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Bauer A, Vordermark D, Seufferlein T, Schmoll HJ, Dralle H, Mau W, Unverzagt S, Boese S, Fach EM, Landenberger M. Trans-sectoral care in patients with colorectal cancer: Protocol of the randomized controlled multi-center trial Supportive Cancer Care Networkers (SCAN). BMC Cancer 2015; 15:997. [PMID: 26694748 PMCID: PMC4689007 DOI: 10.1186/s12885-015-2002-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 12/11/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Managing therapy-related side-effects and improving health-related quality of life in patients with colorectal cancer is still challenging. The need for an effective management of adverse events and unmet supportive care needs have been widely discussed. In the past decade, interventions by nursing staff gained more and more importance. Evidence suggests that a majority of patients even in early stages of the disease experience substantial impairments potentially resulting in diminished therapy adherence as well as impaired quality of life. However, evidence for the effectiveness of nurse-led interventions on symptom management and quality of life is still very limited. This especially applies to care transitions between different inpatient and outpatient health care providers throughout the course of treatment and aftercare. METHODS/DESIGN Supportive Cancer Care Networkers (SCAN) is a prospective randomized controlled trial conducted in eight large and middle-sized German cancer centers and municipal hospitals. The target population is adults with colorectal cancer UICC I-III after initial R-0 resection scheduled for adjuvant chemotherapy or guideline-based aftercare only. 370 patients will be randomly assigned to either intervention or control group. Patients in the intervention group will receive an additional support by specialized oncology nurses for eight weeks after discharge from hospital by telephone, consisting of symptom monitoring, counselling on self-assessment and self-management and dealing with individual resources for coping and psychosocial well-being. The primary endpoint will be health-related quality of life (HRQoL) at eight weeks after discharge from the initial treating hospital. DISCUSSION The presented SCAN trial is to provide information that will be useful to advance our understanding of complex interdependencies between symptom severity, supportive care needs, functioning and the risk for diminished HRQoL. Most importantly, these patient-reported outcomes are not fully implemented in today's clinical routine practice potentially resulting in therapy cessations and lower chemotherapy treatment rates for colorectal cancer especially in older patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01651832.
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Affiliation(s)
- Alexander Bauer
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Dirk Vordermark
- Department of Radiation Oncology, University Hospital Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany.
| | - Thomas Seufferlein
- Department of Internal Medicine I, University Hospital Ulm, Albert Einstein Allee 23, Ulm, D-89081, Germany.
| | - Hans-Joachim Schmoll
- University Hospital Halle, Clinic for Internal Medicine IV, Ernst-Grube-Strasse 40, D-06120, Halle, Germany.
| | - Henning Dralle
- Department of General, Visceral and Vascular Surgery, University Hospital, Ernst-Grube-Strasse 40, D-06120, Halle, Germany.
| | - Wilfried Mau
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Rehabilitation Medicine, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Susanne Unverzagt
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Medical Epidemiology, Biostatistics and Informatics, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Stephanie Boese
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Eva-Maria Fach
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Margarete Landenberger
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Magdeburger Strasse 8, D-06112, Halle, Germany.
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McCorkle R, Jeon S, Ercolano E, Lazenby M, Reid A, Davies M, Viveiros D, Gettinger S. An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial. J Palliat Med 2015; 18:962-9. [PMID: 26305992 PMCID: PMC4638201 DOI: 10.1089/jpm.2015.0113] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Early palliative care provided through a palliative care consultative service is effective in enhancing patient outcomes. However, it is unknown whether the integration of palliative care as part of routine comprehensive cancer care improves patients' self-reported clinical outcomes. OBJECTIVE The objective of this study was to evaluate the effects of a multidisciplinary coordinated intervention by advanced practice nurses at the clinic level on outcomes with patients newly diagnosed with late-stage cancer. METHODS A clustered, randomized, controlled trial design was used. Four disease-specific multidisciplinary clinics were randomized to the 10-week intervention (gynecologic and lung clinics) or to enhanced usual care (head and neck and gastrointestinal clinics). Patient primary outcomes (symptoms, health distress, depression, functional status, self-reported health) were collected at baseline and one and three months, and secondary outcomes were collected one and three months postbaseline. General linear mixed model analyses with a covariance structure of within-subject correlation was used to examine the intervention's effect. RESULTS The sample included 146 patients with newly diagnosed late-stage cancers. We found no differences between the two groups on the primary patient-reported outcomes at one and three months postbaseline; however, physical and emotional symptoms remained stable or significantly improved from baseline for both groups. Overall, secondary outcomes remained stable within the groups. CONCLUSION In this translational study, we demonstrated that if patients newly diagnosed with late-stage cancer were managed by disease-specific multidisciplinary teams who palliated their symptoms, providing whole-patient care, patient outcomes remained stable or improved.
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Affiliation(s)
- Ruth McCorkle
- School of Nursing, Yale University, New Haven, Connecticut
- School of Public Health, Yale University, New Haven, Connecticut
| | - Sangchoon Jeon
- School of Nursing, Yale University, New Haven, Connecticut
| | | | - Mark Lazenby
- School of Nursing, Yale University, New Haven, Connecticut
- Divinity School, Yale University, New Haven, Connecticut
| | - Amanda Reid
- Smilow Cancer Hospital at Yale–New Haven, New Haven, Connecticut
| | - Marianne Davies
- Smilow Cancer Hospital at Yale–New Haven, New Haven, Connecticut
| | - Diane Viveiros
- Smilow Cancer Hospital at Yale–New Haven, New Haven, Connecticut
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Rabin BA, Ellis JL, Steiner JF, Nekhlyudov L, Feuer EJ, Hankey BF, Cynkin L, Bayliss E. Health-care utilization by prognosis profile in a managed care setting: using the Surveillance, Epidemiology and End Results Cancer Survival Calculator SEER*CSC. J Natl Cancer Inst Monogr 2015; 2014:275-81. [PMID: 25417241 DOI: 10.1093/jncimonographs/lgu023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Accurate estimation of the probability of dying of cancer versus other causes is needed to inform goals of care for cancer patients. Further, prognosis may also influence health-care utilization. This paper describes health service utilization patterns of subgroups of prostate cancer and colorectal cancer (CRC) patients with different relative probabilities of dying of their cancer or other conditions. METHODS A retrospective cohort of cancer patients from Kaiser Permanente Colorado were divided into three groups using the predicted probabilities of dying of cancer and other causes calculated by the nomograms in the National Cancer Institute Surveillance, Epidemiology and End Results Cancer Survival Calculator. Demographic, disease-related characteristics, and health service utilization patterns were described across subgroups. RESULTS The cohort consisted of 2092 patients (1102 prostate cancer and 990 CRC). A new diagnosis of cancer increased utilization of cancer-related services with rates as high as 9.1/1000 person-days for prostate cancer and 36.2/1000 person-days for CRC. Little change was observed in the number of primary and other specialty care visits from prediagnosis to 1 and 2 years postdiagnosis. CONCLUSIONS We found that although a new diagnosis of cancer increased utilization of cancer-related services for an extended time period, the timing of cancer diagnosis did not appear to affect other types of utilization. Future research should assess the reason for the lack of impact of cancer and unrelated comorbid conditions on utilization and whether desired outcomes of care were achieved.
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Affiliation(s)
- Borsika A Rabin
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC).
| | - Jennifer L Ellis
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - John F Steiner
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Larissa Nekhlyudov
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Eric J Feuer
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Benjamin F Hankey
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Laurie Cynkin
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Elizabeth Bayliss
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
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Duman-Lubberding S, van Uden-Kraan CF, Peek N, Cuijpers P, Leemans CR, Verdonck-de Leeuw IM. An eHealth Application in Head and Neck Cancer Survivorship Care: Health Care Professionals' Perspectives. J Med Internet Res 2015; 17:e235. [PMID: 26489918 PMCID: PMC4642398 DOI: 10.2196/jmir.4870] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/29/2015] [Accepted: 09/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although many cancer survivors could benefit from supportive care, they often do not utilize such services. Previous studies have shown that patient-reported outcomes (PROs) could be a solution to meet cancer survivors' needs, for example through an eHealth application that monitors quality of life and provides personalized advice and supportive care options. In order to develop an effective application that can successfully be implemented in current health care, it is important to include health care professionals in the development process. OBJECTIVE The aim of this study was to investigate health care professionals' perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care. METHODS Health care professionals involved in head and neck cancer care (N=11) were interviewed on current follow-up care and the anticipated value of the proposed eHealth application (Step 1). A prototype of the eHealth application, OncoKompas, was developed (Step 2). Cognitive walkthroughs were conducted among health care professionals (N=21) to investigate perceived usability (Step 3). Interviews were recorded, transcribed verbatim, and analyzed by 2 coders. RESULTS Health care professionals indicated several barriers in current follow-up care including difficulties in detecting symptoms, patients' perceived need for supportive care, and a lack of time to encourage survivors to obtain supportive care. Health care professionals expected the eHealth application to be of added value. The cognitive walkthroughs demonstrated that health care professionals emphasized the importance of tailoring care. They considered the navigation structure of OncoKompas to be complex. Health care professionals differed in their opinion toward the best strategy to implement the application in clinical practice but indicated that it should be incorporated in the HNC cancer care pathway to ensure all survivors would benefit. CONCLUSIONS Health care professionals experienced several barriers in directing patients to supportive care. They were positive toward the development and implementation of an eHealth application and expected it could support survivors in obtaining supportive care tailored to their needs. The cognitive walkthroughs revealed several points for optimizing the application prototype and developing an efficient implementation strategy. Including health care professionals in an early phase of a participatory design approach is valuable in developing an eHealth application and an implementation strategy meeting stakeholders' needs.
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Affiliation(s)
- Sanne Duman-Lubberding
- Department of Otolaryngology / Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands.
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105
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Jacob E, Childress C, Nathanson JD. Barriers to care and quality of primary care services in children with sickle cell disease. J Adv Nurs 2015; 72:1417-29. [PMID: 26370255 DOI: 10.1111/jan.12756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 01/21/2023]
Abstract
AIMS The aims of this study were: to (1) identify barriers to care in children with sickle cell disease; (2) examine the quality of primary care services received by these children and (3) examine the relationship between barriers to care and quality of primary care services in children with sickle cell disease. BACKGROUND Effective management in children with sickle cell disease requires early access to a comprehensive range of preventive screenings, urgent care treatments for vaso-occlusive pain crisis and ongoing prophylactic treatments. DESIGN A cross-sectional survey of parents of children with sickle cell disease was conducted between April-September 2011. METHODS Parents of children with sickle cell disease completed the Barriers to Care Questionnaire and Parent's Perceptions of Primary Care. RESULTS Parents of children with sickle cell disease (n = 38) reported health system barriers such as inability to contact doctors or clinics, extended wait times and inconvenient clinic hours. Some barriers were reported more frequently among children with concurrent sickle cell disease and asthma, compared with those children without a concurrent asthma condition. Parents who reported more barriers were least likely to perceive their care as accessible, comprehensive and coordinated. CONCLUSIONS Minimizing healthcare barriers may improve the quality of primary care services received by children with sickle cell disease and consequently prevent complications associated with sickle cell disease. IMPLICATIONS FOR NURSING PRACTICE Nurses and other care providers need to identify healthcare barriers, so that access, coordination, comprehensiveness and overall quality of primary care services may be improved in children with sickle cell disease.
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Affiliation(s)
- Eufemia Jacob
- UCLA School of Nursing, Los Angeles, California, USA
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106
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Missel M, Pedersen JH, Hendriksen C, Tewes M, Adamsen L. Regaining familiarity with own body after treatment for operable lung cancer - a qualitative longitudinal exploration. Eur J Cancer Care (Engl) 2015; 25:1076-1090. [PMID: 26361265 DOI: 10.1111/ecc.12383] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 01/23/2023]
Abstract
Little is known about the experiences of operable lung cancer patients during treatment in a clinical setting based on fast-track surgery. The study aimed to explore (1) the embodied meaning of illness in patients with operable lung cancer during treatment to 4 months after surgery and (2) patterns of change over time that may affect the patients' daily lives. Twenty patients referred for lung cancer surgery were interviewed three times, corresponding to potential critical transition points following surgery: hospitalisation; hospital-to-home transition; and resumption of daily life activities. Data collection, analysis and interpretation followed a phenomenological hermeneutical approach inspired by Ricoeur and the theoretical framework was grounded in Merleau-Ponty's phenomenology of perception. The findings reveal the process patients went through in regaining familiarity with their own body after lung cancer treatment. Through the post-operative trajectory the patients' resumption of daily activities involved adjusting to a new awareness of everyday life, physical restrictions and their perception of themselves. The findings are expressed in four sub-themes: (1) perceptions of embodied alterations; (2) transformation of embodied structures in the transition from hospital to home was unexpectedly challenging; (3) embodied perceptions of the intersubjective world; and (4) transforming embodied disruptions into bodily awareness. Patients experienced a smooth treatment trajectory regarding physical consequences of illness and treatment which might be due to the fast-track surgery. Clinicians should be aware of patients' experiences of illness to facilitate patient reconstitution of own identity.
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Affiliation(s)
- M Missel
- Department of Thoracic Surgery, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen.
| | - J H Pedersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Copenhagen
| | - C Hendriksen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - M Tewes
- Heart Center, University Hospital of Copenhagen, Copenhagen
| | - L Adamsen
- The Faculty of Health and Medical Sciences and University Centre for Nursing and Care Research (UCSF), Centre for Integrated Rehabilitation of Cancer Patients (CIRE), Copenhagen, Denmark
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107
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Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C. The expanding role of primary care in cancer control. Lancet Oncol 2015; 16:1231-72. [PMID: 26431866 DOI: 10.1016/s1470-2045(15)00205-3] [Citation(s) in RCA: 355] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
Abstract
The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.
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Affiliation(s)
- Greg Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK.
| | - Annette Berendsen
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | | | - Rachel Dommett
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Craig Earle
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Jon Emery
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Tom Fahey
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Sumit Gupta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - David Hunter
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | | | - Una Macleod
- Hull-York Medical School, University of Hull, Hull, UK
| | - Robert Mason
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Geoffrey Mitchell
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | | | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bohumil Seifert
- Department of General Practice, Charles University, Prague, Czech Republic
| | - Jeff Sisler
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Stephen Taplin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Peter Vedsted
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Teja Voruganti
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fiona Walter
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eila Watson
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Jeremy Whelan
- Research Department of Oncology, University College London, London, UK
| | - James Whitlock
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | - Niek de Wit
- Department of General Practice, University Medical Center Utrecht, Utrecht, Netherlands
| | - Camilla Zimmermann
- Division of Medical Oncology and Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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108
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Levy BP, Chioda MD, Herndon D, Longshore JW, Mohamed M, Ou SHI, Reynolds C, Singh J, Wistuba II, Bunn PA, Hirsch FR. Molecular Testing for Treatment of Metastatic Non-Small Cell Lung Cancer: How to Implement Evidence-Based Recommendations. Oncologist 2015; 20:1175-81. [PMID: 26330460 DOI: 10.1634/theoncologist.2015-0114] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/02/2015] [Indexed: 12/28/2022] Open
Abstract
The recent discovery of relevant biomarkers has reshaped our approach to therapy selection for patients with non-small cell lung cancer. The unprecedented outcomes demonstrated with tyrosine kinase inhibitors in molecularly defined cohorts of patients has underscored the importance of genetic profiling in this disease. Despite published guidelines on biomarker testing, successful tumor genotyping faces significant hurdles at both academic and community-based practices. Oncologists are now faced with interpreting large-scale genomic data from multiple tumor types, possibly making it difficult to stay current with practice standards in lung cancer. In addition, physicians' lack of time, resources, and face-to-face opportunities can interfere with the multidisciplinary approach that is essential to delivery of care. Finally, several challenges exist in optimizing the amount and quality of tissue for molecular testing. Recognizing the importance of biomarker testing, a series of advisory boards were recently convened to address these hurdles and clarify best practices. We reviewed these challenges and established recommendations to help optimize tissue acquisition, processing, and testing within the framework of a multidisciplinary approach.
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Affiliation(s)
- Benjamin P Levy
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Marc D Chioda
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Dana Herndon
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - John W Longshore
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Mohamed Mohamed
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Sai-Hong Ignatius Ou
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Craig Reynolds
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Jaspal Singh
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Ignacio I Wistuba
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Paul A Bunn
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Fred R Hirsch
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
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Kent EE, Mitchell SA, Castro KM, DeWalt DA, Kaluzny AD, Hautala JA, Grad O, Ballard RM, McCaskill-Stevens WJ, Kramer BS, Clauser SB. Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology. J Clin Oncol 2015; 33:2705-11. [PMID: 26195715 PMCID: PMC4559611 DOI: 10.1200/jco.2014.60.6210] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Understanding how health care system structures, processes, and available resources facilitate and/or hinder the delivery of quality cancer care is imperative, especially given the rapidly changing health care landscape. The emerging field of cancer care delivery research (CCDR) focuses on how organizational structures and processes, care delivery models, financing and reimbursement, health technologies, and health care provider and patient knowledge, attitudes, and behaviors influence cancer care quality, cost, and access and ultimately the health outcomes and well-being of patients and survivors. In this article, we describe attributes of CCDR, present examples of studies that illustrate those attributes, and discuss the potential impact of CCDR in addressing disparities in care. We conclude by emphasizing the need for collaborative research that links academic and community-based settings and serves simultaneously to accelerate the translation of CCDR results into practice. The National Cancer Institute recently launched its Community Oncology Research Program, which includes a focus on this area of research.
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Affiliation(s)
- Erin E Kent
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Sandra A Mitchell
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA.
| | - Kathleen M Castro
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Darren A DeWalt
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Arnold D Kaluzny
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Judith A Hautala
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Oren Grad
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Rachel M Ballard
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Worta J McCaskill-Stevens
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Barnett S Kramer
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Steven B Clauser
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
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Traeger L, McDonnell TM, McCarty CE, Greer JA, El-Jawahri A, Temel JS. Nursing intervention to enhance outpatient chemotherapy symptom management: Patient-reported outcomes of a randomized controlled trial. Cancer 2015; 121:3905-13. [PMID: 26194461 DOI: 10.1002/cncr.29585] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/14/2015] [Accepted: 06/16/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND The authors conducted a randomized controlled trial to evaluate a nurse practitioner (NP)-delivered symptom management intervention for patients initiating chemotherapy for nonmetastatic cancer. The aim was to reduce patient-reported symptom burden by facilitating patient-NP collaboration and the early management of symptoms. METHODS At the time of the first chemotherapy visit, adult participants with nonmetastatic breast, colorectal, or lung cancer (120 participants) completed self-report measures and were then randomly assigned to standard care plus the intervention or standard care alone. Intervention participants received proactive telephone calls from their oncology team NP during the week after each of the first 2 chemotherapy administration visits. Measures were repeated at the second and third chemotherapy visits. Group differences were analyzed with regard to patient-reported symptoms (Memorial Symptom Assessment Scale-Short Form items), satisfaction with care (Family Caregiver Satisfaction-patient scale), and the likelihood of depression or anxiety symptoms (Patient Health Questionnaire-4). RESULTS At the time of the first visit, 50.8% of participants reported ≥1 physical symptom, most commonly lack of energy (35.8%) and drowsiness (30.8%). The number of symptoms (gamma coefficient [γ] = 0.16; P<.001), symptom distress (γ = 0.45; P<.001), and satisfaction with care (γ = 0.24; P = .004) increased whereas the likelihood of anxiety symptoms decreased (γ = -0.19; P = .02) and the likelihood of depression symptoms did not change (γ = 0.01; P = .91). Outcomes did not differ by randomized group. Randomized group interacted with emetogenic potential in predicting symptom distress (γ = 0.43; P = .03) and satisfaction with care (γ = -0.45; P = .045). CONCLUSIONS The intervention did not appear to reduce symptom burden compared with standard care. Early symptoms highlight the importance of continuing to examine strategies to improve symptom management during chemotherapy for nonmetastatic disease.
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Affiliation(s)
- Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Caitlin E McCarty
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer S Temel
- Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
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111
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Samson P, Patel A, Garrett T, Crabtree T, Kreisel D, Krupnick AS, Patterson GA, Broderick S, Meyers BF, Puri V. Effects of Delayed Surgical Resection on Short-Term and Long-Term Outcomes in Clinical Stage I Non-Small Cell Lung Cancer. Ann Thorac Surg 2015; 99:1906-12; discussion 1913. [PMID: 25890663 PMCID: PMC4458152 DOI: 10.1016/j.athoracsur.2015.02.022] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/22/2015] [Accepted: 02/06/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Conflicting evidence currently exists regarding the causes and effects of delay of care in non-small cell lung cancer (NSCLC). We hypothesized that delayed surgery in early-stage NSCLC is associated with worse short-term and long-term outcomes. METHODS Treatment data of clinical stage I NSCLC patients undergoing surgical resection were obtained from the National Cancer Data Base (NCDB). Treatment delay was defined as resection 8 weeks or more after diagnosis. Propensity score matching for patient and tumor characteristics was performed to create comparable groups of patients receiving early (less than 8 weeks from diagnosis) and delayed surgery. Multivariable regression models were fitted to evaluate variables influencing delay of surgery. RESULTS From 1998 to 2010, 39,995 patients with clinical stage I NSCLC received early surgery, while 15,658 patients received delayed surgery. Of these, 27,022 propensity-matched patients were identified. Those with a delay in care were more likely to be pathologically upstaged (18.3% stage 2 or higher versus 16.6%, p < 0.001), have an increased 30-day mortality (2.9% vs 2.4%, p = 0.01), and have decreased median survival (57.7 ± 1.0 months versus 69.2 ± 1.3 months, p < 0.001). Delay in surgery was associated with increasing age, non-white race, treatment at an academic center, urban location, income less than $35,000, and increasing Charlson comorbidity score (p < 0.0001 for all). Delayed patients were more likely to receive a sublobar resection (17.2% vs 13.1%, p < 0.001). CONCLUSIONS Patients receiving delayed resection for clinical stage I NSCLC have higher comorbidity scores that may affect ability to perform lobectomy and result in higher perioperative mortality. However, delay in resection is independently associated with increased rates of upstaging and decreased median survival. Strategies to minimize delay while medically optimizing higher risk patients are needed.
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Affiliation(s)
- Pamela Samson
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aalok Patel
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Tasha Garrett
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Traves Crabtree
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - A Sasha Krupnick
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Stephen Broderick
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
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112
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Krok-Schoen JL, Brewer BM, Young GS, Weier RC, Tatum CM, DeGraffinreid CR, Paskett ED. Participants' barriers to diagnostic resolution and factors associated with needing patient navigation. Cancer 2015; 121:2757-64. [PMID: 25921981 DOI: 10.1002/cncr.29414] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patient navigation (PN) may improve cancer care by identifying and removing patient-reported barriers to care. In 2012, the American College of Surgeons Commission on Cancer (CoC) announced that health care facilities seeking CoC accreditation must have PN processes in place by January 1, 2015. Given these unfunded mandates, hospitals are looking for cost-effective ways to implement PN. This study examined demographic and psychosocial predictors of barriers to diagnostic resolution among individuals with a cancer screening abnormality enrolled in the Ohio Patient Navigation Research Project. METHODS Data were obtained from patients who received care at 1 of 9 Ohio Patient Navigation Research Project intervention clinics. Descriptive statistics and logistic regression models were used. RESULTS There were 424 participants, and 151 (35.6%) reported a barrier to diagnostic resolution within 90 days of study consent. The most commonly reported barriers were misconceptions about a test or treatment (16.4%), difficulty in communicating with the provider (15.0%), and scheduling problems (11.5%). Univariate analyses indicated that race, education, employment, income, insurance, clinic type, friend support, and physical and psychological functioning were significantly associated with reporting a barrier to diagnostic resolution. Multivariate analyses found that comorbidities (odds ratio, 1.65; 95% confidence interval, 1.04-2.61) and higher intrusive thoughts and feelings (odds ratio, 1.25; 95% confidence interval, 1.10-1.41) were significantly associated with reporting a barrier to diagnostic resolution. CONCLUSIONS The results suggest that demographic and psychosocial factors are associated with barriers to diagnostic resolution. To ensure compliance with the CoC mandate and provide timely care to all patients, CoC-accredited facilities can systematically identify the patients most likely to have barriers to care and assign them to PN.
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Affiliation(s)
| | | | - Gregory S Young
- Center for Biostatistics, Ohio State University, Columbus, Ohio
| | - Rory C Weier
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Cathy M Tatum
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | | | - Electra D Paskett
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
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113
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Murphy C, Sabesan S, Steer C, Yates P, Booms A, Jones V, Simpson A, Clarke K, Eek R, Ashley D, Goldstein D, Packer C, Tuthill F, Boyce A, Underhill C. Oncology service initiatives and research in regional Australia. Aust J Rural Health 2015; 23:40-8. [DOI: 10.1111/ajr.12173] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Sabe Sabesan
- Department of Medical Oncology; Townsville Cancer Centre; Townsville Queensland Australia
- James Cook University; Townsville Queensland Australia
| | - Christopher Steer
- Border Medical Oncology; Geelong Queensland Australia
- Albury Wodonga Health; Geelong Queensland Australia
- Conjoint Senior Lecturer University of NSW; Sydney New South Wales Australia
| | - Patsy Yates
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane Queensland Australia
- Centre for Palliative Care Research and Education; Queensland Health; Brisbane Queensland Australia
| | - Anne Booms
- Oncology Nurse Practitioner Albury Wodonga Health; Wagga Wagga New South Wales Australia
| | - Victoria Jones
- Psycho-oncology Service Development Social Worker Cancer Services Murrumbidgee; Southern NSW Local Health Districts; Sydney New South Wales Australia
| | - Alison Simpson
- Murrumbidgee Local Health District; Aboriginal Health; Wagga Wagga New South Wales Australia
| | - Kerrie Clarke
- Border Medical Oncology; Geelong Queensland Australia
- Albury Wodonga Health; Geelong Queensland Australia
- Conjoint Senior Lecturer University of NSW; Sydney New South Wales Australia
| | - Richard Eek
- Border Medical Oncology; Geelong Queensland Australia
- Albury Wodonga Health; Geelong Queensland Australia
- Conjoint Senior Lecturer University of NSW; Sydney New South Wales Australia
| | - David Ashley
- Chair of Medicine Barwon Health; Deakin University; Geelong Queensland Australia
- Andrew Love Cancer Centre; Barwon Health; Geelong Queensland Australia
| | - David Goldstein
- University of NSW Clinical School; Sydney New South Wales Australia
- Prince of Wales Hospital; Sydney New South Wales Australia
| | - Chris Packer
- Hume Regional Integrated Cancer Service; Townsville Queensland Australia
| | - Fiona Tuthill
- Border Medical Oncology; Geelong Queensland Australia
| | - Adam Boyce
- Department Oncology North Coast Hospital; St Vincent's Hospital; Sydney Queensland Australia
| | - Craig Underhill
- Border Medical Oncology; Geelong Queensland Australia
- Conjoint Senior Lecturer University of NSW; Sydney New South Wales Australia
- Albury Wodonga Health; Geelong Queensland Australia
- Hume Regional Integrated Cancer Service; Townsville Queensland Australia
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Percac-Lima S, Cronin PR, Ryan DP, Chabner BA, Daly EA, Kimball AB. Patient navigation based on predictive modeling decreases no-show rates in cancer care. Cancer 2015; 121:1662-70. [PMID: 25585595 DOI: 10.1002/cncr.29236] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/21/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patient adherence to appointments is key to improving outcomes in health care. "No-show" appointments contribute to suboptimal resource use. Patient navigation and telephone reminders have been shown to improve cancer care and adherence, particularly in disadvantaged populations, but may not be cost-effective if not targeted at the appropriate patients. METHODS In 5 clinics within a large academic cancer center, patients who were considered to be likely (the top 20th percentile) to miss a scheduled appointment without contacting the clinic ahead of time ("no-shows") were identified using a predictive model and then randomized to an intervention versus a usual-care group. The intervention group received telephone calls from a bilingual patient navigator 7 days before and 1 day before the appointment. RESULTS Over a 5-month period, of the 40,075 appointments scheduled, 4425 patient appointments were deemed to be at high risk of a "no-show" event. After the patient navigation intervention, the no-show rate in the intervention group was 10.2% (167 of 1631), compared with 17.5% in the control group (280 of 1603) (P<.001). Reaching a patient or family member was associated with a significantly lower no-show rate (5.9% and 3.0%, respectively; P<.001 and .006, respectively) compared with leaving a message (14.7%: P = .117) or no contact (no-show rate, 21.6%: P = .857). CONCLUSIONS Telephone navigation targeted at those patients predicted to be at high risk of visit nonadherence was found to effectively and substantially improve patient adherence to cancer clinic appointments. Further studies are needed to determine the long-term impact on patient outcomes, but short-term gains in the optimization of resources can be recognized immediately.
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Affiliation(s)
- Sanja Percac-Lima
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Center for Community Health Improvement, Massachusetts General Hospital, Boston, Massachusetts
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Ludman EJ, McCorkle R, Bowles EA, Rutter CM, Chubak J, Tuzzio L, Jones S, Reid RJ, Penfold R, Wagner EH. Do depressed newly diagnosed cancer patients differentially benefit from nurse navigation? Gen Hosp Psychiatry 2015; 37:236-9. [PMID: 25835508 PMCID: PMC4442728 DOI: 10.1016/j.genhosppsych.2015.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine whether the effects of a nurse navigator intervention for cancer vary with baseline depressive symptoms. METHOD Participants were enrolled in a randomized controlled trial of a nurse navigation intervention for patients newly diagnosed with lung, breast or colorectal cancer (N=251). This exploratory analysis used linear regression models to estimate the effect of a nurse navigator intervention on patient experience of care. Models estimated differential effects by including interactions between randomization group and baseline depressive symptoms. Baseline scores on the 9-item Patient Health Questionnaire (PHQ) were categorized into 3 groups: no depression (PHQ=0-4, N=138), mild symptoms of depression (PHQ=5-9, N=76) and moderate to severe symptoms (PHQ=10 or greater, N=34). Patient experience outcomes were measured by subscales of the Patient Assessment of Chronic Illness Care (PACIC) and subscales from an adaptation of the Picker Institute's patient experience survey at 4-month follow-up. RESULTS With the exception of the PACIC subscale of delivery system/practice design, interaction terms between randomization group and PHQ-9 scores were not statistically significant. CONCLUSIONS The intervention was broadly useful; we found that it was equally beneficial for both depressed patients and patients who were not significantly depressed in the first 4 months postdiagnosis. However, because of the small sample size, we cannot conclude with certainty that patients with depressive symptoms did not differentially benefit from the intervention.
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116
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Jones SMW, Ludman EJ, McCorkle R, Reid R, Aiello Bowles EJ, Penfold R, Wagner EH. A differential item function analysis of somatic symptoms of depression in people with cancer. J Affect Disord 2015; 170:131-7. [PMID: 25240839 PMCID: PMC4253856 DOI: 10.1016/j.jad.2014.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/02/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The overlap of somatic symptoms of depression with symptoms of cancer treatment is widely acknowledged and studied. However, this literature provides little guidance for clinicians as to whether these items should be used in assessing depression. The current study examined the appropriateness of using somatic items for assessment of depression in people with cancer. METHODS People with newly diagnosed breast, lung or colorectal cancer (n=251) completed the Patient Health Questionnaire-9 (PHQ9) shortly after cancer diagnosis but before cancer treatment (baseline), 4 months later, typically during or shortly after treatment, and 12 months later. Pharmacy data was used to classify participants as having low somatic symptoms or high somatic symptoms. Differential item function (DIF) compared the functioning of the somatic items of the PHQ9 in the low vs. high symptom groups and the chemotherapy vs. no chemotherapy groups at the 4-month assessment. RESULTS Significant DIF was not found on any of the four somatic items of the PHQ9 and differences in the item parameters of the somatic items were not consistent across the groups. However, fatigue and sleep indicated only mild depression. Only removing the fatigue item greatly affected the number screening positive for depression at 4 months (8.3%) but removing the other somatic items did not have as large an effect. Only one participant at baseline screened positive for depression by somatic symptoms alone (no psychological symptoms) and no participants screened positive by somatic symptoms alone at 4 months and 12 months. LIMITATIONS The sample size was small for DIF and consisted of mostly women with breast cancer. CONCLUSIONS Somatic symptoms of depression can continue to be administered to people with cancer, however the fatigue and sleep items should be used with caution.
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Sullivan KA, Schultz K, Ramaiya M, Berger M, Parnell H, Quinlivan EB. Experiences of women of color with a nurse patient navigation program for linkage and engagement in HIV care. AIDS Patient Care STDS 2015; 29 Suppl 1:S49-54. [PMID: 25457920 DOI: 10.1089/apc.2014.0279] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patient navigation, a patient-centered model of care coordination focused on reducing barriers to care, is an emerging strategy for linking patients to and retaining them in HIV care. The Guide to Healing Program (G2H), implemented at the Infectious Diseases Clinic at UNC Chapel Hill, provided patient navigation to women of color (WOC) new to or re-engaging in HIV care through a 'nurse guide' with mental health training and experience. The purpose of this study was to qualitatively explore patients' experiences working with the nurse guide. Twenty-one semi-structured telephone interviews with G2H participants were conducted. Interviews were transcribed and thematic analysis was utilized to identify patterns and themes in the data. Women's experiences with the nurse guide were overwhelmingly positive. They described the nurse guide teaching them critical information and skills, facilitating access to resources, and conveying authentic kindness and concern. The findings suggest that a properly trained nurse in this role can provide critical medical and psychosocial support in order to eliminate barriers to engagement in HIV care, and successfully facilitate patient HIV self-management. The nurse guide model represents a promising approach to patient navigation for WOC living with HIV.
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Affiliation(s)
- Kristen A. Sullivan
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Katherine Schultz
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Megan Ramaiya
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Miriam Berger
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Heather Parnell
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - E. Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Rousseau SJ, Humiston SG, Yosha A, Winters PC, Loader S, Luong V, Schwartzbauer B, Fiscella K. Patient navigation moderates emotion and information demands of cancer treatment: a qualitative analysis. Support Care Cancer 2014; 22:3143-51. [PMID: 24890503 PMCID: PMC4221546 DOI: 10.1007/s00520-014-2295-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/19/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Patient navigation is increasingly employed to guide patients through cancer treatment. We assessed the elements of navigation that promoted patients' involvement in treatment among patients with breast and colorectal cancer that participated in a navigation study. METHODS We conducted qualitative analysis of 28 audiotaped and transcribed semi-structured interviews of navigated and unnavigated cancer patients. RESULTS Themes included feeling emotionally and cognitively overwhelmed and desire for a strong patient-navigator partnership. Both participants who were navigated and those who were not felt that navigation did or could help address their emotional, informational, and communicational needs. The benefits of logistical support were cited less often. CONCLUSIONS Findings underscore the salience of personal relationships between patients and navigators in meeting patients' emotional and informational needs.
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119
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Scientific surgery. Br J Surg 2014. [DOI: 10.1002/bjs.9646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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120
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Hryniuk W, Simpson R, McGowan A, Carter P. Patient perceptions of a comprehensive cancer navigation service. ACTA ACUST UNITED AC 2014; 21:69-76. [PMID: 24764695 DOI: 10.3747/co.21.1930] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Our aim was to determine the extent to which comprehensive navigation augments the provincial health system for meeting the needs of newly-diagnosed cancer patients (clients). We also assessed reactions of attending physicians to comprehensive navigation. METHODS Clients who completed navigation as an employee benefit or through membership in an insurance organization were polled to determine whether they needed help beyond that provided by the provincial health system and the extent to which that help was provided by navigation. Exit interviews were analyzed for perceptions of the clients about reactions by their attending physicians to navigation. RESULTS Of eligible clients, 72% responded. They reported needing help beyond that which the provincial system could provide in 64%-98% of specified areas. Navigation provided help in more than 90% of those cases. Almost all respondents (98%) appreciated having a designated oncology nurse navigator. Family doctors were perceived to be positive or neutral about navigation in 100% of exit interviews. Oncologists were positive or neutral in 92% (p < 0.001 for difference from family doctors). CONCLUSIONS In many areas, cancer patients need additional help beyond that which the provincial health system can provide. Comprehensive cancer navigation provides that help to a considerable extent. Clients perceived the reactions of attending physicians to comprehensive navigation to be generally supportive or neutral.
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121
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Wheeler A. The Modern Role of the Clinical Nurse Specialist in Colorectal Cancer in a District General Hospital. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-014-0211-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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LeBlanc TW, Currow DC, Abernethy AP. On Goldilocks, care coordination, and palliative care: making it 'just right'. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 23:8-10. [PMID: 24553823 PMCID: PMC6442284 DOI: 10.4104/pcrj.2014.00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC USA • Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC USA
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Hendren S, Fiscella K. Patient Navigation Improves the Care Experience for Patients With Newly Diagnosed Cancer. J Clin Oncol 2014; 32:3-4. [DOI: 10.1200/jco.2013.53.2960] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chubak J, Aiello Bowles EJ, Tuzzio L, Ludman E, Rutter CM, Reid RJ, Wagner EH. Perspectives of cancer survivors on the role of different healthcare providers in an integrated delivery system. J Cancer Surviv 2013; 8:229-38. [PMID: 24352871 DOI: 10.1007/s11764-013-0335-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this paper is to describe patient perspectives on survivorship care 1 year after cancer diagnosis. METHODS The study was conducted at an integrated healthcare delivery system in western Washington State. Participants were patients with breast, colorectal, and lung cancer who had enrolled in a randomized control trial (RCT) of oncology nurse navigation to improve early cancer care. Those alive and enrolled in the healthcare system 1 year after diagnosis were eligible for this analysis. Participants completed surveys by phone. Questions focused on receipt of treatment summaries and care plans; discussions with different providers; patient opinions on who does and should provide their care; and patient perspectives primary care providers' (PCP) knowledge and skills related to caring for cancer survivors RESULTS Of the 251 participants in the RCT, 230 (91.6%) responded to the 12-month phone survey and were included in this analysis; most (n = 183, 79.6%) had breast cancer. The majority (84.8%) considered their cancer specialist (e.g., medical, radiation, surgical or gynecological oncologist) to be their main provider for cancer follow-up and most (69.4%) had discussed follow-up care with that provider. Approximately half of patients were uncertain how well their PCP communicated with the oncologist and how knowledgeable s/he was in caring for cancer survivors. CONCLUSIONS One year after diagnosis, cancer survivors continue to view cancer specialists as their main providers and are uncertain about their PCP's skills and knowledge in managing their care. Our findings present an opportunity to help patients understand what their PCPs can and cannot provide in the way of cancer follow-up care. IMPLICATIONS FOR CANCER SURVIVORS Additional research on care coordination and delivery is necessary to help cancer survivors manage their care between primary care and specialty providers.
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Affiliation(s)
- Jessica Chubak
- Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA,
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