support. IMPLICATIONS FOR PRACTICE Nurses are instrumental to SCP implementation. Attention to enablers and barriers is important for successful implementation.
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Nekhlyudov L, Ganz PA, Arora NK, Rowland JH. Going Beyond Being Lost in Transition: A Decade of Progress in Cancer Survivorship. J Clin Oncol 2017; 35:1978-1981. [PMID: 28437163 PMCID: PMC5676953 DOI: 10.1200/jco.2016.72.1373] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Larissa Nekhlyudov
- Larissa Nekhlyudov, Brigham & Women’s Hospital, Boston, MA; Patricia A. Ganz, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA; Neeraj K. Arora, Patient-Centered Outcomes Research Institute, Washington, DC; and Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Patricia A. Ganz
- Larissa Nekhlyudov, Brigham & Women’s Hospital, Boston, MA; Patricia A. Ganz, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA; Neeraj K. Arora, Patient-Centered Outcomes Research Institute, Washington, DC; and Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Neeraj K. Arora
- Larissa Nekhlyudov, Brigham & Women’s Hospital, Boston, MA; Patricia A. Ganz, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA; Neeraj K. Arora, Patient-Centered Outcomes Research Institute, Washington, DC; and Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Julia H. Rowland
- Larissa Nekhlyudov, Brigham & Women’s Hospital, Boston, MA; Patricia A. Ganz, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA; Neeraj K. Arora, Patient-Centered Outcomes Research Institute, Washington, DC; and Julia H. Rowland, National Cancer Institute, Bethesda, MD
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Jacobs LA, Shulman LN. Follow-up care of cancer survivors: challenges and solutions. Lancet Oncol 2017; 18:e19-e29. [PMID: 28049574 DOI: 10.1016/s1470-2045(16)30386-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 02/08/2023]
Abstract
Attention to survivors of adult cancers formally began more than 30 years ago with the founding of the National Coalition for Cancer Survivorship by representatives from 20 organisations who envisioned an organisation that would address survivorship issues and include friends, family, and caregivers. Since then, progress has been made in cancer care delivery, which has created challenges for and barriers to provision of optimal follow-up care to patients and survivors living with cancer as a chronic illness. Focus on post-treatment cancer care, including monitoring for long-term and late effects, and concerns regarding the effect of a cancer diagnosis and treatment on quality of life have gained momentum in the past 10 years. This impetus is largely a result of the 2005 Institute of Medicine Report From Cancer Patient to Cancer Survivor: Lost in Transition. Although the issues raised in the report were hardly novel, they gave a new and powerful voice to the cancer survivorship movement that demanded a call to action. In this Series paper, we provide an overview of the issues surrounding provision of cancer survivorship and follow-up care in the USA and discuss potential solutions to these challenges.
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Affiliation(s)
- Linda A Jacobs
- Director for Survivorship Clinical Programs, Research and Educational Initiatives, Abramson Cancer Center, Perelman Center for Advanced Medicine, Philadelphia, PA, USA.
| | - Lawrence N Shulman
- Deputy Director for Clinical Services, Abramson Cancer Center, Perelman Center for Advanced Medicine, Philadelphia, PA, USA
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Desmond RA, Jackson BE, Waterbor JW. Disparities in Cancer Survivorship Indicators in the Deep South Based on BRFSS Data: Recommendations for Survivorship Care Plans. South Med J 2017; 110:181-187. [PMID: 28257542 DOI: 10.14423/smj.0000000000000617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this investigation was to describe cancer survivorship based on the Behavioral Risk Factor Surveillance System (BRFSS) cancer survivorship modules in Alabama, Georgia, and Mississippi, conducted in 2012 and 2014, and to investigate disparities across the US Deep South region. METHODS The optional BRFSS cancer survivorship module was introduced in 2009. Data from Alabama (2012), Georgia (2012), and Mississippi (2014) were assessed. Demographic factors were analyzed through weighted regression for risk of receiving cancer treatment summary information and follow-up care. RESULTS Excluding nonmelanoma skin cancer cases, a total of 1105 adults in the Alabama 2012 survey, 571 adults in the Georgia 2012 survey, and 442 adults in the 2014 Mississippi survey reported ever having cancer and were available for analysis. Among Alabamians, those with a higher level of education (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.1-1.7) and higher income (OR 1.3, 95% CI 1.1-1.6) were more likely to receive a written summary of their cancer treatments. Adults older than age 65 were only half as likely to receive a written summary of cancer treatments compared with adults 65 years or younger (OR 0.5, 95% CI 0.3-0.8). We found no significant differences in receipt of treatment summary by race or sex. Among those who reported receiving instructions from a doctor for follow-up care, these survivors tended to have a higher level of education, higher income, and were younger (younger than 65 years). Receipt of written or printed follow-up care was positively associated with higher income (OR 1.4, 95% CI 1.1-1.8) and inversely associated with age older than 65 years (OR 0.9, 95% CI 0.1-0.6) in Georgia. CONCLUSIONS Addressing the gap identified between survivorship care plan development by the health team and the delivery of it to survivors is important given the evidence of disparities in the receipt of survivorship care plans across survivor age and socioeconomic status in the Deep South.
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Affiliation(s)
- Renee A Desmond
- From the Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Bradford E Jackson
- From the Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham
| | - John W Waterbor
- From the Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham
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Hébert J, Fillion L. Assessment of the feasibility and acceptability, and pre-test of the utility of an individualized survivorship care plan (ISCP) for women with endometrial cancers during the transition of the end of active treatment to cancer survivorship. Can Oncol Nurs J 2017; 27:153-163. [PMID: 31148628 PMCID: PMC6516223 DOI: 10.5737/23688076272153163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The transition from the end of active treatment to survivorship holds many challenges for women with endometrial cancer (WEC) and for the organization of health services. The feasibility and acceptability of implementing an individualized survivorship care plan (ISCP) at the end of treatment are documented as potential solutions. The utility of an ISCP on three indicators (SUNS, FCRI, and HeiQ) was pre-tested by comparing two groups of WEC (control and exposed to the ISCP). The WEC exposed to the ISCP had fewer needs, a lesser intensity of fear of cancer recurrence, and better health-related empowerment skills three months after the end of treatment, as compared to the control group. Obstacles of time, resources, and organization were raised. BACKGROUND The transition from the end of active treatment to cancer survivorship is a time of imbalance and turbulence for women with endometrial cancer (WEC). The transition to survivorship continues to be uncoordinated and the need for information about the side effects to watch for and the health risks is unmet. The implementation of an individualized survivorship care plan (ISCP) is suggested as an information and communication tool that could be a solution for facilitating the transition from the end of treatment to the beginning of survivorship. RESEARCH OBJECTIVE AND METHOD To assess and document the feasibility and acceptability of implementing an ISCP, qualitative data were gathered from WEC, oncology nurse navigators (ONN), and family doctors. A pre-experimental research design with a non-equivalent control group, an end of treatment (T0), and a three-month follow-up (T1) allowed us to pre-test its utility according to three indicators: (1) overall needs (SUNS); (2) fear of cancer recurrence (FCRI); and (3) empowerment (HeiQ) according to exposure to ISCP (control versus exposed) and to the time of measurement in the transition period (T0 versus T1). RESULTS The sample was made up of 18 WEC for the group exposed to the ISCP and 13 WEC for the control group, 12 general practitioners, and two ONN. After ONN training, the ISCP completion time varied between 60 and 75 minutes, and the meeting for providing the ISCP lasted 45-60 minutes. The WEC supported the idea that meetings with the ONN and the ISCP were useful in meeting their needs for information and support. The family doctors supported its relevancy in favouring follow-up and better subsequent healthcare management, as well as in reassuring patients and avoiding a sense of abandonment at the end of treatment. Comparing the group exposed to the ISCP versus the control group, fewer reported needs can be observed: information: 35% versus 74%, p = .030; professional and financial: 6% versus 19%, p = .057; access and continuity: 9% versus 25%, p = .078; support: 18% versus 50%, p = .007, emotional: 13% versus 28%, p = .044). Moreover, at T1, empowerment according to the skill and technique acquisition sub-scale shows a higher trend (M = 75.00 (10.21) versus M = 64.06 (10.67), p = .097). The level of fear of recurrence remains above the clinically significant score of 13 for both groups at the two times of measurement. DISCUSSION The ISCP is an informational tool that seeks to facilitate care-related communication and coordination between specialized and primary care. It is intended to facilitate the transition from the end of treatment to survivorship and survivors' commitment to health-related empowerment behaviours. The feasibility and utility of implementing an ISCP are supported if additional professional, organizational, and financial resources are specified and mobilized.
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Affiliation(s)
- Johanne Hébert
- Professor, Department of Nursing, Université du Québec à Rimouski (UQAR)
| | - Lise Fillion
- Full professor, Faculty of Nursing, Université Laval
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Hébert J, Fillion L. Évaluation de la faisabilité, de l’acceptabilité et pré-test de l’utilité d’un plan de soins de suivi (PSS) auprès de femmes atteintes du cancer de l’endomètre lors de la transition de la fin du traitement actif vers la survie au cancer. Can Oncol Nurs J 2017; 27:142-152. [PMID: 31148643 PMCID: PMC6516233 DOI: 10.5737/23688076272142152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
La transition de la fin des traitements vers la survie représente de nombreux défis pour les femmes atteintes du cancer de l’endomètre (FACE) et pour l’organisation des services de santé. La faisabilité et l’acceptabilité d’implanter un plan de soins de suivi (PSS) à la fin du traitement sont documentées comme pistes de solution. L’utilité du PSS sur trois indicateurs (SUNS, IPRC et HeiQ) est pré-testée en comparant deux groupes de FACE (exposé ou non au PSS). Les FACE exposées au PSS ont moins de besoins, une intensité inférieure de peur de récidive du cancer et de meilleurs comportements d’autogestion de santé trois mois après la fin du traitement comparativement au groupe non exposé. Des barrières de temps, de ressources et d’organisation sont soulevées.
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Affiliation(s)
- Johanne Hébert
- Professeure, Département des sciences infirmières, Université du Québec à Rimouski, UQA
| | - Lise Fillion
- Professeure titulaire, Faculté des sciences infirmières, Université Laval
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Hinyard L, Wirth LS. Race is a Strong Predictor of Receipt of a Written Survivorship Care Plan: Results from the National Health Interview Survey. J Community Health 2017; 42:1156-1162. [PMID: 28455672 DOI: 10.1007/s10900-017-0365-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to investigate the prevalence of receipt of written documentation of follow up care and of cancer treatments and to examine the predictors of receipt of such written documentation. Data from the 2010 National Health Interview Survey was used to identify individuals 18 years or older with a history of cancer. Binary and multinomial logistic regression were used to investigate patient-level variables associated with receipt of written documentation of cancer treatment, written advice about follow-up care, or both written documents. Patient-level variables included in the analysis were age, gender, region of residence, race/ethnicity, marital status, education level, insurance coverage, cancer type, employment status, and psychosocial support. Of the 1185 responses to the questions used to access receipt of a SCP, the prevalence of any receipt of a written documentation was 68%, where 30% obtained written advice only and 8% were provided a written treatment summary only; only 31% received both. Non-white race, cancer type, and psychosocial services were associated with increased odds of receiving written documentation. Patient-level characteristics are associated with receipt of care plan documentation. Further work needs to investigate the interaction of provider and patient-level characteristics. Understanding patient-level characteristics associated with receipt of written documentation may help uncover strategies for improved survivorship care plan implementation.
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Affiliation(s)
- Leslie Hinyard
- Saint Louis University Center for Health Outcomes Research, Saint Louis University Center for Interprofessional Education and Research, 3545 Lafayette Ave., Salus Center, Room 409, St. Louis, MO, 63104, USA. .,Saint Louis University Center for Health Outcomes Research, 3545 Lafayette Ave., Salus Center, 4th Floor, St. Louis, MO, 63104, USA.
| | - Lorinette S Wirth
- Saint Louis University Center for Health Outcomes Research, Saint Louis University Center for Interprofessional Education and Research, 3545 Lafayette Ave., Salus Center, Room 409, St. Louis, MO, 63104, USA
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Bradford NK, Chan RJ. Health promotion and psychological interventions for adolescent and young adult cancer survivors: A systematic literature review. Cancer Treat Rev 2017; 55:57-70. [DOI: 10.1016/j.ctrv.2017.02.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/22/2017] [Accepted: 02/26/2017] [Indexed: 01/08/2023]
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81
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Tevaarwerk AJ, Hocking WG, Zeal JL, Gribble M, Seaborne L, Buhr KA, Wisinski KB, Burkard ME, Wiegmann DA, Sesto ME. Accuracy and Thoroughness of Treatment Summaries Provided as Part of Survivorship Care Plans Prepared by Two Cancer Centers. J Oncol Pract 2017; 13:e486-e495. [PMID: 28221896 DOI: 10.1200/jop.2016.018648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Treatment summaries prepared as part of survivorship care planning should correctly and thoroughly report diagnosis and treatment information. METHODS As part of a clinical trial, summaries were prepared for patients with stage 0 to III breast cancer at two cancer centers. Summaries were prepared per the standard of care at each center via two methods: using the electronic health record (EHR) to create and facilitate autopopulation of content or using manual data entry into an external software program to create the summary. Each participant's clinical data were abstracted and cross-checked against each summary. Errors were defined as inaccurate information, and omissions were defined as missing information on the basis of the Institute of Medicine recommended elements. RESULTS One hundred twenty-one summaries were reviewed: 80 EHR based versus 41 software based. Twenty-four EHR-based summaries (30%) versus six software-based summaries (15%) contained one or more omissions. Omissions included failure to provide dates and specify all axillary surgeries for EHR-based summaries and failure to specify receptors for software-based summaries. Eight EHR-based summaries (10%) versus 19 software-based summaries (46%) contained one or more errors. Errors in EHR-based summaries were mostly discrepancies in dates, and errors in software-based summaries included incorrect stage, surgeries, chemotherapy, and receptors. CONCLUSION A significant proportion of summaries contained at least one error or omission; some were potentially clinically significant. Mismatches between the clinical scenario and templates contributed to many of the errors and omissions. In an era of required care plan provision, quality measures should be considered and tracked to reduce rates, decrease inadvertent contributions from templates, and support audited data use.
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Affiliation(s)
- Amye J Tevaarwerk
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - William G Hocking
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Jamie L Zeal
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Mindy Gribble
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Lori Seaborne
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Kevin A Buhr
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Kari B Wisinski
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Mark E Burkard
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Douglas A Wiegmann
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Mary E Sesto
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
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Iyer NS, Mitchell HR, Zheng DJ, Ross WL, Kadan-Lottick NS. Experiences with the survivorship care plan in primary care providers of childhood cancer survivors: a mixed methods approach. Support Care Cancer 2017; 25:1547-1555. [DOI: 10.1007/s00520-016-3544-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
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Selph JP, Peterson AC. Review Article: Past, Present and Future of Cancer Survivorship and the Importance of the Urologist. UROLOGY PRACTICE 2017; 4:60-70. [PMID: 37592636 DOI: 10.1016/j.urpr.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cancer survivorship is a concept that focuses on the complete medical and holistic care of the patient with cancer from the time of diagnosis to the time of death. In 2015 the number of cancer survivors in the United States was expected to exceed 14.5 million people and a significant portion of these patients have malignancies that affect the genitourinary health of the survivor. In this review we describe the concept of cancer survivorship and review the important role of the urologist in cancer survivor care. METHODS A literature search concerning cancer survivorship and urogenital neoplasms was performed. We systematically searched Medline® from inception until July 2015 with the objective of identifying studies specifically targeting broad survivorship care concerns for genitourinary neoplasms. We also included nonsystematically identified publications, and governmental and agency produced reports that are currently available through various government entities and organizations. RESULTS Systematic searching yielded 35 articles and 7 reports for inclusion in our literature review. Urology relevant Medline findings were categorized into review articles, biopsychosocial aspects of cancer care, guidelines or society recommendations, diet and exercise related materials, models or coordination of care, or other. We found that the development of guidelines and recommendations for survivorship care in urology has been limited by the quality of the studies published to date. CONCLUSIONS More patients are surviving cancer and living with the consequences of treatment of the primary disease. Awareness of the components of survivorship will be critical as more national organizations require specific survivorship care programs to address these issues. Given that a large number of cancer survivors in the United States have survived urological malignancy or have urological side effects of treatment, the urology community must be familiar with the global concept of survivorship.
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Affiliation(s)
- John Patrick Selph
- Department of Urology, University of Alabama-Birmingham, Birmingham, Alabama
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center (ACP), Durham, North Carolina
| | - Andrew C Peterson
- Department of Urology, University of Alabama-Birmingham, Birmingham, Alabama
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center (ACP), Durham, North Carolina
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Burke NJ, Napoles TM, Banks PJ, Orenstein FS, Luce JA, Joseph G. Survivorship Care Plan Information Needs: Perspectives of Safety-Net Breast Cancer Patients. PLoS One 2016; 11:e0168383. [PMID: 27992491 PMCID: PMC5161365 DOI: 10.1371/journal.pone.0168383] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/29/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Despite the Institute of Medicine's (IOM) 2005 recommendation, few care organizations have instituted standard survivorship care plans (SCPs). Low health literacy and low English proficiency are important factors to consider in SCP development. Our study aimed to identify information needs and survivorship care plan preferences of low literacy, multi-lingual patients to support the transition from oncology to primary care and ongoing learning in survivorship. METHODS We conducted focus groups in five languages with African American, Latina, Russian, Filipina, White, and Chinese medically underserved breast cancer patients. Topics explored included the transition to primary care, access to information, knowledge of treatment history, and perspectives on SCPs. RESULTS Analysis of focus group data identified three themes: 1) the need for information and education on the transition between "active treatment" and "survivorship"; 2) information needed (and often not obtained) from providers; and 3) perspectives on SCP content and delivery. CONCLUSIONS Our data point to the need to develop a process as well as written information for medically underserved breast cancer patients. An SCP document will not replace direct communication with providers about treatment, symptom management and transition, a communication that is missing in participating safety-net patients' experiences of cancer care. Women turned to peer support and community-based organizations in the absence of information from providers. IMPLICATIONS FOR CANCER SURVIVORS "Clear and effective" communication of survivorship care for safety-net patients requires dedicated staff trained to address wide-ranging information needs and uncertainties.
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Affiliation(s)
- Nancy J. Burke
- University of California, Merced, School of Social Sciences, Humanities, & Arts, Merced, California, United States of America
- University of California, San Francisco, Department of Anthropology, History, and Social Medicine, San Francisco, California, United States of America
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Tessa M. Napoles
- University of California, San Francisco, Department of Anthropology, History, and Social Medicine, San Francisco, California, United States of America
| | - Priscilla J. Banks
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Fern S. Orenstein
- Breast Care Disparities Program, San Francisco General Hospital, San Francisco, California, United States of America
| | - Judith A. Luce
- Breast Care Disparities Program, San Francisco General Hospital, San Francisco, California, United States of America
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Galen Joseph
- University of California, San Francisco, Department of Anthropology, History, and Social Medicine, San Francisco, California, United States of America
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States of America
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Cadet T, Davis C, Elks J, Wilson P. A Holistic Model of Care to Support Those Living with and beyond Cancer. Healthcare (Basel) 2016; 4:E88. [PMID: 27869728 PMCID: PMC5198130 DOI: 10.3390/healthcare4040088] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/14/2016] [Accepted: 11/11/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Globally, the burden of cancer continues to increase and it is well-documented that while not a homogeneous population, cancer patients and cancer survivors face many physical, psychological, social, spiritual, and financial issues. Cancer care is shifting from a disease-focused to a patient-centered approach resulting in an increased need to address these concerns. METHODS Utilizing a quality improvement approach, this paper describes an integrated cancer care model at Bloomhill Cancer Center (BCC) in Queensland, Australia that demonstrates the ability to meet the holistic needs of patients living with and beyond cancer and to identify opportunities for better practice and service provision. RESULTS Survey results indicate that 67% and 77% of respondents were very satisfied and 27% and 17% were satisfied with their first contact and very satisfied with their first meeting with a nurse at BCC. Clients also reported being very satisfied (46%) or satisfied (30%) with the emotional support they received at BCC and over 90% were very satisfied or satisfied with the touch therapies that the received. CONCLUSION Due to the early success of the interventions provided by BCC, the model potentially offers other states and countries a framework for supportive cancer care provision for people living with and beyond cancer.
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Affiliation(s)
- Tamara Cadet
- School of Social Work, Simmons College, 300 The Fenway, Boston, MA 02115, USA.
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA 02115, USA.
| | - Cindy Davis
- Faculty of Arts, Business & Law, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia.
| | - Jacinta Elks
- School of Nursing, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia.
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Chawla N, Blanch-Hartigan D, Virgo KS, Ekwueme DU, Han X, Forsythe L, Rodriguez J, McNeel TS, Yabroff KR. Quality of Patient-Provider Communication Among Cancer Survivors: Findings From a Nationally Representative Sample. J Oncol Pract 2016; 12:e964-e973. [PMID: 27221992 PMCID: PMC5455584 DOI: 10.1200/jop.2015.006999] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Although patient-provider communication is an essential component of health care delivery, little is known about the quality of these discussions among patients with cancer. METHODS Data are from the 2011 Medical Expenditure Panel Survey Experiences with Cancer survey among 1,202 adult cancer survivors. We evaluated discussions with any provider after a cancer diagnosis about: (1) follow-up care; (2) late or long-term treatment effects; (3) lifestyle recommendations, such as diet, exercise, and quitting smoking; and (4) emotional or social needs. Using a response scale ranging from "did not discuss" to "discussed in detail," a summary score was constructed to define communication quality as high, medium, or low. Patient factors associated with the quality of provider discussions were examined using multivariable polytomous logistic regression analyses. RESULTS At the time of the survey, approximately one half of the patients (46%) were either within 1 year (24.1%) or between 1 and 5 years (22.0%) of treatment. More than one third of cancer survivors reported that they did not receive detailed communication about follow-up care, and more than one half reported that they did not receive detailed communication regarding late or long-term effects, lifestyle recommendations, or emotional and social needs. Only 24% reported high-quality communication for all four elements, indicating that the vast majority experienced suboptimal communication. In multivariable analysis, survivors reporting a high communication quality with providers included those who were within 1 year of treatment, between the ages of 18 and 64 years, non-Hispanic black or other ethnicity, and married. CONCLUSION Study findings demonstrate gaps in the communication quality experienced by cancer survivors in the United States and help identify survivors for targeted interventions.
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Affiliation(s)
- Neetu Chawla
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Danielle Blanch-Hartigan
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Katherine S Virgo
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Donatus U Ekwueme
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Xuesong Han
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Laura Forsythe
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Juan Rodriguez
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Timothy S McNeel
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - K Robin Yabroff
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
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Selove R, Birken SA, Skolarus TA, Hahn EE, Sales A, Proctor EK. Using Implementation Science to Examine the Impact of Cancer Survivorship Care Plans. J Clin Oncol 2016; 34:3834-3837. [PMID: 27621409 PMCID: PMC5477985 DOI: 10.1200/jco.2016.67.8060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Rebecca Selove
- Rebecca Selove, Tennessee State University, Nashville, TN; Sarah A. Birken, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Ted A. Skolarus, University of Michigan; Veterans Affairs Health Services Research and Development Center for Clinical Management Research; and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Erin E. Hahn, Kaiser Permanente Southern California, Pasadena, CA; Anne Sales, University of Michigan, Ann Arbor, MI; and Enola K. Proctor, Washington University in St Louis, St Louis, MO
| | - Sarah A Birken
- Rebecca Selove, Tennessee State University, Nashville, TN; Sarah A. Birken, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Ted A. Skolarus, University of Michigan; Veterans Affairs Health Services Research and Development Center for Clinical Management Research; and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Erin E. Hahn, Kaiser Permanente Southern California, Pasadena, CA; Anne Sales, University of Michigan, Ann Arbor, MI; and Enola K. Proctor, Washington University in St Louis, St Louis, MO
| | - Ted A Skolarus
- Rebecca Selove, Tennessee State University, Nashville, TN; Sarah A. Birken, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Ted A. Skolarus, University of Michigan; Veterans Affairs Health Services Research and Development Center for Clinical Management Research; and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Erin E. Hahn, Kaiser Permanente Southern California, Pasadena, CA; Anne Sales, University of Michigan, Ann Arbor, MI; and Enola K. Proctor, Washington University in St Louis, St Louis, MO
| | - Erin E Hahn
- Rebecca Selove, Tennessee State University, Nashville, TN; Sarah A. Birken, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Ted A. Skolarus, University of Michigan; Veterans Affairs Health Services Research and Development Center for Clinical Management Research; and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Erin E. Hahn, Kaiser Permanente Southern California, Pasadena, CA; Anne Sales, University of Michigan, Ann Arbor, MI; and Enola K. Proctor, Washington University in St Louis, St Louis, MO
| | - Anne Sales
- Rebecca Selove, Tennessee State University, Nashville, TN; Sarah A. Birken, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Ted A. Skolarus, University of Michigan; Veterans Affairs Health Services Research and Development Center for Clinical Management Research; and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Erin E. Hahn, Kaiser Permanente Southern California, Pasadena, CA; Anne Sales, University of Michigan, Ann Arbor, MI; and Enola K. Proctor, Washington University in St Louis, St Louis, MO
| | - Enola K Proctor
- Rebecca Selove, Tennessee State University, Nashville, TN; Sarah A. Birken, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Ted A. Skolarus, University of Michigan; Veterans Affairs Health Services Research and Development Center for Clinical Management Research; and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Erin E. Hahn, Kaiser Permanente Southern California, Pasadena, CA; Anne Sales, University of Michigan, Ann Arbor, MI; and Enola K. Proctor, Washington University in St Louis, St Louis, MO
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Lengacher CA, Reich RR, Paterson CL, Ramesar S, Park JY, Alinat C, Johnson-Mallard V, Moscoso M, Budhrani-Shani P, Miladinovic B, Jacobsen PB, Cox CE, Goodman M, Kip KE. Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. J Clin Oncol 2016; 34:2827-34. [PMID: 27247219 PMCID: PMC5012660 DOI: 10.1200/jco.2015.65.7874] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The purpose of this randomized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program in improving psychological and physical symptoms and quality of life among breast cancer survivors (BCSs) who completed treatment. Outcomes were assessed immediately after 6 weeks of MBSR(BC) training and 6 weeks later to test efficacy over an extended timeframe. PATIENTS AND METHODS A total of 322 BCSs were randomly assigned to either a 6-week MBSR(BC) program (n = 155) or a usual care group (n = 167). Psychological (depression, anxiety, stress, and fear of recurrence) and physical symptoms (fatigue and pain) and quality of life (as related to health) were assessed at baseline and at 6 and 12 weeks. Linear mixed models were used to assess MBSR(BC) effects over time, and participant characteristics at baseline were also tested as moderators of MBSR(BC) effects. RESULTS Results demonstrated extended improvement for the MBSR(BC) group compared with usual care in both psychological symptoms of anxiety, fear of recurrence overall, and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference (P < .01). Overall effect sizes were largest for fear of recurrence problems (d = 0.35) and fatigue severity (d = 0.27). Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC). CONCLUSION The MBSR(BC) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC) training, with generally small to moderate overall effect sizes.
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Affiliation(s)
- Cecile A Lengacher
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA.
| | - Richard R Reich
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Carly L Paterson
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Sophia Ramesar
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Jong Y Park
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Carissa Alinat
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Versie Johnson-Mallard
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Manolete Moscoso
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Pinky Budhrani-Shani
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Branko Miladinovic
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Paul B Jacobsen
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Charles E Cox
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Matthew Goodman
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Kevin E Kip
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
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Playdon M, Ferrucci LM, McCorkle R, Stein KD, Cannady R, Sanft T, Cartmel B. Health information needs and preferences in relation to survivorship care plans of long-term cancer survivors in the American Cancer Society's Study of Cancer Survivors-I. J Cancer Surviv 2016; 10:674-85. [PMID: 26744339 PMCID: PMC5032143 DOI: 10.1007/s11764-015-0513-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/25/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Survivorship care plans (SCPs) provide cancer patients and health care providers with a treatment summary and outline of recommended medical follow-up. Few studies have investigated the information needs and preferred sources among long-term cancer survivors. METHODS Cancer survivors of the ten most common cancers enrolled in the longitudinal Study of Cancer Survivors-I (SCS-I) completed a survey 9 years post-diagnosis (n = 3138); at time of diagnosis of the SCS-I cohort, SCPs were not considered usual care. We assessed participants' current desire and preferred sources for information across ten SCP items and evaluated factors associated with information need 9 years after diagnosis. RESULTS The proportion of long-term cancer survivors endorsing a need for cancer and health information 9 years post-diagnosis ranged from 43 % (cancer screening) to 9 % (consequences of cancer on ability to work). Print media and personalized reading materials were the most preferred information sources. Younger age, higher education, race other than non-Hispanic white, later cancer stage, having breast cancer, having ≥2 comorbidities, and self-reporting poor health were associated with greater informational need (p < 0.05). CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS Long-term cancer survivors continue to report health information needs for most SCP items and would prefer a print format; however, level of need differs by socio-demographic and cancer characteristics. Cancer survivors who did not previously receive a SCP may still benefit from receiving SCP content, and strategies for enabling dissemination to long-term survivors warrant further investigation.
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Affiliation(s)
- Mary Playdon
- Yale School of Public Health, Yale University, 55 Church Street, Suite 801, New Haven, CT, 06510, USA.
| | - Leah M Ferrucci
- Yale School of Public Health, Yale University, 55 Church Street, Suite 801, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Ruth McCorkle
- Yale Cancer Center, New Haven, CT, USA
- Yale School of Nursing, Yale University, New Haven, CT, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Kevin D Stein
- Behavioral Research Center, American Cancer Society, Atlanta, GA, USA
| | - Rachel Cannady
- Behavioral Research Center, American Cancer Society, Atlanta, GA, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Brenda Cartmel
- Yale School of Public Health, Yale University, 55 Church Street, Suite 801, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, USA
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90
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Kenzik KM, Kvale EA, Rocque GB, Demark-Wahnefried W, Martin MY, Jackson BE, Meneses K, Partridge EE, Pisu M. Treatment Summaries and Follow-Up Care Instructions for Cancer Survivors: Improving Survivor Self-Efficacy and Health Care Utilization. Oncologist 2016; 21:817-24. [PMID: 27245567 PMCID: PMC4943392 DOI: 10.1634/theoncologist.2015-0517] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/29/2016] [Indexed: 12/19/2022] Open
Abstract
To assess the effect of treatment summaries and follow-up care plans on self-efficacy and health care utilization, cancer survivors (≥65 years old) were surveyed. Receiving a verbal explanation of follow-up care instructions was significantly associated with higher self-efficacy scores, which in turn were significantly associated with lower prevalence ratios of emergency room visits and hospitalizations. Background. Treatment summaries and follow-up care plan information should be provided to cancer survivors. This study examines the association of receiving summaries and care plans with cancer survivor self-efficacy for chronic illness management, and whether self-efficacy was associated with health care utilization. Methods. Four hundred forty-one cancer survivors (≥2 years from diagnosis and had completed treatment) ≥65 years old from 12 cancer centers across 5 states completed telephone surveys. Survivors responded to three questions about receiving a written treatment summary, written follow-up plan, and an explanation of follow-up care plans. Respondents completed the Stanford Chronic Illness Management Self-Efficacy Scale and reported emergency room visits and hospitalizations in the past year. Three multiple linear regression models estimated the association of written treatment summary, written follow-up care plan, and verbal explanation of follow-up plan with total self-efficacy score. Log-binomial models estimated the association of self-efficacy scores with emergency room visits and hospitalizations (yes/no). Results. Among survivors, 40% and 35% received a written treatment summary and follow-up care plan, respectively. Seventy-nine percent received an explanation of follow-up care plans. Receiving a verbal explanation of follow-up care instructions was significantly associated with higher self-efficacy scores (β = 0.72, p = .009). Higher self-efficacy scores were significantly associated with lower prevalence ratios of emergency room visits (prevalence ratio, 0.92; 95% confidence interval, 0.88–0.97) and hospitalizations (prevalence ratio, 0.94; 95% confidence interval, 0.89–0.99). Conclusion. Explanation of the follow-up care plan, beyond the written component, enhances survivor self-efficacy for managing cancer as a chronic condition—an important mediator for improving health care utilization outcomes. Implications for Practice: Older cancer survivors (>65 years) are especially vulnerable to poor outcomes in survivorship because of the complexity of follow-up care and other chronic conditions. Delivering written treatment summaries, written follow-up care plans, and verbal explanations of follow-up care plans all independently increased the self-efficacy for chronic illness management among older survivors. In particular, delivering this information in the verbal format was significantly associated with higher self-efficacy and, subsequently, a lower likelihood of emergency room visits. Understanding the mechanism through which summaries and follow-up care plans may positively influence survivor health is critical to increasing the delivery of the information.
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Affiliation(s)
- Kelly M Kenzik
- Institute for Cancer Outcomes Research and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth A Kvale
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA
| | | | - Michelle Y Martin
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradford E Jackson
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karen Meneses
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Edward E Partridge
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA
| | - Maria Pisu
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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91
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Trends in cancer survivors' experience of patient-centered communication: results from the Health Information National Trends Survey (HINTS). J Cancer Surviv 2016; 10:1067-1077. [PMID: 27193357 DOI: 10.1007/s11764-016-0550-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Two Institute of Medicine reports almost a decade apart suggest that cancer survivors often feel "lost in transition" and experience suboptimal quality of care. The six core functions of patient-centered communication: managing uncertainty, responding to emotions, making decisions, fostering healing relationships, enabling self-management, and exchanging information, represent a central aspect of survivors' care experience that has not been systematically investigated. METHODS Nationally representative data from four administrations of the Health Information National Trends Survey (HINTS) was merged with combined replicate weights using the jackknife replication method. Linear and logistic regression models were used to assess (1) characteristics of cancer survivors (N = 1794) who report suboptimal patient-centered communication and (2) whether survivors' patient-centered communication experience changed from 2007 to 2013. RESULTS One third to one half of survivors report suboptimal patient-centered communication, particularly on core functions of providers helping manage uncertainty (48 %) and responding to emotions (49 %). In a fully adjusted linear regression model, survivors with more education (Wald F = 2.84, p = .04), without a usual source of care (Wald F = 11.59, p < .001), and in poorer health (Wald F = 9.08, p < .001) were more likely to report less patient-centered communication. Although ratings of patient-centered communication improved over time (p trend = .04), this trend did not remain significant in fully adjusted models. CONCLUSIONS Despite increased attention to survivorship, many survivors continue to report suboptimal communication with their health care providers. IMPLICATIONS FOR CANCER SURVIVORS Survivorship communication should include managing uncertainty about future risk and address survivors' emotional needs. Efforts to improve patient-centered communication should focus on survivors without a usual source of care and in poorer health.
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92
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Salz T, McCabe MS, Oeffinger KC, Corcoran S, Vickers AJ, Salner AL, Dornelas E, Schnall R, Raghunathan NJ, Fortier E, Baxi SS. A head and neck cancer intervention for use in survivorship clinics: a protocol for a feasibility study. Pilot Feasibility Stud 2016; 2:23. [PMID: 27965842 PMCID: PMC5153865 DOI: 10.1186/s40814-016-0061-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/19/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Head and neck cancer survivors commonly experience severe long-term toxicities, late-occurring symptoms, and significant risks of the second primary malignancy and comorbid illnesses. With multiple simultaneous health issues, these complex cancer survivors often do not receive comprehensive health care that addresses their needs. A tool is needed to streamline and standardize comprehensive care for this cohort. METHODS/DESIGN We designed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR) to address health care challenges for head and neck cancer survivors. HN-STAR is an electronic platform that aims to simplify the provision of personalized care in cancer survivorship clinics. It uses an algorithmic approach to integrate patient-reported outcomes, clinical details, and evidence-based guidelines to standardize comprehensive care provided in routine survivorship visits. It has four integrated components: (1) a simplified treatment summary, which pulls treatment details from a clinical database or can be completed manually using a streamlined form; (2) an online self-assessment for patients to report their own symptoms; (3) an interactive discussion guide presenting all relevant information to the provider during the clinic visit; and (4) a survivorship care plan generated at the end of each visit that reflects decisions made during the visit. By using a modifiable electronic platform, HN-STAR provides a method for incorporating survivorship care plans into clinical practice and for disseminating evidence on symptom management and preventive care. This is a study to assess the feasibility of a future multi-site, randomized clinical trial of HN-STAR. We will enroll head and neck cancer survivors who are followed in one of two nurse practitioner-led survivorship clinics. We will implement HN-STAR for one routine survivorship visits. We will assess (1) usability and feasibility outcomes of HN-STAR from the perspective of key stakeholders and (2) the planned outcomes intended for the larger trial. We will collect usability and feasibility data from online surveys of survivors and their providers. Our findings will inform whether it is feasible to advance HN-STAR to trial. If so, we will adapt HN-STAR and the study design of the trial in response to feedback from survivors and providers. The long-term goal is to determine if such an intervention will lead to improved and simplified comprehensive survivorship care. DISCUSSION This feasibility study will evaluate implementation of HN-STAR into clinical practice in terms of usability, practicality, and clinical flow in two distinct clinical settings. This study will also provide critical baseline data to characterize this vulnerable population. Findings from this study will inform a multicenter randomized trial of HN-STAR, aimed at standardizing and streamlining the delivery of evidence-guided comprehensive care for head and neck cancer survivors. Ultimately, if found effective, the modular structure of HN-STAR could permit its expansion to survivors of other complex cancers. TRIAL REGISTRATION ClinicalTrials.gov, NCT02571673.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Mary S. McCabe
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Kevin C. Oeffinger
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Stacie Corcoran
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Andrew J. Vickers
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | | | - Ellen Dornelas
- Hartford Hospital, 80 Seymour St, Hartford, CT 06102 USA
| | - Rebecca Schnall
- Columbia University School of Nursing, 617 W 168th St, New York, NY 10032 USA
| | | | - Elizabeth Fortier
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Shrujal S. Baxi
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
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93
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Lindau ST, Abramsohn EM, Baron SR, Florendo J, Haefner HK, Jhingran A, Kennedy V, Krane MK, Kushner DM, McComb J, Merritt DF, Park JE, Siston A, Straub M, Streicher L. Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist. CA Cancer J Clin 2016; 66:241-63. [PMID: 26784536 PMCID: PMC4860140 DOI: 10.3322/caac.21337] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 12/15/2022] Open
Abstract
Answer questions and earn CME/CNE Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists' findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns. CA Cancer J Clin 2016;66:241-263. © 2016 American Cancer Society.
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Affiliation(s)
- Stacy Tessler Lindau
- Director, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
- Associate Professor, Department of Medicine-Geriatrics, University of Chicago, Chicago, IL
- MacLean Center on Clinical Medical Ethics, University of Chicago, Chicago, IL
- Associate Professor, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Emily M Abramsohn
- Researcher and Project Manager, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Shirley R Baron
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Clinical Associate, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Judith Florendo
- Doctor of Physical Therapy, Florendo Physical Therapy, Chicago, IL
- Clinical Associate, Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Hope K Haefner
- Professor, Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI
| | - Anuja Jhingran
- Professor, Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanessa Kennedy
- Assistant Professor, Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, CA
| | - Mukta K Krane
- Assistant Professor, Department of Surgery, University of Washington, Seattle, WA
| | - David M Kushner
- Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jennifer McComb
- Assistant Clinical Professor, The Family Institute at Northwestern University, Evanston, IL
| | - Diane F Merritt
- Professor, Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, WA University School of Medicine, St. Louis, MO
| | - Julie E Park
- Associate Professor, Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Amy Siston
- Clinical Associate, Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago, IL
| | - Margaret Straub
- Physician's Assistant, Radiation Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Lauren Streicher
- Associate Professor, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL
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94
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Salz T, Baxi S. Moving survivorship care plans forward: focus on care coordination. Cancer Med 2016; 5:1717-22. [PMID: 27075650 PMCID: PMC4944899 DOI: 10.1002/cam4.733] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/19/2016] [Accepted: 03/18/2016] [Indexed: 11/08/2022] Open
Abstract
After completing treatment for cancer, the coordination of oncology and primary care presents a challenge for cancer survivors. Many survivors need continued oncology follow-up, and all survivors require primary care. Coordinating the shared care of a cancer survivor, or facilitating an informed handoff from oncology to primary care, is essential for cancer survivors. Survivorship care plans are personalized documents that summarize cancer treatment and outline a plan of recommended ongoing care, with the goal of facilitating the coordination of post-treatment care. Despite their face validity, five trials have failed to demonstrate the effectiveness of survivorship care plans. We posit that these existing trials have critical shortcomings and do not adequately address whether survivorship care plans improve care coordination. Moving forward, we propose four criteria for future trials of survivorship care plans: focusing on high-needs survivor populations, tailoring the survivorship care plan to the care setting, facilitating implementation of the survivorship care plan in clinical practice, and selecting appropriate trial outcomes to assess care coordination. When trials meet these criteria, we can finally assess whether survivorship care plans help cancer survivors receive optimal oncology and primary care.
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Affiliation(s)
- Talya Salz
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shrujal Baxi
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weil Medical College of Cornell University, New York, New York
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95
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Solanki PA, Ko NY, Qato DM, Calip GS. Risk of cancer-specific, cardiovascular, and all-cause mortality among Asian and Pacific Islander breast cancer survivors in the United States, 1991-2011. SPRINGERPLUS 2016; 5:82. [PMID: 26844029 PMCID: PMC4728166 DOI: 10.1186/s40064-016-1726-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 01/21/2023]
Abstract
Asian and Pacific Islander (API) women in the United States (U.S.) are a heterogeneous group reported to have better prognosis after breast cancer (BC) compared to their Non-Hispanic White (NHW) counterparts. Few studies have examined differences in BC survival between individual API ethnic groups. We conducted a retrospective cohort study of 462,005 NHW and 44,531 API women diagnosed with incident, stage I-III BC between 1991 and 2011 in the Surveillance, Epidemiology and End Results (SEER) 18 registries. SEER-reported API ethnicity was grouped as Chinese, Japanese, Filipino, Hawaiian, Korean, Vietnamese, Asian Indian and Pakistani, and Pacific Islander. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for risk of BC-specific, cardiovascular and all-cause mortality comparing API to NHW women. We also estimated mortality risk comparing U.S.-born to non-U.S.-born women. Compared to NHW women, API women overall had lower BC-specific, cardiovascular and all-cause mortality. BC-specific mortality risk was lowest among Japanese women (HR 0.69, 95 % CI 0.63-0.77). Other women had similar (Filipino, HR 0.93, 0.86-1.00; Hawaiian, HR 1.01, 0.89-1.17) or greater (Pacific Islander, HR 1.44, 1.17-1.78) risk of BC-specific death. Compared to non-U.S. born API women, findings were suggestive of increased cardiovascular (HR 1.12, 1.03-1.20) and all-cause mortality (HR 1.29, 1.08-1.54) among U.S.-born API women. Mortality risk varies greatly between BC survivors from different API backgrounds. Further research is warranted to understand these disparities in BC survivorship and the social and cultural factors that possibly contribute to greater mortality among later-generation API women born in the United States.
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Affiliation(s)
- Pooja A Solanki
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor St., Chicago, IL 60612 USA
| | - Naomi Y Ko
- Section of Hematology Oncology, Boston University, Boston Medical Center, 725 Albany St., Boston, MA 02118 USA
| | - Dima M Qato
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor St., Chicago, IL 60612 USA ; Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St., Chicago, IL 60612 USA
| | - Gregory S Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St., Chicago, IL 60612 USA ; Population Health, Behavior and Outcomes Program, University of Illinois Cancer Center, 1801 W. Taylor St., Chicago, IL 60612 USA
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96
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Yabroff KR, Dowling EC, Guy GP, Banegas MP, Davidoff A, Han X, Virgo KS, McNeel TS, Chawla N, Blanch-Hartigan D, Kent EE, Li C, Rodriguez JL, de Moor JS, Zheng Z, Jemal A, Ekwueme DU. Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors. J Clin Oncol 2015; 34:259-67. [PMID: 26644532 DOI: 10.1200/jco.2015.62.0468] [Citation(s) in RCA: 380] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. METHODS We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one's share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). RESULTS Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. CONCLUSION Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.
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Affiliation(s)
- K Robin Yabroff
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA.
| | - Emily C Dowling
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Gery P Guy
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Matthew P Banegas
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Amy Davidoff
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Xuesong Han
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Katherine S Virgo
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Timothy S McNeel
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Neetu Chawla
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Danielle Blanch-Hartigan
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Erin E Kent
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Chunyu Li
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Juan L Rodriguez
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Janet S de Moor
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Zhiyuan Zheng
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Ahmedin Jemal
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Donatus U Ekwueme
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
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Warner EL, Wu YP, Hacking CC, Wright J, Spraker-Perlman HL, Gardner E, Kirchhoff AC. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:677-684. [PMID: 25893925 DOI: 10.1007/s13187-015-0829-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care.
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Affiliation(s)
- Echo L Warner
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA.
| | - Yelena P Wu
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA
- Division of Public Health, University of Utah, 375 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Claire C Hacking
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA
| | - Jennifer Wright
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
- Huntsman Cancer Institute Pediatric Cancer Late Effects Clinic, 1950 Circle of Hope, Salt Lake City, UT, 84112, USA
- Primary Children's Hospital, 100 No. Mario Capecchi Dr., Salt Lake City, UT, 84113, USA
| | - Holly L Spraker-Perlman
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
- Primary Children's Hospital, 100 No. Mario Capecchi Dr., Salt Lake City, UT, 84113, USA
| | - Emmie Gardner
- Intermountain Healthcare, 36 S State Street, Salt Lake City, UT, 84111, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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98
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Underwood JM, Lakhani N, Finifrock D, Pinkerton B, Johnson KL, Mallory SH, Migliore Santiago P, Stewart SL. Evidence-Based Cancer Survivorship Activities for Comprehensive Cancer Control. Am J Prev Med 2015; 49:S536-42. [PMID: 26590649 PMCID: PMC7894748 DOI: 10.1016/j.amepre.2015.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION One of six priorities of CDC's National Comprehensive Cancer Control Program (NCCCP) is to address the needs of cancer survivors within the local population served by individually funded states, tribes, and territories. This report examines cancer survivorship activities implemented in five NCCCP grantees, which have initiated evidence-based activities outlined in A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies (NAP). METHODS NCCCP action plans, submitted annually to CDC, from 2010 to 2014 were reviewed in February 2015 to assess implementation of cancer survivorship activities and recommended strategies consistent with the NAP. Four state-level and one tribal grantee with specific activities related to one of each of the four NAP strategies were chosen for inclusion. Brief case reports describing the initiation and impact of implemented activities were developed in collaboration with each grantee program director. RESULTS New Mexico, South Carolina, Vermont, Washington state, and Fond Du Lac Band of Lake Superior Chippewa programs each implemented activities in surveillance and applied research; communication, education, and training; programs, policies, and infrastructure; and access to quality care and services. CONCLUSIONS This report provides examples for incorporating cancer survivorship activities within Comprehensive Cancer Control programs of various sizes, demographic makeup, and resource capacity. New Mexico, South Carolina, Vermont, Washington state, and Fond Du Lac Band developed creative cancer survivorship activities that meet CDC recommendations. NCCCP grantees can follow these examples by implementing evidence-based survivorship interventions that meet the needs of their specific populations.
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Affiliation(s)
- J Michael Underwood
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Naheed Lakhani
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - DeAnna Finifrock
- Fond du Lac Human Services Division, Community Health Services Department, Cloquet, Minnesota
| | - Beth Pinkerton
- New Mexico Comprehensive Cancer Program, New Mexico Department of Health, Albuquerque, New Mexico
| | - Krystal L Johnson
- Division of Cancer Prevention and Control, Bureau of Community Health & Chronic Disease Prevention, South Carolina Department of Health & Environmental Control, Columbia, South Carolina
| | - Sharon H Mallory
- Vermont Comprehensive Cancer Control Program, Vermont Department of Health, Burlington, Vermont
| | - Patricia Migliore Santiago
- Washington State Comprehensive Cancer Control Program, Office of Healthy Communities, Washington State Department of Health, Olympia, Washington
| | - Sherri L Stewart
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Panwar A, Cheung VWF, Lydiatt WM. Supportive Care and Survivorship Strategies in Management of Squamous Cell Carcinoma of the Head and Neck. Hematol Oncol Clin North Am 2015; 29:1159-68. [DOI: 10.1016/j.hoc.2015.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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100
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Nicolaije KA, Ezendam NP, Vos MC, Pijnenborg JM, Boll D, Boss EA, Hermans RH, Engelhart KC, Haartsen JE, Pijlman BM, van Loon-Baelemans IE, Mertens HJ, Nolting WE, van Beek JJ, Roukema JA, Zijlstra WP, Kruitwagen RF, van de Poll-Franse LV. Impact of an Automatically Generated Cancer Survivorship Care Plan on Patient-Reported Outcomes in Routine Clinical Practice: Longitudinal Outcomes of a Pragmatic, Cluster Randomized Trial. J Clin Oncol 2015; 33:3550-9. [DOI: 10.1200/jco.2014.60.3399] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This study was conducted to longitudinally assess the impact of an automatically generated survivorship care plan (SCP) on patient-reported outcomes in routine clinical practice. Primary outcomes were patient satisfaction with information and care. Secondary outcomes included illness perceptions and health care use. Methods Twelve hospitals were randomly assigned to SCP care or usual care in a pragmatic, cluster randomized trial. Newly diagnosed patients with endometrial cancer completed questionnaires after diagnosis (n = 221; 75% response), 6 months (n = 158), and 12 months (n = 147). An SCP application was built in the Web-based ROGY (Registration System Oncological Gynecology). By clicking the SCP button, a patient-tailored SCP was generated. Results In the SCP care arm, 74% of patients received an SCP. They reported receiving more information about their treatment (mean [M] = 57, standard deviation [SD] = 20 v M = 47, SD = 24; P = .03), other services (M = 35, SD = 22 v M = 25, SD = 22; P = .03), and different places of care (M = 27, SD = 25 v M = 23, SD = 26; P = .04) than the usual care arm (scales, 0 to 100). However, there were no differences regarding satisfaction with information or care. Patients in the SCP care arm experienced more symptoms (M = 3.3, SD = 2.0 v M = 2.6, SD = 1.6; P = .03), were more concerned about their illness (M = 4.4, SD = 2.3 v M = 3.9, SD = 2.1; P = .03), were more affected emotionally (M = 4.0, SD = 2.2 v M = 3.7, SD = 2.2; P = .046), and reported more cancer-related contact with their primary care physician (M = 1.8, SD = 2.0 v M = 1.1, SD = 0.9; P = .003) than those in the usual care arm (scale, 1 to 10). These effects did not differ over time. Conclusion The present trial showed no evidence of a benefit of SCPs on satisfaction with information and care. Furthermore, SCPs increased patients' concerns, emotional impact, experienced symptoms, and the amount of cancer-related contact with the primary care physician. Whether this may ultimately lead to more empowered patients should be investigated further.
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Affiliation(s)
- Kim A.H. Nicolaije
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Nicole P.M. Ezendam
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - M. Caroline Vos
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Johanna M.A. Pijnenborg
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Dorry Boll
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Erik A. Boss
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Ralph H.M. Hermans
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Karin C.M. Engelhart
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Joke E. Haartsen
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Brenda M. Pijlman
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Ingrid E.A.M. van Loon-Baelemans
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Helena J.M.M. Mertens
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Willem E. Nolting
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Johannes J. van Beek
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Jan A. Roukema
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Wobbe P. Zijlstra
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Roy F.P.M. Kruitwagen
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
| | - Lonneke V. van de Poll-Franse
- Kim A.H. Nicolaije, Nicole P.M. Ezendam, Wobbe P. Zijlstra, and Lonneke V. van de Poll-Franse, Tilburg University, Tilburg; Kim A.H. Nicolaije, Nicole P.M. Ezendam, and Lonneke V. van de Poll-Franse, Comprehensive Cancer Center the Netherlands, Eindhoven; M. Caroline Vos and Dorry Boll, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk; Erik A. Boss, Maxima Medical Center, Veldhoven and Eindhoven, the Netherlands; Ralph H.M. Hermans, Catharina Hospital, Eindhoven; Karin C.M. Engelhart, St Anna Hospital
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