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Lammers EMJ, Nijdam A, Zijlstra JM, Janus CPM, de Weijer RJ, Appelman Y, Manintveld OC, Teske AJ, van Leeuwen FE, Aleman BMP. Cardiovascular screening outcomes in the Dutch survivorship care program for Hodgkin lymphoma survivors. J Cancer Surviv 2024:10.1007/s11764-024-01561-y. [PMID: 38649650 DOI: 10.1007/s11764-024-01561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 03/02/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular disease (CVD) due to former lymphoma treatment. In 2013, cardiovascular screening for 5-year HL survivors according to national guidelines was implemented in Dutch survivorship clinics. We aim to assess the following: (1) adherence to screening guidelines and (2) the yield of (risk factors for) CVD in the screening program. METHODS The study population consisted of 5-year HL survivors who received survivorship care at three University Medical Centers from 2013 to 2016 through 2021. Patient characteristics, cardiovascular screening procedures, and outcomes were collected from the medical records. RESULTS In 186 survivors eligible for cardiovascular screening (mean age 47.8 years, 60.8% female), the following diagnostics were performed: complete blood tests (81.0%, median frequency: yearly instead of advised 5-yearly evaluation), electrocardiogram (93.0%), echocardiography (94.6%). Fifty-five percent of survivors had at least one modifiable cardiovascular risk factor (i.e., current smoking, overweight, new/insufficiently controlled hypertension, dyslipidemia, or diabetes). Screening detected ≥ 1 CVD in 31.1% of survivors. Among survivors with available echocardiography report (n = 106), screening detected new aortic and/or mitral valve dysfunction(s) in 51.0% (with grades 3-4 in 4.9%) and impaired left ventricular ejection fraction in 10.3%. CONCLUSIONS Adherence to the screening guidelines in the Dutch HL survivorship care program was reasonable to good and a substantial number of actionable (risk factors for) CVD were diagnosed. IMPLICATIONS FOR CANCER SURVIVORS Our findings inform HL survivors at high risk of late cardiotoxicity about cardiovascular screening findings and demonstrate appropriate therapeutic actions after diagnosis of (risk factors for) CVD.
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Affiliation(s)
- Eline M J Lammers
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annelies Nijdam
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Cécile P M Janus
- Department of Radiation Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Roel J de Weijer
- Department of Hematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | - Arco J Teske
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Lammers EMJ, Zijlstra JM, Retèl VP, Aleman BMP, van Leeuwen FE, Nijdam A. Effectiveness and Cost-Effectiveness of Survivorship Care for Survivors of Hodgkin Lymphoma (INSIGHT Study): Protocol for a Multicenter Retrospective Cohort Study With a Quasi-Experimental Design. JMIR Res Protoc 2024; 13:e55601. [PMID: 38635308 PMCID: PMC11066749 DOI: 10.2196/55601] [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: 12/26/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Hodgkin lymphoma (HL) occurs at young ages, with the highest incidence between 20 and 40 years. While cure rates have improved to 80%-90% over the past decades, survivors of HL are at substantial risk of late treatment-related complications, such as cardiovascular diseases, breast cancer, severe infections, and hypothyroidism. To reduce morbidity and mortality from late treatment effects, the Dutch Better care after lymphoma, Evaluation of long-term Treatment Effects and screening Recommendations (BETER) consortium developed a survivorship care program for 5-year survivors of HL that includes risk-based screening for and treatment of (risk factors for) late adverse events. Even though several cancer survivorship care programs have been established worldwide, there is a lack of knowledge about their effectiveness in clinical practice. OBJECTIVE The Improving Nationwide Survivorship care Infrastructure and Guidelines after Hodgkin lymphoma Treatment (INSIGHT) study evaluates whether Dutch BETER survivorship care for survivors of HL decreases survivors' burden of disease from late adverse events after HL treatment and associated health care costs and improves their quality of life. METHODS The INSIGHT study is a multicenter retrospective cohort study with a quasi-experimental design and prospective follow-up, embedded in the national BETER survivorship care infrastructure. The first BETER clinics started in 2013-2016 and several other centers started or will start BETER clinics in 2019-2024. This allows us to compare survivors who did and those who did not receive BETER survivorship care in the last decade. Survivors in the intervention group are matched to controls (n=450 per group) based on sex, age at diagnosis (±5 years), age in 2013 (±5 years), and treatment characteristics. The primary outcome is the burden of disease in disability-adjusted life years from cardiovascular disease, breast cancer, severe infections, and hypothyroidism. In a cost-effectiveness analysis, we will assess the cost of BETER survivorship care per averted or gained disability-adjusted life year and quality-adjusted life year. Secondary outcomes are BETER clinic attendance, adherence to screening guidelines, and knowledge and distress about late effects among survivors of HL. Study data are collected from a survivor survey, a general practitioner survey, medical records, and through linkages with national disease registries. RESULTS The study was funded in November 2020 and approved by the institutional review board of the Netherlands Cancer Institute in July 2021. We expect to finalize recruitment by October 2024, data collection by early 2025, and data analysis by May 2025. CONCLUSIONS INSIGHT is the first evaluation of a comprehensive survivorship program using real-world data; it will result in new information on the (cost-)effectiveness of survivorship care in survivors of HL in clinical practice. The results of this study will be used to improve the BETER program where necessary and contribute to more effective evidence-based long-term survivorship care for lymphoma survivors. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55601.
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Affiliation(s)
- Eline M J Lammers
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC, location Vrije Universiteit, Cancer Center, Amsterdam, Netherlands
| | - Valesca P Retèl
- Department of Health Technology Assessment, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Annelies Nijdam
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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Ghinea N, Lipworth W, Kerridge I, Zalcberg JR. How therapeutic advances have transformed the medical landscape: a primer for clinicians. Intern Med J 2023; 53:1306-1310. [PMID: 37255280 DOI: 10.1111/imj.16142] [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: 02/20/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
Novel medicines are entering the market rapidly and are increasingly being used alone or in combination to treat illnesses of every sort. While transforming the lives of many patients, these new therapies have also forced us to reconsider the way we evaluate, use and fund medicines. This article offers a primer to help practitioners understand how the therapeutic landscape is changing and how this might impact the evidence generation, access to interventions, patient experience and quality of care.
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Affiliation(s)
- Narcyz Ghinea
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
| | - Wendy Lipworth
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
| | - Ian Kerridge
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
- Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - John R Zalcberg
- Department of Medical Oncology, Alfred Health and School of Public Health, Monash University, Melbourne, Victoria, Australia
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Hensley A, Campbell T, Gonzales C. Using Patient-Reported Outcomes Measurement Information System® (PROMIS) to Identify Physical and Psychosocial Quality of Life Issues in Lung Cancer Survivors. J Dr Nurs Pract 2023; 16:22-35. [PMID: 36918282 DOI: 10.1891/jdnp-2022-0018] [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: 03/16/2023]
Abstract
Background: Lung cancer survivors (LCS) are living longer due to improved screening and treatment but often experience long-term treatment effects. Due to a traditionally poor prognosis, research related to LCS symptomology and associated quality of life (QOL) is lacking. Objective: The objective of this study was to develop a process for identifying symptomology and unmet needs affecting QOL in LCS. Methods: A literature review identified recommended methods of implementing a QOL screening program in LCS. Training guidelines using the best evidence were presented to the survivorship clinic (SC) staff. The Patient-Reported Outcomes Measurement Information System® (PROMIS-29) profile was used to collect data from LCS. The experience of the SC staff (N = 2) and providers (N = 2) in implementing the QOL screening program in LCS was assessed. Results: A 100% compliance rate in completing the PROMIS-29 profile was achieved. Physical function and pain interference were the most impacted QOL domains identified by LCS, while depression was the least. No challenges were identified in assisting LCS with profile completion. Providers agreed that the PROMIS-29 was instrumental in identifying QOL issues. Conclusion: A QOL screening program tailored to LCS-improved compliance and reliability in identifying QOL issues. Implications for Nursing: A QOL screening program using the PROMIS-29 may improve patient-provider interactions and value-based oncology care.
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Affiliation(s)
- Amy Hensley
- Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Tracy Campbell
- Forsyth Technical Community College, Clemmons, North Carolina, USA
| | - Clifford Gonzales
- Department of Academic Nursing, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Jeon M, Youn N, Kim S. What are the late effects of older gastric cancer survivors?: A scoping review. Asia Pac J Oncol Nurs 2022; 9:100113. [PMID: 36158706 PMCID: PMC9500514 DOI: 10.1016/j.apjon.2022.100113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Methods Results Conclusions
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Affiliation(s)
- Misun Jeon
- College of Nursing & Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Nayung Youn
- College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Sanghee Kim
- College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
- Corresponding author.
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Evaluation of an APN service in acute inpatient care of patients with a malignant brain tumor: a qualitative study in a Swiss university hospital / Evaluation eines APN-Angebots in der akut-stationären Versorgung von Patienten und Patientinnen mit malignem Hirntumor: eine qualitative Studie in einem Schweizer Universitätsspital. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2022. [DOI: 10.2478/ijhp-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
Caring for patients with a malignant brain tumor is complex and requires a high degree of coordination. The disease reduces life expectancy and affects quality of life. Therefore, patients often depend on the support of their relatives. To achieve better care for such patients and their relatives, a Department of Neurosurgery at a Swiss university hospital introduced a Nurse Practitioner (NP) and their service in 2017. 18 months after implementation, an evaluation of this NP role was conducted. It was aimed for to explore the experience of the interprofessional health care team.
Method
A qualitative research design was used. Eight individual interviews and one focus group interview were conducted with representatives of the interprofessional health care team. Using a literature-based structured interview guide, the experience of participants was explored. Interviews were analyzed thematically.
Results
The NP and their service was appreciated. Collaboration with the medical profession and the coordination of profession-specific demands also improved. The NP as a constant person of contact had a positive effect on the continuity of care e.g., with regard to discharge management. Medical doctors and registered nurses experienced an improved patient satisfaction. Further need for improvement was identified regarding the clarification of the NP role and the interprofessional collaboration.
Conclusion
The study reports on the successful introduction of an NP and their service in oncological care; it demonstrates that the implementation of this role can also be beneficial in acute inpatient care.
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Incurable but treatable: Understanding, uncertainty and impact in chronic blood cancers-A qualitative study from the UK's Haematological Malignancy Research Network. PLoS One 2022; 17:e0263672. [PMID: 35143569 PMCID: PMC8830712 DOI: 10.1371/journal.pone.0263672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Most blood cancers are incurable and typically follow unpredictable remitting-relapsing pathways associated with varying need for treatment, which may be distressing for patients. Our objective was to conduct a qualitative study to explore understanding among patients with such malignancies, including the explanations given by HCPs and the impact of uncertain trajectories, to generate evidence that could guide improvements in clinical practice. Methods The study is set within a population-based patient cohort (the Haematological Malignancy Research Network), in which care is delivered across 14 hospitals according to national guidelines. In-depth interviews were conducted with 35 patients with chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma or myeloma; and 10 accompanying relatives. Purposive sampling ensured selection of information-rich participants and the data were interrogated using reflective thematic analysis. Results Rich data were collected and four themes (11 sub-themes) were identified: 1) Knowledge and understanding of chronic haematological malignancies; 2) Incurable but treatable; 3) Uncertainty about the future; and 4) Treatable (but still incurable): Impact on patients. Patients had rarely heard of blood cancer and many expressed difficulty understanding how an incurable malignancy that could not be removed, was treatable, often for long periods. While some were reassured that their cancer did not pose an immediate survival threat, others were particularly traumatised by the uncertain future it entailed, suffering ongoing emotional distress as a result, which could be more burdensome than any physical symptoms. Nonetheless, most interviewees understood that uncertain pathways were caused by the unpredictability of their disease trajectory, and not information being withheld. Conclusions Many participants lacked knowledge about chronic haematological malignancies. HCPs acted to reassure patients about their diagnosis, and while this was appropriate and effective for some, it was less so for others, as the cancer-impact involved struggling to cope with ongoing uncertainty, distress and a shortened life-span.
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Geese F, Willener R, Spichiger E. Patients' and partners' experiences with prostate cancer and advanced practice nurse counselling. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2021. [DOI: 10.1111/ijun.12270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Franziska Geese
- Department of Health Profession Academic‐Practice‐Partnership, Bern University of Applied Sciences Bern Switzerland
| | - Rita Willener
- Department of Urology Inselspital Bern University Hospital Bern Switzerland
| | - Elisabeth Spichiger
- Department of Nursing Development Directorate of Nursing, Medical‐Technical and Medical‐Therapeutic Areas, Inselspital Bern University Hospital Bern Switzerland
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Esser P, Mehnert-Theuerkauf A. [Cancer survivorship care programs and self-management]. DER ONKOLOGE : ORGAN DER DEUTSCHEN KREBSGESELLSCHAFT E.V 2021; 27:766-770. [PMID: 33935378 PMCID: PMC8063579 DOI: 10.1007/s00761-021-00945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Survivorship care programs (SCP) are increasingly being implemented in order to ensure long-term and comprehensive care of physical and psychosocial cancer-related sequelae among survivors. In this article, we provide a short overview of SCP and the importance of health-related self-management. RESULTS The broad definition of "survivorship" and the high diversity of impairments among cancer survivors warrants a personalized and multidimensional approach. This in turn requires both interdisciplinary and integrated care. To date, the state of knowledge on the efficacy of SCP is limited. A central aim of SCP is to increase health-related self-management, which in turn requires the ability to correctly evaluate and apply health-related information in order to resolve health-related problems (health literacy). Due to the technological developments, additional skills are needed to stay health literate (digital health literacy). CONCLUSION Further research on the efficacy of SCP is warranted. Both advantages and risks of digital health programs need to be carefully weighed to avoid inequalities in health care ("digital divide"). Specific education programs to improve digital health literacy may help to minimize such risks.
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Affiliation(s)
- Peter Esser
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Deutschland
| | - Anja Mehnert-Theuerkauf
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Deutschland
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Murphy CF, Fanning M, Raftery N, Elliott JA, Docherty NG, Donohoe CL, Ravi N, le Roux CW, Reynolds JV. Early experience with a nutrition and survivorship clinic in esophageal cancer. Dis Esophagus 2021; 34:5860595. [PMID: 32566939 DOI: 10.1093/dote/doaa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
Improved cure rates in esophageal cancer care have increased focus on health-related quality of life (HRQL) in survivorship. To optimize recovery after esophagectomy, particularly nutritional well-being, a personalized multidisciplinary survivorship clinic was established at this center. Assessments at 6 and 12 months postoperatively include validated European Organization for the Research and Treatment of Cancer (EORTC) symptom and health-related quality of life (HRQL) questionnaires, functional status review, anthropometry, and biochemical screening for micronutrient deficiencies. 75 patients, at a mean age of 63 years, 84% male, 85% with adenocarcinoma, and 73% receiving multimodal therapy were included. Mean preoperative body mass index (BMI) was 27.5 (4.3) kg m -2. 6- and 12-month assessments were completed by 66 (88%) and 37 (93%) recurrence-free patients, respectively. Mean body weight loss at 6 months was 8.5 ± 6.6% and at 12 months 8.8 ± 7.3%. Of the 12-month cohort, micronutrient deficiency was present in 27 (79.4%) preoperatively and 29 (80.6%) after 1 year (P = 0.727), most commonly iron deficiency (preoperative: 16 [43.2%] and postoperative: 17 [45.9%] patients, P = 0.100). 26 (70.3%) of these patients also had clinically significant dumping syndrome persisting to 12 months after surgery. We describe a novel follow-up support structure for esophageal cancer patients in the first year of survivorship. This may serve as an exemplar model with parallel application across oncological care.
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Affiliation(s)
- Conor F Murphy
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.,Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Michelle Fanning
- Department of Clinical Nutrition, St James's Hospital, Dublin, Ireland
| | - Nicola Raftery
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Jessie A Elliott
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.,Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Claire L Donohoe
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Narayanasamy Ravi
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - John V Reynolds
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
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Wollersheim BM, van Asselt KM, van der Poel HG, van Weert HCPM, Hauptmann M, Retèl VP, Aaronson NK, van de Poll-Franse LV, Boekhout AH. Design of the PROstate cancer follow-up care in Secondary and Primary hEalth Care study (PROSPEC): a randomized controlled trial to evaluate the effectiveness of primary care-based follow-up of localized prostate cancer survivors. BMC Cancer 2020; 20:635. [PMID: 32641023 PMCID: PMC7346492 DOI: 10.1186/s12885-020-07112-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/25/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In its 2006 report, From cancer patient to cancer survivor: lost in transition, the U.S. Institute of Medicine raised the need for a more coordinated and comprehensive care model for cancer survivors. Given the ever increasing number of cancer survivors, in general, and prostate cancer survivors, in particular, there is a need for a more sustainable model of follow-up care. Currently, patients who have completed primary treatment for localized prostate cancer are often included in a specialist-based follow-up care program. General practitioners already play a key role in providing continuous and comprehensive health care. Studies in breast and colorectal cancer suggest that general practitioners could also consider to provide survivorship care in prostate cancer. However, empirical data are needed to determine whether follow-up care of localized prostate cancer survivors by the general practitioner is a feasible alternative. METHODS This multicenter, randomized, non-inferiority study will compare specialist-based (usual care) versus general practitioner-based (intervention) follow-up care of prostate cancer survivors who have completed primary treatment (prostatectomy or radiotherapy) for localized prostate cancer. Patients are being recruited from hospitals in the Netherlands, and randomly (1:1) allocated to specialist-based (N = 195) or general practitioner-based (N = 195) follow-up care. This trial will evaluate the effectiveness of primary care-based follow-up, in comparison to usual care, in terms of adherence to the prostate cancer surveillance guideline for the timing and frequency of prostate-specific antigen assessments, the time from a biochemical recurrence to retreatment decision-making, the management of treatment-related side effects, health-related quality of life, prostate cancer-related anxiety, continuity of care, and cost-effectiveness. The outcome measures will be assessed at randomization (≤6 months after treatment), and 12, 18, and 24 months after treatment. DISCUSSION This multicenter, prospective, randomized study will provide empirical evidence regarding the (cost-) effectiveness of specialist-based follow-up care compared to general practitioner-based follow-up care for localized prostate cancer survivors. TRIAL REGISTRATION Netherlands Trial Registry, Trial NL7068 (NTR7266). Prospectively registered on 11 June 2018.
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Affiliation(s)
- Barbara M Wollersheim
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
| | - Kristel M van Asselt
- Department of General Practice, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Michael Hauptmann
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
| | - Lonneke V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer organization (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Annelies H Boekhout
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands.
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Hewison A, Atkin K, McCaughan D, Roman E, Smith A, Smith G, Howell D. Experiences of living with chronic myeloid leukaemia and adhering to tyrosine kinase inhibitors: A thematic synthesis of qualitative studies. Eur J Oncol Nurs 2020; 45:101730. [PMID: 32169687 PMCID: PMC7167512 DOI: 10.1016/j.ejon.2020.101730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the experiences of adults living with chronic myeloid leukaemia and treated with tyrosine kinase inhibitors, with particular reference to factors influencing adherence. METHODS A thematic synthesis of all published qualitative studies examining adults with chronic myeloid leukaemia, receiving tyrosine kinase inhibitors. Eligible publications were identified by searching five electronic databases using defined criteria. The synthesis involved complete coding of extracted data and inductive theme development. RESULTS Nine studies were included and three overarching themes defined. Overarching themes were: 1) Disease impacts whole life; 2) Disease management strategies; and 3) Valued aspects of care. Side-effects often required physical and psychological adaptation. Patients developed individual decision-making processes to promote adherence and manage side effects. Unintentional non-adherence occurred due to forgetfulness and system failures. Intentional omission also occurred, which together with side effects, was unlikely to be reported to healthcare professionals (HCPs). HCP reassurance about missed doses could reinforce non-adherence. Information needs varied over time and between individuals. Knowledge among patients about treatment was often lacking and could lead to misunderstandings. Patients valued psychological support from HCPs and suggested an individualised approach, facilitating discussion of symptoms, adherence and their perspectives about living with chronic myeloid leukaemia, would improve care. CONCLUSIONS Patients with chronic myeloid leukaemia experienced significant side-effects from treatment and changes to their psychological and physical well-being. They developed their own strategies to manage their disease and treatment. This should be recognised in interventions to improve education, support and the delivery of care that is compassionate and adequately resourced.
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Affiliation(s)
- Ann Hewison
- Corresponding author. ECSG, Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD, UK.
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Nijdam A, Dekker N, Aleman BMP, van 't Veer MB, Daniels LA, van der Maazen RW, Janus CPM, de Weijer RJ, Zijlstra JM, Stedema FG, Ta BD, Posthuma EFM, Manenschijn A, Dielwart MFH, Bilgin YM, van den Heuvel MJ, Boersma RS, van Leeuwen FE, Raemaekers JMM. Setting up a national infrastructure for survivorship care after treatment for Hodgkin lymphoma. Br J Haematol 2019; 186:e103-e108. [PMID: 31090916 DOI: 10.1111/bjh.15936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Annelies Nijdam
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nicky Dekker
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Berthe M P Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mars B van 't Veer
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - Laurien A Daniels
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Cecile P M Janus
- Department of Radiotherapy, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Roel J de Weijer
- Department of Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Josée M Zijlstra
- Department of Haematology, Amsterdam UMC, Location VU Medical Centre, Amsterdam, the Netherlands
| | - Floriske G Stedema
- Department of Haematology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Bastiaan D Ta
- Department of Radiotherapy, MAASTRO Clinic, Maastricht, the Netherlands
| | | | | | - Michel F H Dielwart
- Department of Radiotherapy, Zeeuws Radiotherapy Institute, Vlissingen, the Netherlands
| | - Yavuz M Bilgin
- Department of Haematology, Adrz Hospital, Goes, the Netherlands
| | | | - Rinske S Boersma
- Department of Haematology, Amphia Hospital, Breda, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - John M M Raemaekers
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
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Johnston L, Young J, Campbell K. The implementation and impact of Holistic Needs Assessments for people affected by cancer: A systematic review and thematic synthesis of the literature. Eur J Cancer Care (Engl) 2019; 28:e13087. [DOI: 10.1111/ecc.13087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Lucy Johnston
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
| | - Jenny Young
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
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15
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Heuser C, Halbach S, Kowalski C, Enders A, Pfaff H, Ernstmann N. Sociodemographic and disease-related determinants of return to work among women with breast cancer: a German longitudinal cohort study. BMC Health Serv Res 2018; 18:1000. [PMID: 30594181 PMCID: PMC6311058 DOI: 10.1186/s12913-018-3768-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/26/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Return to work (RTW) is a key parameter of outcome quality that ensures social participation. Therefore, this study analyses the sociodemographic and disease-related determinants of RTW among newly diagnosed breast cancer patients. METHODS In a prospective, multicentre cohort study, breast cancer patients were surveyed three times: directly after surgery, after 10 weeks, and after 40 weeks. Logistic regression analysis was applied to estimate the association of RTW at 40 weeks following discharge with sociodemographic and disease-related characteristics (n = 577). RESULTS The sociodemographic variables "entrance certificate at a university of applied science" compared to "university entrance certificate" (OR = 3.1, 95%-CI = 1.2-8.1), age group "55-59 years" compared to "18-44 years" (OR = 3.2, 95%-CI = 1.2-8.4) and "having children" (OR = 2.8, 95%-CI = 1.2-6.2) as well as the disease-related variables "rehabilitation" (OR = 0.5, 95%-CI = 0.3-0.9), self-rated health "good" and "excellent" compared to "bad" (OR = 2.7, 95%-CI = 1.4-5.5; OR = 11.6, 95%-CI = 4.2-31.8) and the UICC-classification "stage II" and "stage III/IV" in comparison to "stage 0/I" (OR = 0.5, 95%-CI = 0.3-0.8; OR = 0.2, 95%-CI = 0.1-0.5) significantly affect RTW among breast cancer patients (Nagelkerke's Pseudo-R2 = 0.275). CONCLUSIONS The findings show that significant differences in RTW exist between patient groups and suggest that RTW issues must be addressed more effectively before, during and after treatment. For future research on RTW in Germany, longitudinal studies with a follow-up of several years are necessary. Information and support deficits should be tackled by social services or breast care nurses. TRIAL REGISTRATION Database Health Services Research, VfD_PIAT_12_001630 , registered 01.03.2012.
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Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Christoph Kowalski
- German Cancer Society e.V. (DKG), Department for Certification, Kuno-Fischer-Straße 8, 14057 Berlin, Germany
| | - Anna Enders
- The Federal Centre for Health Education (BZgA), Department for Research and Quality Management, Maarweg 149-161, 50825 Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology,Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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16
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Lemanska A, Dearnaley DP, Jena R, Sydes MR, Faithfull S. Older Age, Early Symptoms and Physical Function are Associated with the Severity of Late Symptom Clusters for Men Undergoing Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:334-345. [PMID: 29459102 PMCID: PMC5952898 DOI: 10.1016/j.clon.2018.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/15/2017] [Accepted: 12/22/2017] [Indexed: 12/21/2022]
Abstract
AIMS To identify symptom clusters and predisposing factors associated with long-term symptoms and health-related quality of life after radiotherapy in men with prostate cancer. MATERIALS AND METHODS Patient-reported outcomes (PROs) data from the Medical Research Council RT01 radiotherapy with neoadjuvant androgen deprivation therapy trial of 843 patients were used. PROs were collected over 5 years with the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI) and the 36 item Short-Form Health Survey (SF-36). Symptom clusters were explored using hierarchical cluster analysis. The association of treatment dose, baseline patient characteristics and early symptom clusters with the change in severity of PROs over 3 years was investigated with multivariate linear mixed effects models. RESULTS Seven symptom clusters of three or more symptoms were identified. The clusters were stable over time. The longitudinal profiles of symptom clusters showed the onset of acute symptoms during treatment for all symptom clusters and significant recovery by 6 months. Some clusters, such as physical health and sexual function, were adversely affected more than others by androgen deprivation therapy, and were less likely to return to pretreatment levels over time. Older age was significantly associated with decreased long-term physical function, physical health and sexual function (P < 0.001). Both baseline and acute symptom clusters were significant antecedents for impaired function and health-related quality of life at 3 years. CONCLUSIONS Men with poorer physical function and health before or during treatment were more likely to report poorer PROs at year 3. Early assessment using PROs and lifestyle interventions should be used to identify those with higher needs and provide targeted rehabilitation and symptom management.
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Affiliation(s)
- A Lemanska
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | - D P Dearnaley
- Institute of Cancer Research and Royal Marsden NHS Trust, London, UK
| | - R Jena
- Cambridge University Hospitals, Addenbrookes Hospital, Cambridge, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - S Faithfull
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Kristiansen M, Adamsen L, Piil K, Halvorsen I, Nyholm N, Hendriksen C. A three-year national follow-up study on the development of community-level cancer rehabilitation in Denmark. Scand J Public Health 2017; 47:511-518. [PMID: 29212431 DOI: 10.1177/1403494817746535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Scandinavian cancer care policies emphasise community-level rehabilitation services, but little is known about changes in service provision over time. This follow-up study explores development in these services in Danish municipalities, focusing on availability, utilisation and organisation of services, including existing opportunities and challenges. Methods: A national survey among all 98 Danish municipalities was conducted in 2013 (baseline) and repeated in 2016 (follow-up). The electronic questionnaire comprised closed- and open-ended questions. Data were analysed using descriptive statistics and content analysis. Results: A total of 93 municipalities responded (95% response rate) and the services offered primarily comprised group physical activity, dietary advice, smoking cessation and individual counselling on physical activity. The number of patients enrolled was below the estimated number needing rehabilitation in Denmark. Inequality in utilisation by ethnicity, age and gender was reported. Key challenges for the delivery of services were: inadequate referral and recruitment procedures; lack of needs assessment tools; obstacles to ensuring collaboration and referral of patients between hospitals and municipalities; and inadequate evidence on the rehabilitation's effect. Key recommendations include ensuring collaboration between municipalities; provision of diagnosis-specific group-based activities; services focusing on physical activity; and gender-specific activities directed particularly at men. Conclusions: This study, which highlights improvements in the provision of community-level cancer rehabilitation, recommends that more effort be made to ensure equality in utilisation across patient groups, improved integration of municipal-level services into cancer care trajectories, more uniform documentation of service delivery and the enforcement of patient outcomes to gradually build a more robust evidence base for community-level cancer rehabilitation.
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Affiliation(s)
| | - Lis Adamsen
- 1 Department of Public Health, University of Copenhagen, Denmark.,2 The University Hospitals Centre for Health Research (UCSF) and Center for Integrated Rehabilitation for Cancer Patients (CIRE), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Karin Piil
- 2 The University Hospitals Centre for Health Research (UCSF) and Center for Integrated Rehabilitation for Cancer Patients (CIRE), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ida Halvorsen
- 1 Department of Public Health, University of Copenhagen, Denmark
| | - Nanna Nyholm
- 1 Department of Public Health, University of Copenhagen, Denmark
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Sakai H, Katsumata N, Takahashi M. Providing written information increases patient satisfaction: a web-based questionnaire survey of Japanese cancer survivors. Jpn J Clin Oncol 2017; 47:611-617. [PMID: 28369566 DOI: 10.1093/jjco/hyx043] [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] [Received: 11/01/2016] [Accepted: 03/08/2017] [Indexed: 12/22/2022] Open
Abstract
Purpose The Institute of Medicine (IOM) of the United States recommends that all cancer survivors be provided with a survivorship care plan (SCP), which includes a patient treatment summary and a follow-up care plan. However, SCPs have not been widely adopted in Japan. To provide basic data necessary for implementing SCPs in Japan, we aimed to investigate the forms of clinical and survivorship-related information that Japanese cancer survivors receive from their healthcare providers, and to examine whether written information increases their satisfaction. Methods We performed a cross-sectional online survey of cancer survivors who underwent acute cancer treatment and had at least one follow-up with a physician in the past year. Cancer survivors provided the elements and forms (verbally and/or written) of information they received, as well as the degree of satisfaction with the information provided. Results Responses were obtained from 545 cancer survivors. Information elements such as surgical procedure (98.3%), surgical outcome (98.1%), and names of administered chemotherapy agents (97.8%) were commonly provided, whereas mental care resources and providers (29.7%), effects on marital relationship and sexual health (35.7%), and effects on fertility (43.4%) were less common. A large proportion of cancer survivors received verbal information only. For 18 of 20 elements, except for effects on fertility and duration of hormonal therapy, satisfaction was significantly higher when both forms of information were provided (P < 0.05). Conclusions Providing written and verbal explanations of clinical and survivorship-related information can better meet the needs of Japanese cancer survivors.
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Affiliation(s)
- Hitomi Sakai
- Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital
| | - Noriyuki Katsumata
- Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital
| | - Miyako Takahashi
- Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center, Japan
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Altschuler A, Liljestrand P, Grant M, Hornbrook MC, Krouse RS, McMullen CK. Caregiving and mutuality among long-term colorectal cancer survivors with ostomies: qualitative study. Support Care Cancer 2017; 26:529-537. [PMID: 28844086 DOI: 10.1007/s00520-017-3862-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The cancer caregiving literature focuses on the early phases of survivorship, but caregiving can continue for decades when cancer creates disability. Survivors with an ostomy following colorectal cancer (CRC) have caregiving needs that may last decades. Mutuality has been identified as a relationship component that can affect caregiving. This paper discusses how mutuality may affect long-term ostomy caregiving. METHODS We conducted semi-structured, in-depth interviews with 31 long-term CRC survivors with ostomies and their primary informal caregivers. Interviewees were members of an integrated health care delivery system in the USA. We used inductive theme analysis techniques to analyze the interviews. RESULTS Most survivors were 71 years of age or older (67%), female (55%), and with some college education (54%). Two thirds lived with and received care from spouses. Caregiving ranged from minimal support to intimate assistance with daily ostomy care. While some survivors received caregiving far beyond what was needed, others did not receive adequate caregiving for their health care needs. Low mutuality created challenges for ostomy caregiving. CONCLUSIONS Mutuality impacts the quality of caregiving, and this quality may change over time, depending on various factors. Emotional feedback and amplification is the proposed mechanism by which mutuality may shift over time. Survivorship care should include assessment and support of mutuality as a resource to enhance health outcomes and quality of life for survivors with long-term caregiving needs and their caregivers. Appropriate questionnaires can be identified or developed to assess mutuality over the survivorship trajectory.
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Affiliation(s)
- Andrea Altschuler
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Petra Liljestrand
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Marcia Grant
- City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA
| | - Mark C Hornbrook
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
| | - Robert S Krouse
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA
- Cpl. Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave., Philadelphia, PA, 19104, USA
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
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20
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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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Partner's survivorship care needs: An analysis in head and neck cancer patients. Oral Oncol 2017; 71:113-121. [PMID: 28688678 DOI: 10.1016/j.oraloncology.2017.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 06/05/2017] [Accepted: 06/15/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the number, type and predictors of unmet needs for head and neck cancer (HNC) survivors' partner's. METHODS Partners of HNC patients were invited to complete the Cancer Survivors' Partners Unmet Needs Survey (CaSPUN). Analysis determined number, proportion and factors associated with greater unmet needs using linear regression. Agreement between the unmet needs of patients and their partners was determined. RESULTS Among the 44 partners participated 29 reported ≥1 unmet need and 4 had a very high number of needs (31-35). The most common unmet needs were related to concerns about cancer returning, coping with supporting someone with cancer, and the changes cancer has caused. The highest reported needs were in the Relationships domain. Increasing patient unmet needs was significantly associated with increasing partner unmet needs (p<0.01). CONCLUSIONS A significant proportion of head and neck cancer partners experience unmet needs, which often differ from the patient's needs.
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Survivorship care for postmenopausal breast cancer patients in Ireland: What do women want ? Eur J Oncol Nurs 2017; 28:69-76. [DOI: 10.1016/j.ejon.2017.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 11/21/2022]
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Singh K, Warnock C, Ireson J, Strickland S, Short D, Seckl M, Hancock B. Experiences of Women With Gestational Trophoblastic Neoplasia Treated With
High-Dose Chemotherapy and Stem Cell Transplantation: A Qualitative Study. Oncol Nurs Forum 2017. [DOI: 10.1188/17.onf.375-383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Edwards D, Anstey S, Kelly D, Ballie J, Hopkinson J. What is important for student nurses to know about cancer treatment and care: a qualitative study of student nurses' and stakeholder perspectives. J Clin Nurs 2017; 26:2045-2054. [DOI: 10.1111/jocn.13616] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Deborah Edwards
- School of Healthcare Sciences; College of Biomedical and Life Sciences; Cardiff University; Cardiff UK
| | - Sally Anstey
- School of Healthcare Sciences; College of Biomedical and Life Sciences; Cardiff University; Cardiff UK
| | - Daniel Kelly
- School of Healthcare Sciences; College of Biomedical and Life Sciences; Cardiff University; Cardiff UK
| | - Jessica Ballie
- School of Healthcare Sciences; College of Biomedical and Life Sciences; Cardiff University; Cardiff UK
| | - Jane Hopkinson
- School of Healthcare Sciences; College of Biomedical and Life Sciences; Cardiff University; Cardiff UK
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Polo KM, Smith C. Taking Our Seat at the Table: Community Cancer Survivorship. Am J Occup Ther 2017; 71:7102100010p1-7102100010p5. [DOI: 10.5014/ajot.2017.020693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Cancer survivors are at risk for occupational performance issues related to activities of daily living, instrumental activities of daily living, work, and social and community participation. Occupational therapy practitioners can address these performance issues by offering services within existing community cancer survivorship programs that focus on adaptive and compensatory strategies to facilitate meaningful lifestyles and optimize health and well-being. Occupational therapy services do not currently exist at these community sites, nor are occupational therapy practitioners recognized as providers in existing community cancer survivorship programs. Recognition of practitioners’ distinct value in cancer survivorship, advocacy for occupational therapy services in the community, development of supporting documentation for occupational therapy’s role in community survivorship, and research on the efficacy of interventions in community cancer survivorship are needed to expand occupational therapy’s role with this growing population.
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Affiliation(s)
- Katie M. Polo
- Katie M. Polo, DHS, OTR/L, CLT-LANA, is Assistant Professor, College of Health Sciences, School of Occupational Therapy, University of Indianapolis, Indianapolis, IN. At the time of writing, she was Assistant Professor, Occupational Therapy Program, Midwestern University, Downers Grove, IL;
| | - Caitlin Smith
- Caitlin Smith, OTD, OTR/L, is Occupational Therapist, PhysioPartners, Chicago, IL
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Abstract
BACKGROUND Patients with cancer are living longer with their disease and have improved survival rates because of early detection and more effective cancer treatments. Lifestyle modification and exercise improve clinical outcomes in breast cancer survivors. OBJECTIVES Exercise has important implications for the survivor and should be integrated into the aftercare trajectory of survivorship. METHODS A literature review of articles published from 2002-2014 was conducted using the key words cancer survivor, survivorship, breast cancer, collaboration, and exercise. PubMed, Cochrane Database of Systematic Reviews, and CINAHL® databases were searched. FINDINGS Nurse practitioners can build an environment to motivate patients to exercise, empowering them to be active participants in their own survivorship care. Collaboration is necessary to ensure that healthy lifestyle choices, including exercise, are being discussed and implemented in survivorship care plans to help optimize patient outcomes.
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Halpern MT, McCabe MS, Burg MA. The Cancer Survivorship Journey: Models of Care, Disparities, Barriers, and Future Directions. Am Soc Clin Oncol Educ Book 2017; 35:231-9. [PMID: 27249703 DOI: 10.1200/edbk_156039] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although the number of long-term cancer survivors has increased substantially over past years, the journey of survivorship does not always include high-quality, patient-centered care. A variety of survivorship care models have evolved based on who provides this care, the survivor population, the site of care, and/or the capacity for delivering specific services. Other areas of survivorship care being explored include how long follow-up care is needed, application of a risk-based approach to survivorship care, and the role of the survivor in his or her own recovery. However, there is little evidence indicating whether any models improve clinical or patient-reported outcomes. A newer focus in survivorship care has included assessment of potential disparities; the sociodemographic characteristics of population subgroups associated with barriers to receiving high-quality cancer treatment may also affect the survivorship period. Developing policies and programs to address disparities in survivorship care is not simple, and examining how financial hardship affects cancer outcomes, reducing economic barriers to care, and increasing incorporation of patient-centered strategies may be important components. Here too, there is little evidence regarding the best strategies to address these disparities. Barriers to providing high-quality, patient-centered survivorship care include lack of evidence, lack of a trained survivorship workforce, lack of reimbursement structures/insurance coverage, and lack of a health care system that reduces fragmented care. Future research needs to focus on developing a survivorship care evidence base, exploring strategies to facilitate provision of survivorship care, and disseminating best survivorship care practices to diverse and international audiences.
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Affiliation(s)
- Michael T Halpern
- From the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; University of Central Florida School of Social Work, Orlando, FL
| | - Mary S McCabe
- From the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; University of Central Florida School of Social Work, Orlando, FL
| | - Mary Ann Burg
- From the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; University of Central Florida School of Social Work, Orlando, FL
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Protagonismo del paciente y papel de los médicos en el seguimiento a largo plazo de los supervivientes del cáncer infantil. Med Clin (Barc) 2016; 147:511-515. [DOI: 10.1016/j.medcli.2016.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/15/2022]
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Hashmi SK, Bredeson C, Duarte RF, Farnia S, Ferrey S, Fitzhugh C, Flowers MED, Gajewski J, Gastineau D, Greenwald M, Jagasia M, Martin P, Rizzo JD, Schmit-Pokorny K, Majhail NS. National Institutes of Health Blood and Marrow Transplant Late Effects Initiative: The Healthcare Delivery Working Group Report. Biol Blood Marrow Transplant 2016; 23:717-725. [PMID: 27713091 DOI: 10.1016/j.bbmt.2016.09.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 09/30/2016] [Indexed: 12/16/2022]
Abstract
Hematopoietic cell transplantation (HCT) survivors are at risk for development of late complications and require lifelong monitoring for screening and prevention of late effects. There is an increasing appreciation of the issues related to healthcare delivery and coverage faced by HCT survivors. The 2016 National Institutes of Health Blood and Marrow Transplant Late Effects Initiative included an international and broadly representative Healthcare Delivery Working Group that was tasked with identifying research gaps pertaining to healthcare delivery and to identify initiatives that may yield a better understanding of the long-term value and costs of care for HCT survivors. There is a paucity of literature in this area. Critical areas in need of research include pilot studies of novel and information technology supported models of care delivery and coverage for HCT survivors along with development and validation of instruments that capture patient-reported outcomes. Investment in infrastructure to support this research, such as linkage of databases including electronic health records and routine inclusion of endpoints that will inform analyses focused around care delivery and coverage, is required.
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Affiliation(s)
| | - Christopher Bredeson
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Rafael F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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Wiedenbein L, Kristiansen M, Adamsen L, Hjort D, Hendriksen C. Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark. Acta Oncol 2016; 55:705-11. [PMID: 26808254 DOI: 10.3109/0284186x.2015.1131332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Systematic assessments of cancer patients' rehabilitation needs are a prerequisite for devising appropriate survivorship programs. Little is known about the fit between needs assessment outlined in national rehabilitation policies and clinical practice. This study aimed to explore clinical practices related to identification and documentation of rehabilitation needs among patients with colorectal cancer at Danish hospitals. Material and methods A retrospective clinical audit was conducted utilizing data from patient files randomly selected at surgical and oncology hospital departments treating colorectal cancer patients. Forty patients were included, 10 from each department. Semi-structured interviews were carried out among clinical nurse specialists. Audit data was analyzed using descriptive statistics, qualitative data using thematic analysis. Results Documentation of physical, psychological and social rehabilitation needs initially and at end of treatment was evident in 10% (n = 2) of surgical patient trajectories and 35% (n = 7) of oncology trajectories. Physical rehabilitation needs were documented among 90% (n = 36) of all patients. Referral to municipal rehabilitation services was documented among 5% (n = 2) of all patients. Assessments at surgical departments were shaped by the inherent continuous assessment of rehabilitation needs within standardized fast-track colorectal cancer surgery. In contrast, the implementation of locally developed assessment tools inspired by the distress thermometer (DT) in oncology departments was challenged by a lack of competencies and funding, impeding integration of data into patient files. Conclusion Consensus must be reached on how to ensure more systematic, comprehensive assessments of rehabilitation needs throughout clinical cancer care. Fast-track surgery ensures systematic documentation of physical needs, but the lack of inclusion of data collected by the DT in oncological departments questions the efficacy of assessment tools and points to a need for distinguishing between surgical and oncological settings in national rehabilitation policies.
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Affiliation(s)
- Liza Wiedenbein
- Rigshospitalet, The University Hospitals Centre for Health Research (UCSF), Copenhagen, Denmark
| | - Maria Kristiansen
- Section for Health Services Research, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lis Adamsen
- Rigshospitalet, The University Hospitals Centre for Health Research (UCSF), Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Dorte Hjort
- Section for Surgical Pathophysiology, Rigshospitalet and Glostrup Hospital, Copenhagen, Denmark
| | - Carsten Hendriksen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Giuliani M, McQuestion M, Jones J, Papadakos J, Le LW, Alkazaz N, Cheng T, Waldron J, Catton P, Ringash J. Prevalence and nature of survivorship needs in patients with head and neck cancer. Head Neck 2016; 38:1097-103. [PMID: 26894614 DOI: 10.1002/hed.24411] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/08/2015] [Accepted: 12/29/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the number, type, and predictors of patients with head and neck cancer unmet survivorship needs. METHODS This study accrued patients with head and neck cancer at any time point in their survivorship course, and they completed a survey, including demographic information and the Cancer Survivors' Unmet Needs Measure (CaSUN). RESULTS The median age of the 158 participants was 64 years. Ninety-six patients (61%) reported at least one unmet need on the CaSUN and 6 patients had a very high number of needs between 31 and 35. The mean number of unmet needs was 5.8 ± 8.9. Comprehensive Cancer Care was the most common domain of unmet need (n = 69; 45%). Younger age, earlier survivorship phase, and worse quality of life were associated with increased survivorship unmet needs on multivariable analysis. CONCLUSION A high proportion of patients with head and neck cancer have unmet needs. These data can guide the development of head and neck survivorship programs. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1097-1103, 2016.
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Affiliation(s)
- Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Maurene McQuestion
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jennifer Jones
- Cancer Survivorship Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Janet Papadakos
- Patient and Survivorship Education, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nour Alkazaz
- Cancer Survivorship Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Terry Cheng
- Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Pamela Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Faithfull S, Samuel C, Lemanska A, Warnock C, Greenfield D. Self-reported competence in long term care provision for adult cancer survivors: A cross sectional survey of nursing and allied health care professionals. Int J Nurs Stud 2016; 53:85-94. [DOI: 10.1016/j.ijnurstu.2015.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/17/2015] [Accepted: 09/01/2015] [Indexed: 01/05/2023]
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Taylor K, Monterosso L. Survivorship Care Plans and Treatment Summaries
in Adult Patients With Hematologic Cancer:
An Integrative Literature Review. Oncol Nurs Forum 2015; 42:283-91. [DOI: 10.1188/15.onf.283-291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Boekhout AH, Maunsell E, Pond GR, Julian JA, Coyle D, Levine MN, Grunfeld E. A survivorship care plan for breast cancer survivors: extended results of a randomized clinical trial. J Cancer Surviv 2015; 9:683-91. [PMID: 25896265 DOI: 10.1007/s11764-015-0443-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/18/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Prevailing wisdom suggests that implementation of a survivorship care plan (SCP) will address deficits in survivorship care planning and delivery for cancer patients. Here, we present 24-month results of a randomized clinical trial on health service and patient-reported outcomes among breast cancer patients transferred to their primary care physician for follow-up care. The 24-month assessments represent the long-term benefit and sustainability of the implantation of a SCP. METHODS In all, 408 patients with early-stage breast cancer were randomized to the SCP or control group. Patient self-completed questionnaires, supplemented with telephone interviews, during the 24-month study period assessed health service and patient-reported outcomes. The primary outcome was cancer-specific distress. Secondary outcomes included health-related quality of life, patient satisfaction, continuity and coordination of care, and health service outcomes such as adherence to guidelines. RESULTS Over the course of 24 months, there were no differences between both groups in health service and patient-reported outcomes. Women from Quebec compared to those from Western Canada (p < 0.001), women within 2 years of completion of primary treatment compared to a longer period (p = 0.013), and those with a higher SF-36 mental component score compared to a lower score (p = 0.044) were positively associated with adherence to guidelines. CONCLUSION The implementation of a SCP in the transition of survivorship care from cancer center to primary care did not contribute to improved health service or patient-reported outcomes in this study population. Therefore, additional research is needed before widespread implementation of a SCP in clinical practice. IMPLICATIONS OF CANCER SURVIVORS The transition of survivorship care from cancer center to the primary care setting showed no negative effect on health service and patient-reported outcomes.
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Affiliation(s)
- Annelies H Boekhout
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. .,Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Elizabeth Maunsell
- Center de Recherché du CHU de Québec, Québec, Québec, Canada.,Département de Médecine Sociale et Préventive, Université Laval, Québec, Québec, Canada
| | - Gregory R Pond
- Ontario Clinical Oncology Group, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jim A Julian
- Ontario Clinical Oncology Group, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Doug Coyle
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark N Levine
- Ontario Clinical Oncology Group, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Taylor K, Chan RJ, Monterosso L. Models of survivorship care provision in adult patients with haematological cancer: an integrative literature review. Support Care Cancer 2015; 23:1447-58. [PMID: 25691361 DOI: 10.1007/s00520-015-2652-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/08/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE Increasing numbers of haematology cancer survivors warrants identification of the most effective model of survivorship care to survivors from a diverse range of haematological cancers with aggressive treatment regimens. This review aimed to identify models of survivorship care to support the needs of haematology cancer survivors. METHOD An integrative literature review method utilised a search of electronic databases (CINAHL, Medline, PsycInfo, PubMed, EMBASE, PsycArticles, and Cochrane Library) for eligible articles (up to July 2014). Articles were included if they proposed or reported the use of a model of care for haematology cancer survivors. RESULTS Fourteen articles were included in this review. Eight articles proposed and described models of care, and six reported the use of a range of survivorship models of care in haematology cancer survivors. No randomised controlled trials or literature reviews were found to have been undertaken specifically with this cohort of cancer survivors. There was variation in the models described and who provided the survivorship care. CONCLUSION Due to the lack of studies evaluating the effectiveness of models of care, it is difficult to determine the best model of care for haematology cancer survivors. Many different models of care are being put into practice before robust research is conducted. Therefore, well-designed high-quality pragmatic randomised controlled trials are required to inform clinical practice.
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Affiliation(s)
- Karen Taylor
- Western Australia Cancer and Palliative Care Network, 189 Royal St., East Perth, WA, 6004, Australia,
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The psychosocial needs of gynaecological cancer survivors: A framework for the development of a complex intervention. Eur J Oncol Nurs 2015; 19:349-58. [PMID: 25697547 DOI: 10.1016/j.ejon.2015.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 12/20/2014] [Accepted: 01/20/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE To develop and pilot test an intervention targeting the women's psychosocial needs during the follow-up period after surgical treatment for gynaecological cancer. METHODS The project consisted of four phases. Phase 1 involved development of an intervention on the basis of meetings with key healthcare professionals, a literature review and six semi-structured interviews with women who attended the existing follow-up program. The Guided Self-Determination (GSD) method developed in diabetes care was identified as an appropriate framework for the intervention. GSD consists of reflection sheets for patients and advanced professional communication skills. The GSD method was adapted to women in a follow-up program after gynaecologic cancer treatment (GSD-GYN-C). Phase 2 involved primary pilot testing of the intervention and the findings were used to modify the intervention in phase 3. This modification involved the development of additional reflection sheets and a fidelity assessment tool. A systematic training program was arranged for the GSD-GYN-C-nurses. Phase 4 involved secondary pilot testing where nurses and women confirmed the applicability of GSD-GYN-C and final adjustments were made. Selected measurements were tested for sensitivity during pilot testing. Data from phase 2 and 4 were also used to select the primary outcome and calculate power for a future randomized clinical trial (RCT). RESULTS Pilot testing supported our hypothesis that GSD-GYN-C may be transferable and useful to survivors of gynaecological cancer. CONCLUSION GSD-GYN-C was developed and validated and is now ready for evaluation in an RCT.
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Cox A, Faithfull S. Aiding a reassertion of self: a qualitative study of the views and experiences of women with ovarian cancer receiving long-term nurse-led telephone follow-up. Support Care Cancer 2015; 23:2357-64. [PMID: 25588575 DOI: 10.1007/s00520-014-2578-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study explored the views and experiences of women following treatment for ovarian cancer who had received long-term (at least 3 years) nurse-led telephone follow-up. Exploring the long-term experiences of follow-up for women with ovarian cancer provides important information regarding the coping processes of cancer survivors that can inform the development of innovative and patient-centred approaches of cancer follow-up. METHODS This is a qualitative study approach using interpretative phenomenological analysis (IPA). Eleven women were identified by a clinical nurse specialist as having received nurse-led telephone follow-up for a period of at least 3 years. These women were interviewed in person or over the telephone using a semi-structured interview schedule; interviews were audio-recorded and transcriptions were analysed using IPA. RESULTS Nurse-led telephone follow-up was felt to support a reassertion of self and a rejection of patient identity. Three core themes emerged regarding the positive impact of nurse-led telephone follow-up: 'Somebody was looking out for me' highlights the perception of increased psychosocial support; 'It's just reassurance' includes both the deep trust in the expertise of the nurse and the reassurance of the continued blood tests; and 'Time was never an issue' presents the perception of relaxed follow-up appointments with time to talk and the perceived practical benefits of this approach. CONCLUSIONS Nurse-led telephone follow-up was broadly recommended for women following treatment for ovarian cancer, particularly for those later on in the survivorship trajectory when focus may move from biomedical aspects of cure to holistic approaches to well-being. Remote interventions which provide a perception of a consistent and constant source of medical and psychosocial support may support adaption to cancer survivorship by enabling a reassertion of self and a rejection of patient identity.
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Affiliation(s)
- Anna Cox
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK,
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Yu XQ, De Angelis R, Luo Q, Kahn C, Houssami N, O'Connell DL. A population-based study of breast cancer prevalence in Australia: predicting the future health care needs of women living with breast cancer. BMC Cancer 2014; 14:936. [PMID: 25494610 PMCID: PMC4295409 DOI: 10.1186/1471-2407-14-936] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/06/2014] [Indexed: 11/18/2022] Open
Abstract
Background Breast cancer places a heavy burden on the Australian healthcare system, but information about the actual number of women living with breast cancer and their current or future health service needs is limited. We used existing population-based data and innovative statistical methods to address this critical research question in a well-defined geographic region. Methods Breast cancer data from the New South Wales (NSW) Central Cancer Registry and PIAMOD (Prevalence and Incidence Analysis MODel) software were used to project future breast cancer prevalence in NSW. Parametric models were fitted to incidence and survival data, and the modelled incidence and survival estimates were then used to estimate current and future prevalence. To estimate future healthcare requirements the projected prevalence was then divided into phases of care according to the different stages of the survivorship trajectory. Results The number of women in NSW living with a breast cancer diagnosis had increased from 19,305 in 1990 to 48,754 in 2007. This number is projected to increase further to 68,620 by 2017. The majority of these breast cancer survivors will require continued monitoring (31,974) or will be long-term survivors (29,785). About 9% will require active treatment (either initial therapy, or treatment for subsequent metastases or second cancer) and 1% will need end of life care due to breast cancer. Conclusions Extrapolating these projections to the national Australian population would equate to 209,200 women living with breast cancer in Australia in 2017, many of whom will require active treatment or post-treatment monitoring. Thus, careful planning and development of a healthcare system able to respond to this increased demand is required. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-936) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xue Qin Yu
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.
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Coyle D, Grunfeld E, Coyle K, Pond G, Julian JA, Levine MN. Cost Effectiveness of a Survivorship Care Plan for Breast Cancer Survivors. J Oncol Pract 2014; 10:e86-92. [DOI: 10.1200/jop.2013.001142] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors conclude that this survivorship care plan would be costly to introduce and would not be a cost-effective use of scarce health care resources.
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Affiliation(s)
- Doug Coyle
- University of Ottawa; Ottawa Hospital Research Institute; Applied Health Economics Research Unit, Ottawa; Ontario Institute for Cancer Research; University of Toronto, Toronto; Ontario Clinical Oncology Group; McMaster University; and Juravinski Regional Cancer Centre, Hamilton, Ontario, Canada
| | - Eva Grunfeld
- University of Ottawa; Ottawa Hospital Research Institute; Applied Health Economics Research Unit, Ottawa; Ontario Institute for Cancer Research; University of Toronto, Toronto; Ontario Clinical Oncology Group; McMaster University; and Juravinski Regional Cancer Centre, Hamilton, Ontario, Canada
| | - Kathryn Coyle
- University of Ottawa; Ottawa Hospital Research Institute; Applied Health Economics Research Unit, Ottawa; Ontario Institute for Cancer Research; University of Toronto, Toronto; Ontario Clinical Oncology Group; McMaster University; and Juravinski Regional Cancer Centre, Hamilton, Ontario, Canada
| | - Gregory Pond
- University of Ottawa; Ottawa Hospital Research Institute; Applied Health Economics Research Unit, Ottawa; Ontario Institute for Cancer Research; University of Toronto, Toronto; Ontario Clinical Oncology Group; McMaster University; and Juravinski Regional Cancer Centre, Hamilton, Ontario, Canada
| | - Jim A. Julian
- University of Ottawa; Ottawa Hospital Research Institute; Applied Health Economics Research Unit, Ottawa; Ontario Institute for Cancer Research; University of Toronto, Toronto; Ontario Clinical Oncology Group; McMaster University; and Juravinski Regional Cancer Centre, Hamilton, Ontario, Canada
| | - Mark N. Levine
- University of Ottawa; Ottawa Hospital Research Institute; Applied Health Economics Research Unit, Ottawa; Ontario Institute for Cancer Research; University of Toronto, Toronto; Ontario Clinical Oncology Group; McMaster University; and Juravinski Regional Cancer Centre, Hamilton, Ontario, Canada
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Affiliation(s)
| | | | | | - Craig Earle
- Institute for Clinical Evaluative Sciences; University of Toronto, Toronto, Ontario, Canada
| | - Patricia A. Ganz
- Jonsson Comprehensive Cancer Center, Fielding School of Public Health, and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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