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van den Oever SR, de Beijer IAE, Kremer LCM, Alfes M, Balaguer J, Bardi E, Nieto AC, Cangioli G, Charalambous E, Chronaki C, Costa T, Degelsegger A, Düster V, Filbert AL, Grabow D, Gredinger G, Gsell H, Haupt R, van Helvoirt M, Ladenstein R, Langer T, Laschkolnig A, Muraca M, Rascon J, Schreier G, Tomasikova Z, Tormo MT, Trinkunas J, Trollip J, Trunner K, Uyttebroeck A, van der Pal HJH, Pluijm SMF. Barriers and facilitators to implementation of the interoperable Survivorship Passport (SurPass) v2.0 in 6 European countries: a PanCareSurPass online survey study. J Cancer Surviv 2024; 18:928-940. [PMID: 36808389 DOI: 10.1007/s11764-023-01335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/09/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) is essential to improve and maintain their quality of life. The Survivorship Passport (SurPass) is a digital tool which can aid in the delivery of adequate LTFU care. During the European PanCareSurPass (PCSP) project, the SurPass v2.0 will be implemented and evaluated at six LTFU care clinics in Austria, Belgium, Germany, Italy, Lithuania and Spain. We aimed to identify barriers and facilitators to the implementation of the SurPass v2.0 with regard to the care process as well as ethical, legal, social and economical aspects. METHODS An online, semi-structured survey was distributed to 75 stakeholders (LTFU care providers, LTFU care program managers and CCSs) affiliated with one of the six centres. Barriers and facilitators identified in four centres or more were defined as main contextual factors influencing implementation of SurPass v2.0. RESULTS Fifty-four barriers and 50 facilitators were identified. Among the main barriers were a lack of time and (financial) resources, gaps in knowledge concerning ethical and legal issues and a potential increase in health-related anxiety in CCSs upon receiving a SurPass. Main facilitators included institutions' access to electronic medical records, as well as previous experience with SurPass or similar tools. CONCLUSIONS We provided an overview of contextual factors that may influence SurPass implementation. Solutions should be found to overcome barriers and ensure effective implementation of SurPass v2.0 into routine clinical care. IMPLICATIONS FOR CANCER SURVIVORS These findings will be used to inform on an implementation strategy tailored for the six centres.
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Affiliation(s)
- Selina R van den Oever
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Ismay A E de Beijer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Julia Balaguer
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | | | | | | | | | | | | | - Vanessa Düster
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Anna-Liesa Filbert
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Desiree Grabow
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | | | | | - Ruth Ladenstein
- St. Anna Children's Hospital, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Thorsten Langer
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Lubeck, Germany
| | | | | | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | | | - Justas Trinkunas
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jessica Trollip
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | | | - Anne Uyttebroeck
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Lubeck, Germany
| | - Helena J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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2
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de Beijer IAE, van den Oever SR, Charalambous E, Cangioli G, Balaguer J, Bardi E, Alfes M, Cañete Nieto A, Correcher M, Pinto da Costa T, Degelsegger-Márquez A, Düster V, Filbert AL, Grabow D, Gredinger G, Gsell H, Haupt R, van Helvoirt M, Ladenstein R, Langer T, Laschkolnig A, Muraca M, Pluijm SMF, Rascon J, Schreier G, Tomášikova Z, Trauner F, Trinkūnas J, Trunner K, Uyttebroeck A, Kremer LCM, van der Pal HJH, Chronaki C. IT-Related Barriers and Facilitators to the Implementation of a New European eHealth Solution, the Digital Survivorship Passport (SurPass Version 2.0): Semistructured Digital Survey. J Med Internet Res 2024; 26:e49910. [PMID: 38696248 PMCID: PMC11099813 DOI: 10.2196/49910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/24/2023] [Accepted: 02/28/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND To overcome knowledge gaps and optimize long-term follow-up (LTFU) care for childhood cancer survivors, the concept of the Survivorship Passport (SurPass) has been invented. Within the European PanCareSurPass project, the semiautomated and interoperable SurPass (version 2.0) will be optimized, implemented, and evaluated at 6 LTFU care centers representing 6 European countries and 3 distinct health system scenarios: (1) national electronic health information systems (EHISs) in Austria and Lithuania, (2) regional or local EHISs in Italy and Spain, and (3) cancer registries or hospital-based EHISs in Belgium and Germany. OBJECTIVE We aimed to identify and describe barriers and facilitators for SurPass (version 2.0) implementation concerning semiautomation of data input, interoperability, data protection, privacy, and cybersecurity. METHODS IT specialists from the 6 LTFU care centers participated in a semistructured digital survey focusing on IT-related barriers and facilitators to SurPass (version 2.0) implementation. We used the fit-viability model to assess the compatibility and feasibility of integrating SurPass into existing EHISs. RESULTS In total, 13/20 (65%) invited IT specialists participated. The main barriers and facilitators in all 3 health system scenarios related to semiautomated data input and interoperability included unaligned EHIS infrastructure and the use of interoperability frameworks and international coding systems. The main barriers and facilitators related to data protection or privacy and cybersecurity included pseudonymization of personal health data and data retention. According to the fit-viability model, the first health system scenario provides the best fit for SurPass implementation, followed by the second and third scenarios. CONCLUSIONS This study provides essential insights into the information and IT-related influencing factors that need to be considered when implementing the SurPass (version 2.0) in clinical practice. We recommend the adoption of Health Level Seven Fast Healthcare Interoperability Resources and data security measures such as encryption, pseudonymization, and multifactor authentication to protect personal health data where applicable. In sum, this study offers practical insights into integrating digital health solutions into existing EHISs.
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Affiliation(s)
| | | | - Eliana Charalambous
- Health Level Seven Europe, Brussels, Belgium
- Venizeleio General Hospital of Heraklion, Heraklion, Greece
| | | | - Julia Balaguer
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Marie Alfes
- Childhood Cancer International Europe, Vienna, Austria
| | | | | | | | | | - Vanessa Düster
- Department of Studies and Statistics for Integrated Research and Projects, St Anna Children's Cancer Research Institute, Vienna, Austria
| | - Anna-Liesa Filbert
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Hannah Gsell
- Childhood Cancer International Europe, Vienna, Austria
| | - Riccardo Haupt
- Diagnosi, Osservazione, Prevenzione dopo trattamento Oncologico Clinic, Department of Hematology/Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genova, Italy
| | - Maria van Helvoirt
- University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ruth Ladenstein
- St Anna Children's Hospital, Vienna, Austria
- Department of Studies and Statistics for Integrated Research and Projects, St Anna Children's Cancer Research Institute, Vienna, Austria
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Thorsten Langer
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Monica Muraca
- Diagnosi, Osservazione, Prevenzione dopo trattamento Oncologico Clinic, Department of Hematology/Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genova, Italy
| | | | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Clinics for Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Günter Schreier
- Center for Health and Bioresources, Austrian Institute of Technology, Graz, Austria
| | | | | | - Justas Trinkūnas
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Anne Uyttebroeck
- University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Filbert AL, Kremer L, Ladenstein R, Chronaki C, Degelsegger-Márquez A, van der Pal H, Bardi E, Uyttebroeck A, Langer T, Muraca M, Nieto AC, Rascon J, Bagnasco F, Beyer S, Te Dorsthorst J, Essiaf S, Galan AO, Kienesberger A, O'Brien K, Palau MC, Pluijm SMF, di Profio S, Saraceno D, Schneider C, Schreier G, Trinkūnas J, Zamberlan I, Grabow D, Haupt R. Scaling up and implementing the digital Survivorship Passport tool in routine clinical care - The European multidisciplinary PanCareSurPass project. Eur J Cancer 2024; 202:114029. [PMID: 38513384 DOI: 10.1016/j.ejca.2024.114029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Childhood cancer survivors (CCS), of whom there are about 500,000 living in Europe, are at an increased risk of developing health problems [1-6] and require lifelong Survivorship Care. There are information and knowledge gaps among CCS and healthcare providers (HCPs) about requirements for Survivorship Care [7-9] that can be addressed by the Survivorship Passport (SurPass), a digital tool providing CCS and HCPs with a comprehensive summary of past treatment and tailored recommendations for Survivorship Care. The potential of the SurPass to improve person-centred Survivorship Care has been demonstrated previously [10,11]. METHODS The EU-funded PanCareSurPass project will develop an updated version (v2.0) of the SurPass allowing for semi-automated data entry and implement it in six European countries (Austria, Belgium, Germany, Italy, Lithuania and Spain), representative of three infrastructure healthcare scenarios typically found in Europe. The implementation study will investigate the impact on person-centred care, as well as costs and processes of scaling up the SurPass. Interoperability between electronic health record systems and SurPass v2.0 will be addressed using the Health Level Seven (HL7) International interoperability standards. RESULTS PanCareSurPass will deliver an interoperable digital SurPass with comprehensive evidence on person-centred outcomes, technical feasibility and health economics impacts. An Implementation Toolkit will be developed and freely shared to promote and support the future implementation of SurPass across Europe. CONCLUSIONS PanCareSurPass is a novel European collaboration that will improve person-centred Survivorship Care for CCS across Europe through a robust assessment of the implementation of SurPass v2.0 in different healthcare settings.
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Affiliation(s)
- Anna-Liesa Filbert
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ruth Ladenstein
- St. Anna Children's Cancer Research Institute, Vienna, Austria; St Anna Children's Hospital, Vienna, Austria
| | | | | | | | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria; Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | | | - Thorsten Langer
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Germany
| | | | | | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Clinics for Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | | | - Stefan Beyer
- AIT Austrian Institute of Technology, Graz, Austria
| | | | | | | | | | | | | | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Sonia di Profio
- Clinical Psychology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | | | - Justas Trinkūnas
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Manne S, Nekhlyudov L. Introduction: The history of cancer survivorship programs in the USA: progress, challenges, and opportunities. J Cancer Surviv 2024; 18:1-4. [PMID: 38294602 DOI: 10.1007/s11764-023-01528-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Sharon Manne
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, 120 Albany Street, 8th Floor, New Brunswick, NJ, USA.
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Tan SY, Dhillon HM, Mak C, Liang R, Kerin-Ayres K, Vuong K, Malalasekera A, Vardy JL. Utility of survivorship care plans: A mixed-method study exploring general practitioners' and cancer specialists' views. Asia Pac J Clin Oncol 2023. [PMID: 38051140 DOI: 10.1111/ajco.14038] [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: 05/16/2023] [Revised: 09/22/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Survivorship care plans (SCP) are recommended as integral to survivorship care but are not routinely provided in many centers. We explore whether SCP from the Sydney Cancer Survivorship Centre (SCSC) clinic was received by general practitioners (GP) and cancer specialists, and their views on SCP. METHODS A mixed-method study comprising a quality assurance audit, a questionnaire of GP practices and GP, and semi-structured interviews of cancer specialists who referred patients to the SCSC clinic between 2019-2020. Descriptive statistics were used for quantitative data and content analysis for qualitative data. RESULTS The audit found 153/190 (80.5%) SCSC attendees had SCP uploaded to hospital medical records. The response rate from GP practices was 41%; among the 55 responding practices, 38 (69%) did not receive the SCP. The response rate from GP was 19%; among the 29 responding GP, 25 (86%) indicated the SCP was worthwhile, especially follow-up plans and multidisciplinary team recommendations. Analysis of 14 cancer specialist interviews identified themes of 1) awareness of SCP; 2) access: SCP difficult to locate; 3) process: access and distribution require improvement; 4) systemic issues; 5) content and layout: more concise and better readability required; 6) value: mainly for GP and survivors; 7) use of SCP: limited; 8) recommendations: improve delivery process, enhance layout/content, more stakeholder input, more tailored information. CONCLUSION Although response rates from GP were low, those responding perceived SCP to be useful. Cancer specialists believed SCP were more valuable for GP and survivors. Process issues, especially SCP delivery, need to be improved.
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Affiliation(s)
- Sim Yee Tan
- Concord Cancer Centre, Concord Hospital, Concord, Australia
- Nutrition and Dietetics Department, Concord Hospital, Concord, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia
| | - Channel Mak
- Nutrition and Dietetics Department, Concord Hospital, Concord, Australia
| | - Roger Liang
- Concord Cancer Centre, Concord Hospital, Concord, Australia
| | | | - Kylie Vuong
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | | | - Janette L Vardy
- Concord Cancer Centre, Concord Hospital, Concord, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia
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6
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de Beijer IAE, Hardijzer EC, Haupt R, Grabow D, Balaguer J, Bardi E, Cañete Nieto A, Ciesiūniene A, Düster V, Filbert AL, Gsell H, Kapitančukė M, Ladenstein R, Langer T, Muraca M, van den Oever SR, Prikken S, Rascon J, Tormo MT, Uyttebroeck A, Vercruysse G, van der Pal HJH, Kremer LCM, Pluijm SMF. Barriers and facilitators to the implementation of a new European eHealth solution (SurPass v2.0): the PanCareSurPass Open Space study. J Cancer Surviv 2023:10.1007/s11764-023-01498-8. [PMID: 38015382 DOI: 10.1007/s11764-023-01498-8] [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: 05/30/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To identify barriers and facilitators for implementing the Survivorship Passport (SurPass) v2.0 in six long-term follow-up (LTFU) care centres in Europe. METHODS Stakeholders including childhood cancer survivors (CCSs), healthcare providers (HCPs), managers, information and technology (IT) specialists, and others, participated in six online Open Space meetings. Topics related to Care, Ethical, Legal, Social, Economic, and Information & IT-related aspects of implementing SurPass were evaluated. RESULTS The study identified 115 barriers and 159 facilitators. The main barriers included the lack of standardised LTFU care in centres and network cooperation, uncertainty about SurPass accessibility, and uncertainty about how to integrate SurPass into electronic health information systems. The main facilitators included standardised and coordinated LTFU care in centres, allowing CCSs to conceal sensitive information in SurPass and (semi)automatic data transfer and filing. CONCLUSIONS Key barriers to SurPass implementation were identified in the areas of care, ethical considerations, and information & IT. To address these barriers and facilitate the implementation on SurPass, we have formulated 27 recommendations. Key recommendations include using the internationally developed protocols and guidelines to implement LTFU care, making clear decisions about which parties have access to SurPass data in accordance with CCSs, and facilitating (semi)automated data transfer and filing using Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR). IMPLICATIONS FOR CANCER SURVIVORS The findings of this study can help to implement SurPass and to ensure that cancer survivors receive high-quality LTFU care with access to the necessary information to manage their health effectively.
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Affiliation(s)
- Ismay A E de Beijer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Emma C Hardijzer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | | | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Balaguer
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | | | | | - Vanessa Düster
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Studies and Statistics for Integrated Research and Projects, Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Anna-Liesa Filbert
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Ruth Ladenstein
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Studies and Statistics for Integrated Research and Projects, Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Thorsten Langer
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Lübeck, Germany
| | | | - Selina R van den Oever
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Sofie Prikken
- University Hospitals Leuven, KU Leuven, Louvain, Belgium
| | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | | | - Helena J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Duggan C, Cushing-Haugen KL, Cole AM, Allen J, Gilles R, Hornecker JR, Gutierrez AI, Warner J, Scott Baker K, Ceballos RM, Chow EJ. Feasibility of delivering survivorship care via lay health educators: A pilot randomized controlled trial among rural cancer survivors. J Rural Health 2023; 39:666-675. [PMID: 36593127 PMCID: PMC10650940 DOI: 10.1111/jrh.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE We tested the feasibility of survivorship care plan (SCP) delivery with/without a lay health educator (LHE) telephone-delivered information session among rural cancer survivors, and their effects on health-related self-efficacy and knowledge of cancer history. METHODS Randomized trial of cancer survivors from 3 rural oncology clinics featuring either SCP alone (control) or SCP plus LHE-delivered information session (intervention). Participants completed a questionnaire on health-related self-efficacy and knowledge of cancer-specific medical history. Responses were compared to medical records for accuracy. SCPs were then mailed to participants. Approximately 5 months later, participants completed a follow-up questionnaire. A subset of participants took part in subsequent qualitative interviews about their study experience. FINDINGS Of 301 survivors approached, 72 (23.9%) were randomized (mean age 66.4 years; 3.1 years from diagnosis; 62.5% female), and 65 (90.3%) completed the study. Global mental and physical health or self-efficacy scores did not change significantly from baseline to follow-up for either group. In exploratory analyses, self-efficacy increased in participants with inadequate/marginal health literacy in the intervention arm (+0.7, 95% CI = 0.1-1.2; P = .01). Accuracy of knowledge did not improve but was high at baseline (mean 76.0±14.5%). 60.1% and 48.4% of control and intervention participants, respectively, found SCPs definitely/somewhat useful. Qualitative data (n = 20) suggested that SCPs were helpful to patients when primary and oncology care were less integrated. CONCLUSIONS An LHE-delivered informational session was feasible but had limited benefit to rural cancer survivors versus delivery of SCP alone but may be of benefit to patients with low health literacy or with less integrated care.
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Affiliation(s)
- Catherine Duggan
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | | | - Allison M. Cole
- Institute of Translational Health Sciences, University of Washington, Seattle, WA 98105, USA
| | | | - Ryan Gilles
- Kootenai Health, Coeur d’Alene ID 83814, USA
| | - Jaime R. Hornecker
- University of Wyoming Family Medicine Residency Program, Caspar, WY 82071, USA
| | | | - Jude Warner
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - K. Scott Baker
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Rachel M. Ceballos
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Eric J. Chow
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
- University of Washington, Seattle, Washington, USA
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8
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Swisher AK, Kennedy-Rea S, Starkey A, Duckworth A, Burkart M, Graebe G, Harper R, Yanosik MA, Hudson A. Bridging the gap: identifying and meeting the needs of lung cancer survivors. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01332-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Morken C, Tevaarwerk AJ, Juckett MB, Swiecichowski AK, Haine JE, Zhang X, Williams ZT, Norslien K, Campbell B, Wassenaar T, Sesto ME. Barriers and facilitators to the use of survivorship care plans by hematopoietic stem cell transplant survivors and clinicians. Support Care Cancer 2022; 30:1323-1330. [PMID: 34482447 PMCID: PMC8732291 DOI: 10.1007/s00520-021-06492-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/07/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Survivors of hematopoietic stem cell transplants (HSCT) have complex care needs for the remainder of their lives, known as the survivorship period. Survivorship care plans (SCPs) have been proposed to improve care coordination and ultimately survivorship outcomes. We explored the barriers and facilitators of SCP use among HSCT survivors and their clinicians in order to develop more useful SCPs for the HSCT context. METHODS Analogous surveys regarding perceived barriers to and facilitators of SCP use based on a sample SCP for a female allogenic HSCT survivor were administered to HSCT survivors and non-transplant oncology and primary care clinicians. RESULTS Twenty-seven HSCT survivors and 18 clinicians completed the survey. The main barriers to SCP use were lack of awareness of SCP existence, uncertainty regarding where to find SCP, unclear roles and responsibilities among healthcare teams, length of SCP, and difficultly understanding SCPs. The facilitators of SCP use were increased understanding of survivorship care needs, clarified roles and responsibilities of survivors and clinicians, SCPs that are readily available and searchable in electronic health record, increased awareness of SCP existence and provision to all survivors, and if the SCP is survivor-specific and up-to-date. CONCLUSIONS Much of the work regarding SCPs has looked at barriers to creation and provision; however, our study examines factors influencing use of SCPs. By determining the barriers and facilitators surrounding SCP use for HSCT survivors and their clinicians, we can create SCP templates and clinical workflows to optimize SCP use, ideally leading to better outcomes for HSCT survivors.
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Affiliation(s)
| | - Amye J Tevaarwerk
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Mark B Juckett
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | - James E Haine
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Xiao Zhang
- Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | | | | | | | - Mary E Sesto
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
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Coschi CH, Bainbridge D, Sussman J. Understanding the Attitudes and Beliefs of Oncologists Regarding the Transitioning and Sharing of Survivorship Care. Curr Oncol 2021; 28:5452-5465. [PMID: 34940093 PMCID: PMC8700375 DOI: 10.3390/curroncol28060454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 01/23/2023] Open
Abstract
Transitioning survivorship care from oncologists to primary care physicians (PCPs) is a reasonable alternative to oncologist-led care. This study assessed oncologists’ attitudes and beliefs regarding sharing/transitioning survivorship care. A prospective survey of oncologists within a regional cancer program assessing self-reported barriers and facilitators to sharing/transitioning survivorship care was disseminated. In total, 63% (n = 39) of surveyed oncologists responded. Patient preference (89%) and anxiety (84%) are key to transition of care decisions; reduced remuneration (95%) and fewer longitudinal relationships (63%) do not contribute. Oncologists agreed that more patients could be shared/transitioned. Barriers include treatment-related toxicities (82% agree), tumor-specific factors (60–90% agree) and perception of PCP willingness to participate in survivorship care (47% agree). Oncologists appear willing to share/transition more survivors to PCPs, though barriers exist that warrant further study. Understanding these issues is critical to developing policies supporting comprehensive survivorship care models that address both cancer and non-cancer health needs. The demonstrated feasibility of this project warrants a larger-scale survey of oncologists with respect to the transition of survivorship care to PCPs, to further inform effective interventions to support high-quality survivorship care.
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Affiliation(s)
- Courtney H. Coschi
- Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada;
| | - Daryl Bainbridge
- Juravinski Hospital and Cancer Centre, Department of Oncology, McMaster University, 711 Concession Street, Hamilton, ON L8V 1C3, Canada;
| | - Jonathan Sussman
- Juravinski Hospital and Cancer Centre, Department of Oncology, McMaster University, 711 Concession Street, Hamilton, ON L8V 1C3, Canada;
- Hamilton Health Sciences Juravinski Cancer Centre, 699 Concession Street, Hamilton, ON L8V 5C2, Canada
- Correspondence:
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11
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Salz T, Ostroff JS, Nightingale CL, Atkinson TM, Davidson EC, Jinna SR, Kriplani A, Lesser GJ, Lynch KA, Mayer DK, Oeffinger KC, Patil S, Salner AL, Weaver KE. The Head and Neck Survivorship Tool (HN-STAR) Trial (WF-1805CD): A protocol for a cluster-randomized, hybrid effectiveness-implementation, pragmatic trial to improve the follow-up care of head and neck cancer survivors. Contemp Clin Trials 2021; 107:106448. [PMID: 34023515 DOI: 10.1016/j.cct.2021.106448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
Survivors of head and neck cancer (HNC) can have multiple health concerns. To facilitate their care, we developed and pilot-tested a clinical informatics intervention, HN-STAR. HN-STAR elicits concerns online from HNC survivors prior to a routine oncology clinic visit. HN-STAR then presents tailored evidence-based clinical recommendations as a clinical decision support tool to be used during the visit where the oncology clinician and survivor select symptom management strategies and other actions. This generates a survivorship care plan (SCP). Online elicitation of health concerns occurs 3, 6, and 9 months after the clinic visit, generating an updated SCP each time. HN-STAR encompasses important methods of improving survivorship care (e.g., needs assessment, tailored interventions, dissemination of guidelines) and will be evaluated in a pragmatic trial to maximize external validity. This hybrid type 1 implementation-effectiveness trial tests HN-STAR effectiveness while studying barriers and facilitators to implementation in community oncology practices within the National Cancer Institute Community Oncology Research Program. Effectiveness will be measured as differences in key survivorship outcomes between HNC participants who do and do not use HN-STAR over one year after the clinic visit. The primary endpoint is HNC-specific quality of life; other outcomes include patient-centered measures and receipt of guideline-concordant care. Implementation outcomes will be assessed of survivors, providers, and clinic stakeholders. The hybrid design will provide insight into a dose-response relationship between the extent of implementation fidelity and effectiveness outcomes, as well as how to incorporate HN-STAR into standard practice outside the research setting.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Chandylen L Nightingale
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Thomas M Atkinson
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Eleanor C Davidson
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Sankeerth R Jinna
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Glenn J Lesser
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Kathleen A Lynch
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Deborah K Mayer
- University of North Carolina Lineberger Comprehensive Cancer Center, 450 West Dr, Chapel Hill, NC 27599, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, 2424 Erwin Dr, Suite 601, Durham, NC 27705, USA
| | - Sujata Patil
- The Cleveland Clinic Foundation, 9500 Euclid Avenue, CA6-160, Cleveland, OH 44195, USA
| | - Andrew L Salner
- Hartford HealthCare Cancer Institute at Hartford Hospital, 79 Retreat Ave, Hartford, CT 06106, USA
| | - Kathryn E Weaver
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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12
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Kue J, Klemanski DL, Browning KK. Evaluating Readability Scores of Treatment Summaries and Cancer Survivorship Care Plans. JCO Oncol Pract 2021; 17:615-621. [PMID: 33555930 DOI: 10.1200/op.20.00789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Treatment Summaries and Survivorship Care Plans (TS/SCPs) may be difficult for patients to comprehend because of readability, magnitude of information, and complex medical verbiage. METHODS Readability scores were calculated for TS/SCP templates including ASCO, Oncolink, Journey Forward, and the authors' institution. The Simple Measure of Gobbledygook (SMOG) index, Flesch-Kincaid reading grade level, Coleman-Liau Index, and Gunning Fog index were used to assess readability. RESULTS The Flesch-Kincaid reading ease scores for the blank ASCO templates ranged from 47.4 to 53.3, requiring a reading grade level of 10-12. Coleman-Liau and Gunning Fog scores showed that an 11th grade reading level is essential, and SMOG required a college education to comprehend the ASCO templates. For the colorectal case exemplar, Oncolink's template resulted in the lowest SMOG score (11.3; 11th grade), Flesch-Kincaid reading grade level (11; 11th grade), and Coleman-Liau score (12; 12th grade). Journey Forward's TS/SCP template scored the highest on the SMOG (21.2; college graduate), Flesch-Kincaid reading grade level (18.3; college graduate), and Gunning-Fog index (25.8; college graduate) compared with other TS/SCPs. CONCLUSION The existing TS/SCP templates used by US cancer centers are written at a grade level beyond the comprehension of most adults. Cancer care teams should assess TS/SCP content for readability and use of plain language and reduce medical jargon.
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Affiliation(s)
- Jennifer Kue
- College of Nursing, The Ohio State University, Columbus, OH
| | - Dori L Klemanski
- Cancer Support Services, The Ohio State University Comprehensive Cancer Center - James Care Hospital, Columbus, OH
| | - Kristine K Browning
- College of Nursing, The Ohio State University, Columbus, OH.,Cancer Support Services, The Ohio State University Comprehensive Cancer Center - James Care Hospital, Columbus, OH
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13
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Arem H, Duan X, Ehlers DK, Lyon ME, Rowland JH, Mama SK. Provider Discussion about Lifestyle by Cancer History: A Nationally Representative Survey. Cancer Epidemiol Biomarkers Prev 2020; 30:278-285. [PMID: 33268489 DOI: 10.1158/1055-9965.epi-20-1268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/12/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Providers are uniquely positioned to encourage health-promoting behaviors, particularly among cancer survivors where patients develop trust in providers. METHODS We utilized the National Health Interview Survey to identify adults who reported a visit to a provider in the prior year (44,385 individuals with no cancer history and 4,792 cancer survivors), and reported prevalence of provider discussions on weight loss, physical activity, diet, and smoking. We used generalized linear mixed models to examine predicted prevalence of provider lifestyle discussions by cancer history overall, and among those who do not meet body mass index (BMI), activity, or smoking guidelines. RESULTS Among those with a BMI of 25-<60 kg/m2, 9.2% of those with a cancer history and 11.6% of those without a cancer history reported being told to participate in a weight loss program (P < 0.001). Overall, 31.7% of cancer survivors and 35.3% of those with no cancer history were told to increase their physical activity (P < 0.001). Only 27.6% of cancer survivors and 32.2% of those with no cancer history reported having a general discussion of diet (P < 0.001). Among smokers, 67.3% of cancer survivors and 69.9% of those with no cancer history reported counseling on smoking (P = 0.309). CONCLUSIONS Fewer cancer survivors, who are at increased risk for health complications, are reporting provider discussions about critical lifestyle issues than those with no cancer history. IMPACT Our nationally representative results suggest that providers are missing an opportunity for influencing patient lifestyle factors, which could lead to mitigation of late and long-term effects of treatment.
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Affiliation(s)
- Hannah Arem
- Department of Epidemiology, George Washington Milken Institute School of Public Health, Washington, DC.
- George Washington Cancer Center, Washington, DC
| | - Xuejing Duan
- Department of Biostatistics, George Washington Milken Institute School of Public Health, Washington, DC
| | | | | | | | - Scherezade K Mama
- Division of Cancer Prevention and Population Sciences, Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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14
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Lo AC, Samuel V, Chen B, Savage KJ, Freeman C, Goddard K. Evaluation of the discussion of late effects and screening recommendations in survivors of adolescent and young adult (AYA) lymphoma. J Cancer Surviv 2020; 15:179-189. [PMID: 32767044 DOI: 10.1007/s11764-020-00922-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/31/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The study objective was to assess the discussion of late effects (LEs) and screening recommendations (SRs) for adolescent and young adults (AYAs) treated for lymphoma. METHODS A retrospective study was conducted on AYA lymphoma survivors aged 15-24 years at diagnosis who received radiation therapy (RT) ± chemotherapy between 1984 and 2010 at any of the six British Columbia (BC) Cancer treatment centers across the province. Charts were reviewed to evaluate discussion of LEs and SRs. Susceptibility to specific LEs was determined by reviewing treatment details. RESULTS Of 305 patients, 212 (70%) had documented discussion of at least one specific LE, 39 (13%) had non-specific documentation only, and 54 (18%) had no documented discussion of LEs. Accounting only for patients susceptible to each LEs, the most frequently discussed LEs was radiation-induced (RI) neoplasm (42%), and the least frequently discussed LEs was carotid artery stenosis (0.4%). The most common SRs discussed in susceptible patients was for RI breast cancer (43%). Of patients discharged between 1985 and 1999 vs 2000 and 2014, LEs were discussed in 63 vs 93% (P < 0.0005), and SRs were discussed in 30 vs 65%, respectively (P < 0.0005). Older age at discharge, presence of a discharge note, and occurrence of a discharge appointment were associated with increased discussion of SRs. CONCLUSIONS Most survivors of AYA lymphoma received some discussion of LEs and SRs, but each relevant LEs and SRs was discussed in only a minority of susceptible patients. IMPLICATIONS FOR CANCER SURVIVORS Survivors of AYA lymphoma and their primary care professionals may not be appropriately informed of health risks and how to screen for them.
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Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Vanessa Samuel
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ben Chen
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry J Savage
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Ciara Freeman
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Karen Goddard
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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15
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Hill RE, Wakefield CE, Cohn RJ, Fardell JE, Brierley ME, Kothe E, Jacobsen PB, Hetherington K, Mercieca‐Bebber R. Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes. Oncologist 2020; 25:e351-e372. [PMID: 32043786 PMCID: PMC7011634 DOI: 10.1634/theoncologist.2019-0184] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision. METHODS We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome. RESULTS Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects. CONCLUSION SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies. IMPLICATIONS FOR PRACTICE Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.
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Affiliation(s)
- Rebecca E. Hill
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Claire E. Wakefield
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Richard J. Cohn
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Joanna E. Fardell
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Mary‐Ellen E. Brierley
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Emily Kothe
- School of Psychology, Deakin UniversityGeelongAustralia
| | | | - Kate Hetherington
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Rebecca Mercieca‐Bebber
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of SydneyCamperdownAustralia
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16
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Swoboda CM, Fareed N, Walker DM, Huerta TR. The effect of cancer treatment summaries on patient-centered communication and quality of care for cancer survivors: A pooled cross-sectional HINTS analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:301-308. [PMID: 31477514 DOI: 10.1016/j.pec.2019.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Provision of cancer treatment summaries to patients is recommended to improve patient-centered communication (PCC). The objective of this study is to assess relationships between cancer treatment summary receipt, PCC, and quality of care (QOC). METHODS Linear and logistic regression of cross-sectional data from the Health Information National Trends Survey (HINTS) was conducted using data from years 2012, 2014, and 2017. The independent variable was receipt of treatment summary; the dependent variables were overall PCC score, six domains of PCC, and QOC. RESULTS In the pooled sample, 36.9% of patients with cancer treatment history reported receiving a treatment summary. There was a significant positive association between overall PCC score and treatment summary receipt, and higher odds of high scores for the PCC domains "responding to emotions" and "managing uncertainty." We did not observe significant associations between treatment summary receipt and other PCC domains or QOC. CONCLUSION Providing patients cancer treatment summaries may improve PCC, but fewer than half of patients reported receiving one of these summaries. PRACTICE IMPLICATIONS Providing cancer treatment summaries is important, however, providing them without engaging in additional communication may be insufficient to improve all patient-centered care domains or quality of care.
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Affiliation(s)
- Christine M Swoboda
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Naleef Fareed
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Daniel M Walker
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Timothy R Huerta
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Hohmann NS, McDaniel CC, Mason SW, Cheung WY, Williams MS, Salvador C, Graves EK, Camp CN, Chou C. Healthcare providers’ perspectives on care coordination for adults with cancer and multiple chronic conditions: a systematic review. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Natalie S. Hohmann
- Department of Pharmacy Practice Harrison School of Pharmacy Auburn University Auburn AlabamaUSA
| | - Cassidi C. McDaniel
- Health Outcomes Research and Policy Harrison School of Pharmacy Auburn University Auburn Alabama USA
| | - S. Walker Mason
- Department of Pharmacy University of North Carolina Medical Center Chapel Hill North Carolina USA
| | - Winson Y. Cheung
- Department of Oncology Tom Baker Cancer Centre Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Michelle S. Williams
- Cancer Institute and Department of Population Health Science University of Mississippi Medical Center Jackson Mississippi USA
| | - Carolina Salvador
- Division of Hematology/Oncology School of Medicine University of Alabama at Birmingham Birmingham Alabama USA
| | - Edith K. Graves
- Medical Oncology Cancer Center of East Alabama Medical Center Opelika Alabama USA
| | - Christina N. Camp
- Health Outcomes Research and Policy Harrison School of Pharmacy Auburn University Auburn Alabama USA
| | - Chiahung Chou
- Health Outcomes Research and Policy Harrison School of Pharmacy Auburn University Auburn Alabama USA
- Department of Medical Research China Medical University Hospital Taichung City Taiwan
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18
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Development of Phase-Specific Breast Cancer Survivorship Care Plans. Clin Breast Cancer 2019; 19:e723-e730. [DOI: 10.1016/j.clbc.2019.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/02/2019] [Accepted: 05/27/2019] [Indexed: 11/21/2022]
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Abstract
OPINION STATEMENT As cancer care has evolved so has the awareness of the issues cancer patients, their caregivers and families face during and after treatment, giving rise to the cancer survivorship care initiative. The body of research pertaining to quality of life, health-related quality of life, and multidimensional symptom burden of neuro-oncology patients and their caregivers has grown significantly, yielding a wealth of data and information indicating interventions and actions targeting symptoms and needs are both warranted and desired. The provision of survivorship care aiming to deliver care in a patient-centered, whole-person model offers a means by which these interventions and actions can be actualized. The research specific to survivorship care models and survivorship care plans and their delivery remains a large opportunity, one worth the careful consideration and participation of neuro-oncology healthcare providers for the benefit of their highly deserving patients and their caregivers and families.
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20
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Salz T, Schnall RB, McCabe MS, Oeffinger KC, Corcoran S, Vickers AJ, Salner AL, Dornelas E, Raghunathan NJ, Fortier E, McKiernan J, Finitsis DJ, Chimonas S, Baxi S. Incorporating Multiple Perspectives Into the Development of an Electronic Survivorship Platform for Head and Neck Cancer. JCO Clin Cancer Inform 2019; 2:1-15. [PMID: 30652547 DOI: 10.1200/cci.17.00105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To improve the care of survivors of head and neck cancer, we developed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR). HN-STAR is an electronic platform that incorporates patient-reported outcomes into a clinical decision support tool for use at a survivorship visit. Selections in the clinical decision support tool automatically populate a survivorship care plan (SCP). We aimed to refine HN-STAR by eliciting and incorporating feedback on its ease of use and usefulness. METHODS Human-computer interaction (HCI) experts reviewed HN-STAR using think-aloud testing and the Nielsen Heuristic Checklist. Nurse practitioners (NPs) thought aloud while reviewing the clinical decision support tool and SCP and responded to an interview. Survivors used HN-STAR as part of a routine visit and were interviewed afterward. We analyzed themes from the feedback. We described how we addressed each theme to improve the usability of HN-STAR. RESULTS Five HCI experts, 10 NPs, and 10 cancer survivors provided complementary usability insight that we categorized into themes of improvements. For ease of use, themes included technical design considerations to enhance user interface, ease of completion of a self-assessment, streamlining text, disruption of the clinic visit, and threshold for symptoms to appear on the SCP. The theme addressing usefulness was efficiency and comprehensiveness of the clinic visit. For each theme, we report revisions to HN-STAR in response to the feedback. CONCLUSION HCI experts provided key technical design insights into HN-STAR, whereas NPs and survivors provided usability feedback and clinical perspectives. We incorporated the feedback into the preparation for additional testing of HN-STAR. This method can inform and improve the ease of use and usefulness of the survivorship applications.
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Affiliation(s)
- Talya Salz
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Rebecca B Schnall
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Mary S McCabe
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Kevin C Oeffinger
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Stacie Corcoran
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew J Vickers
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew L Salner
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Ellen Dornelas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Nirupa J Raghunathan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Elizabeth Fortier
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Janet McKiernan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - David J Finitsis
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Susan Chimonas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Shrujal Baxi
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
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Rosenberg SM, Ligibel JA, Meyerhardt JA, Jacobsen ED, Garber JE, Nekhlyudov L, Bunnell CA, Nutting P, Sprunck-Harrild K, Walsh SK, Partridge AH. Developing a Novel Model to Improve Research and care for Cancer Survivors: a Feasibility Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:229-233. [PMID: 29052110 PMCID: PMC5910291 DOI: 10.1007/s13187-017-1291-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite a growing number of clinical trials and supportive care programs for cancer survivors, recruitment of patients for these opportunities during the survivorship phase of care is challenging. We piloted a novel process to systematically educate patients about available research studies and supportive care programs as part of a survivorship care visit. Between 3/2015 and 8/2015, patients seen in the Adult Survivorship Program who had not previously received a treatment summary and survivorship care plan (TS/SCP) were provided with one accompanied by a list of survivorship research studies and care programs tailored to their diagnosis. Survivorship providers discussed the opportunities and recorded whether the patient was interested in relevant studies and placed referrals to study staff. Following the visit, we tracked study enrollment and surveyed patients about their experience. Fifty of 56 (89%) pilot participants completed the survey. Almost all (98%) reported that the TS/SCP visit and document helped with knowledge of research opportunities and supportive care interventions. Following receipt of the TS/SCP, 44% were interested in at least one study and in further follow-up with research staff. Of the 30 survivors eligible for at least one study, 6 (20%) have enrolled in at least one study to date. This pilot program demonstrates that the systematic sharing of available clinical studies and supportive care programming as part of a survivorship care plan visit is feasible and well received by cancer survivors and may facilitate and enhance accrual to clinical trials in the survivorship phase of care.
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Affiliation(s)
- Shoshana M Rosenberg
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Jennifer A Ligibel
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Meyerhardt
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Eric D Jacobsen
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Judy E Garber
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Larissa Nekhlyudov
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Craig A Bunnell
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Patricia Nutting
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | | | - Sarah K Walsh
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
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22
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Baxi SS, Sukhu R, Fortier E, Oeffinger K, Corcoran S, Salner A, Vickers AJ, McCabe MS, Salz T. Automating Treatment Summary Development Using Electronic Billing Information: A Pilot Study of Survivors of Head and Neck Cancer. J Oncol Pract 2018; 15:e84-e90. [PMID: 30523752 DOI: 10.1200/jop.18.00022] [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
PURPOSE Although the provision of a treatment summary (TS) is a quality indicator in oncology, routine delivery of TSs remains challenging. Automatic TS generation could facilitate use, but data on accuracy are lacking in complex cancers such as head and neck cancer (HNC). We developed and evaluated an electronic platform to automate TS generation for HNC. METHODS The algorithms autopopulated TSs using data from billing records and an institutional cancer registry. A nurse practitioner used the medical record to verify the accuracy of the information and made corrections electronically. Inaccurate and missing data were considered errors. We described and investigated reasons for errors in the automatically generated TSs. RESULTS We enrolled a heterogeneous population of 43 survivors of HNC. Using billing data, the information on primary site, lymph node status, radiation, and chemotherapy use was accurate in 93%, 95%, 93%, and 95% of patients, respectively. Billing data captured surgery accurately in 77% of patients; once an omitted billing code was identified, accuracy increased to 98%. Chemotherapies were captured in 90% of patients. Using the cancer registry, month and year of diagnosis were accurate in 91% of cases; stage was accurate in 28% of cases. Reprogramming the algorithm to ascertain clinical stage when pathologic stage was unavailable resulted in 100% accuracy. The algorithms inconsistently identified radiation receipt and treating physicians from billing data. CONCLUSION It is feasible to automatically and accurately generate most components of TSs for HNC using billing and cancer registry data, although clinical review is necessary in some cases.
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Affiliation(s)
- Shrujal S Baxi
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Ranjit Sukhu
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Andrew Salner
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Mary S McCabe
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Talya Salz
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
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23
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Psihogios AM, Pauly-Hubbard H, Schwartz L, Ginsberg JP, Hobbie W, Szalda D. Understanding and Improving Knowledge of Cancer Survivorship Care Among College Providers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1075-1081. [PMID: 28299542 DOI: 10.1007/s13187-017-1208-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study aimed to assess college providers' basic knowledge of the health risks of young adult cancer survivors (YAS) and related care guidelines and to determine whether an educational in-service is an effective platform for increasing college health providers' knowledge about survivorship care at a large university health center. During phase 1, staff from college health centers and office of disabilities in the Philadelphia area (n = 40 staff members from 24 colleges/universities) completed a needs assessment on their experiences with YAS and preferences for education and care coordination. During phase 2, a 1-h educational in-service, informed by results of the survey, was provided to 18 health center medical providers. While most providers indicated that YAS are at risk for chronic health conditions because of cancer treatment, nearly all were unfamiliar with the content of published long-term follow-up guidelines for cancer survivorship. Over half did not have knowledge of cancer survivorship services in their area. All respondents were interested in more education on cancer survivorship care. Attendees of the in-service increased their knowledge of survivorship follow-up guidelines, awareness of local survivorship resources, and comfort with caring for YAS at posttest relative to baseline. The in-service was highly acceptable to providers and feasible to implement. College providers had little baseline knowledge of cancer survivorship guidelines, but were motivated to obtain more information. Through an educational in-service, college health providers may be better equipped to provide acute and longitudinal survivorship care to a vulnerable population who are at risk for inadequate engagement in risk-based follow-up care.
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Affiliation(s)
- Alexandra M Psihogios
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | | | - Lisa Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jill P Ginsberg
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wendy Hobbie
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dava Szalda
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Advancing Uterine Cancer Survivorship Among African American Women. J Natl Med Assoc 2018; 110:391-395. [PMID: 30126566 DOI: 10.1016/j.jnma.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have examined health behavior interventions for African American women who are uterine cancer survivors. Black-white differences in uterine cancer survival suggest that there are unmet needs among these survivors. METHODS This article identifies opportunities to address disparities in uterine corpus cancer survival and quality of life, and thereby to increase uterine cancer survivorship among African American women. RESULTS For cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, lymphedema, and difficulty sleeping. A variety of interventions have been evaluated to address physical and mental health concerns, including exercise and dietary interventions. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among cancer survivors, but few studies have focused specifically on African American women with a uterine corpus cancer diagnosis. Research-tested culturally tailored lifestyle interventions are lacking. CONCLUSIONS There is a need for a better understanding of uterine cancer survivorship among African American women. Additional evaluations of interventions for improving the quality of life and survival of African American uterine cancer survivors are needed.
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Haupt R, Essiaf S, Dellacasa C, Ronckers CM, Caruso S, Sugden E, Zadravec Zaletel L, Muraca M, Morsellino V, Kienesberger A, Blondeel A, Saraceno D, Ortali M, Kremer LCM, Skinner R, Roganovic J, Bagnasco F, Levitt GA, De Rosa M, Schrappe M, Hjorth L, Ladenstein R. The 'Survivorship Passport' for childhood cancer survivors. Eur J Cancer 2018; 102:69-81. [PMID: 30138773 DOI: 10.1016/j.ejca.2018.07.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/15/2018] [Accepted: 07/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Currently, there are between 300,000 and 500,000 childhood cancer survivors (CCSs) in Europe. A significant proportion is at high risk, and at least 60% of them develop adverse health-related outcomes that can appear several years after treatment completion. Many survivors are unaware of their personal risk, and there seems to be a general lack of information among healthcare providers about pathophysiology and natural history of treatment-related complications. This can generate incorrect or delayed diagnosis and treatments. METHOD The Survivorship Passport (SurPass) consists of electronic documents, which summarise the clinical history of the childhood or adolescent cancer survivor. It was developed by paediatric oncologists of the PanCare and SIOPE networks and IT experts of Cineca, together with parents, patients, and survivors' organisations within the European Union-funded European Network for Cancer research in Children and Adolescents. It consists of a template of a web-based, simply written document, translatable in all European languages, to be given to each CCS. The SurPass provides a summary of each survivor's clinical history, with detailed information about the original cancer and of treatments received, together with personalised follow-up and screening recommendations based on guidelines published by the International Guidelines Harmonization Group and PanCareSurFup. RESULTS The SurPass data schema contains a maximum of 168 variables and uses internationally approved nomenclature, except for radiotherapy fields, where a new classification was defined by radiotherapy experts. The survivor-specific screening recommendations are mainly based on treatment received and are automatically suggested, thanks to built-in algorithms. These may be adapted and further individualised by the treating physician in case of special disease and survivor circumstances. The SurPass was tested at the Istituto Giannina Gaslini, Italy, and received positive feedback. It is now being integrated at the institutional, regional and national level. CONCLUSIONS The SurPass is potentially an essential tool for improved and more harmonised follow-up of CCS. It also has the potential to be a useful tool for empowering CCSs to be responsible for their own well-being and preventing adverse events whenever possible. With sufficient commitment on the European level, this solution should increase the capacity to respond more effectively to the needs of European CCS.
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Affiliation(s)
- Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.
| | - Samira Essiaf
- The European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - Chiara Dellacasa
- Inter-University Consortium Cineca, Casalecchio di Reno (BO), Italy
| | - Cecile M Ronckers
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Silvia Caruso
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | | | - Monica Muraca
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Vera Morsellino
- Department of Hematology and Oncology, Istituto Giannina Gaslini, Genova, Italy
| | - Anita Kienesberger
- Austrian Childhood Cancer Organisation on behalf of CCI (Childhood Cancer International), Vienna, Austria
| | - Anne Blondeel
- The European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - Davide Saraceno
- Inter-University Consortium Cineca, Casalecchio di Reno (BO), Italy
| | - Maurizio Ortali
- Inter-University Consortium Cineca, Casalecchio di Reno (BO), Italy
| | - Leontien C M Kremer
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, Children's BMT Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Jelena Roganovic
- Department of Pediatrics, Division of Hematology and Oncology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Gill A Levitt
- Department of Haematology/Oncology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, UK
| | - Marisa De Rosa
- Inter-University Consortium Cineca, Casalecchio di Reno (BO), Italy
| | - Martin Schrappe
- Department of Paediatrics, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lund, Sweden
| | - Ruth Ladenstein
- St. Anna Children's Cancer Research Institute, Vienna, Austria
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Jacobsen PB, DeRosa AP, Henderson TO, Mayer DK, Moskowitz CS, Paskett ED, Rowland JH. Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery. J Clin Oncol 2018; 36:2088-2100. [PMID: 29775389 PMCID: PMC6036622 DOI: 10.1200/jco.2018.77.7482] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Numerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers' concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors. Methods Randomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis. Results Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care. Conclusion Existing research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.
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Affiliation(s)
- Paul B. Jacobsen
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Antonio P. DeRosa
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Tara O. Henderson
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Deborah K. Mayer
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Chaya S. Moskowitz
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Electra D. Paskett
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
| | - Julia H. Rowland
- Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; Antonio P. DeRosa, Weill Cornell Medicine; Chaya S. Moskowitz, Memorial Sloan-Kettering Cancer Center, New York, NY; Tara O. Henderson, Pritzker School of Medicine, University of Chicago, Chicago, IL; Deborah K. Mayer, University of North Carolina at Chapel Hill, Chapel Hill, NC; Electra D. Paskett, The Ohio State University, Columbus, OH; and Julia H. Rowland, Smith Center for Healing and the Arts, Washington, DC
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de Rooij BH, Park ER, Perez GK, Rabin J, Quain KM, Dizon DS, Post KE, Chinn GM, McDonough AL, Jimenez RB, van de Poll-Franse LV, Peppercorn J. Cluster Analysis Demonstrates the Need to Individualize Care for Cancer Survivors. Oncologist 2018; 23:1474-1481. [PMID: 29739897 DOI: 10.1634/theoncologist.2017-0558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/05/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In efforts to inform clinical screening and development of survivorship care services, we sought to characterize patterns of health care needs among cancer survivors by (a) identifying and characterizing subgroups based on self-reported health care needs and (b) assessing sociodemographic, clinical, and psychosocial factors associated with these subgroups. METHODS We conducted a cross-sectional self-administered survey among patients presenting for routine follow-up care for early-stage cancer at our academic medical center. Latent class cluster analysis was used to identify clusters of survivors based on survivorship care needs within seven domains. Multiple logistic regression analyses were used to assess factors associated with these clusters. RESULTS Among 292 respondents, the highest unmet needs were related to the domains of side effects (53%), self-care (51%), and emotional coping (43%). Our analysis identified four clusters of survivors: (a) low needs (n = 123, 42%), (b) mainly physical needs (n = 46, 16%), (c) mainly psychological needs (n = 57, 20%), and (d) both physical and psychological needs (n = 66, 23%). Compared with cluster 1, those in clusters 2, 3, and 4 were younger (p < .03), those in clusters 3 and 4 had higher levels of psychological distress (p < .05), and those in clusters 2 and 4 reported higher levels of fatigue (p < .05). CONCLUSION Unmet needs among cancer survivors are prevalent; however, a substantial group of survivors report low or no health care needs. The wide variation in health care needs among cancer survivors suggests a need to screen all patients, followed by tailored interventions in clinical care delivery and research. IMPLICATIONS FOR PRACTICE The characterization of patients as having few needs, predominantly physical needs, predominantly psychological needs, or substantial needs that are both physical and psychological provides a productive framework for clinical care of cancer survivors and to guide further research in this field. Further research is needed to define the tailored information and services appropriate for each group of patients and to define optimal screening tools to efficiently identify the needs of individuals in oncology practice.
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Affiliation(s)
- Belle H de Rooij
- Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Elyse R Park
- Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Giselle K Perez
- Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Rabin
- Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Katharine M Quain
- Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Don S Dizon
- Lifespan Cancer Institute, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kathryn E Post
- Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Garrett M Chinn
- Division of General Internal Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Allison L McDonough
- Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel B Jimenez
- Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lonneke V van de Poll-Franse
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeffrey Peppercorn
- Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Huenerberg KJ, Anderson BM, Tevaarwerk AJ, Neuman HB, Wilke LG, Seaborne LA, Sesto M. Integrating survivorship care planning in radiation oncology workflow. ACTA ACUST UNITED AC 2018; 16:e66-e71. [PMID: 30631797 DOI: 10.12788/jcso.0392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Various groups, including the American College of Surgeons' Commission on Cancer and the National Accreditation Program for Breast Centers, are mandating the provision of a survivorship care plan (SCP) to cancer survivors who have completed curative-intent treatment as a requirement for oncology practice accreditation. This article reviews the development of survivorship care, including survivorship care in radiation oncology. Challenges of developing treatment summaries and SCPs and implementing their delivery are explored. Details of the article include how the University of Wisconsin Health radiation oncology department integrated a survivorship visit into the existing radiation oncology workflow. Oncology practices may benefit from the model described here to meet accreditation requirements for SCP delivery to cancer survivors.
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Affiliation(s)
- Karol J Huenerberg
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bethany M Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amye J Tevaarwerk
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Heather B Neuman
- Division of General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Lee G Wilke
- Division of General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Lori A Seaborne
- Department of Surgery, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Mary Sesto
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.,Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, Wisconsin
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Isaacson MJ, Hulme PA, Cowan J, Kerkvliet J. Cancer survivorship care plans: Processes, effective strategies, and challenges in a Northern Plains rural state. Public Health Nurs 2018; 35:291-298. [DOI: 10.1111/phn.12393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mary J. Isaacson
- College of Nursing; South Dakota State University; Sioux Falls SD USA
| | - Polly A. Hulme
- College of Nursing; South Dakota State University; Sioux Falls SD USA
| | - Jenna Cowan
- College of Nursing; South Dakota State University; Sioux Falls SD USA
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Bilodeau K, Tremblay D, Durand MJ. Exploration of the contexts surrounding the implementation of an intervention supporting return-to-work after breast cancer in a primary care setting: starting point for an intervention development. J Multidiscip Healthc 2018; 11:75-83. [PMID: 29440910 PMCID: PMC5798536 DOI: 10.2147/jmdh.s152947] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many recommendations have been made regarding survivorship care provided by teams of primary care professionals. However, the nature of that follow-up, including support for return-to-work (RTW) after cancer, remains largely undefined. As implementation problems are frequently context-related, a pilot study was conducted to describe the contexts, according to Grol and Wensing, in which a new intervention is to be implemented. This pilot study is the first of three steps in intervention development planning. METHOD In-depth semi-structured interviews (n=6) were carried out with stakeholders selected for their knowledgeable perspective of various settings, such as hospitals, primary care, employers, and community-based organizations. Interviews focused on participants' perceptions of key contextual facilitators and barriers to consider for the deployment of an RTW intervention in a primary care setting. Data from interviews were transcribed and analyzed. A content analysis was performed based on an iterative process. RESULTS An intervention supporting the process of RTW in primary care makes sense for participants. Results suggest that important levers are present in organizational, professional, and social settings. However, many barriers, mainly related to organizational settings, have been identified, eg, distribution of tasks for survivor follow-up, continuity of information, and coordination of care between specialized oncology care and general primary care. CONCLUSION To develop and deploy the intervention, recommendations that emerged from this pilot study for overcoming barriers were identified, eg, training (professionals, survivors, and employers), the use of communication tools, and adopting a practice guide for survivor care. The results were also helpful in focusing on the relevance of an intervention supporting the RTW process as a component of primary care for survivors.
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Affiliation(s)
- Karine Bilodeau
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
- Hôpital Charles-LeMoyne Research Center, Longueuil, QC, Canada
| | - Dominique Tremblay
- Hôpital Charles-LeMoyne Research Center, Longueuil, QC, Canada
- School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Marie-José Durand
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
- Centre for Action in Work Disability Prevention and Rehabilitation, Longueuil, QC, Canada
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Ramsay JM, Mann K, Kaul S, Zamora ER, Smits-Seemann RR, Kirchhoff AC. Follow-Up Care Provider Preferences of Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2018; 7:204-209. [PMID: 29346008 DOI: 10.1089/jayao.2017.0083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To explore the experiences and perspectives of adolescent and young adult (AYA) cancer survivors regarding patient-provider relationships and their preferences surrounding type of healthcare provider for follow-up care. METHODS We recruited AYA cancer survivors who were diagnosed between the ages of 15 and 39 using the Utah Cancer Registry. Twenty-eight survivors participated in six focus groups held between March and May of 2015 in Salt Lake City and St. George, Utah. This analysis focuses on how survivors' preferences about type of healthcare provider may influence their transition into, and utilization of, follow-up care. RESULTS On average, survivors were 6.3 (standard deviation = 1.7) years from their cancer diagnosis. A majority of survivors expressed a desire not to transition to a new provider and preferred continuing to see their oncologist for follow-up care. For these survivors, this was due to already having a close relationship with their oncologist and because they trusted their provider's knowledge about cancer and how to handle late effects. However, survivors placed emphasis on being comfortable with their healthcare provider, regardless of provider type. CONCLUSIONS Our findings demonstrate the importance of formalizing provider transitions and roles after cancer therapy to improve patient comfort with new providers. By understanding the complexities of the transition from active cancer treatment to follow-up care for AYA survivors, these findings can inform programs undertaking post-care educational activities to ensure a seamless transition into survivorship care. Survivorship care plans can facilitate these transitions and improve patient confidence in follow-up care.
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Affiliation(s)
- Joemy M Ramsay
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Karely Mann
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Sapna Kaul
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Eduardo R Zamora
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Rochelle R Smits-Seemann
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anne C Kirchhoff
- 1 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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Demoor-Goldschmidt C, Tabone MD, Bernier V, de Vathaire F, Berger C. Long-term follow-up after childhood cancer in France supported by the SFCE-force and weakness-current state, results of a questionnaire and perspectives. Br J Radiol 2018; 91:20170819. [PMID: 29293375 DOI: 10.1259/bjr.20170819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The survival rate of children treated for cancer is currently about 80% at 5 years and we estimate that about 50,000 adults in France have survived childhood cancer. In 2011, there was a call for projects relating to long-term follow-up (LTFU), which led to several studies being conducted. Five years later, we sent a questionnaire to present LTFU in France and describe its strengths and weaknesses and to establish appropriate steps that should be taken. METHODS A questionnaire was sent by email to all the members of the French Society of Childhood Cancers in spring 2016. The study involved 44 centres/hospitals with a Paediatric Oncology Department. RESULTS 54 answers were analysed, provided by 31/44 (70%) centres working together with the French Society of Childhood Cancers. Screening is the main objective of LTFU care (90%). The main difficulties that arose were: lack of sufficient time to devote to this activity (57%), difficulties contacting adult childhood cancer survivors (aCCSs) (26%), aCCSs who ultimately did not show up to the consultation (19%), cost (15%), and lack of organization (13%). Seven LTFU programmes were identified: two regional organizations (Rhône Alpes and Grand Ouest), four centre-size organizations, and one national study (involving 15 Haematology Centres) relating to Child and Adolescent Leukaemia. CONCLUSION LTFU is a major concern for French centres specialized in paediatric oncology. Organization is not well defined and difficulties still arise (Who are the best care providers? What frequency of care is most appropriate? etc.). Advances in knowledge: LTFU focused on health problems (physical, psychological, social, economic issues) that affect CCSs is needed to ensure that these patients regain the most optimal physical and emotional health possible. Practitioners suggest different ways to improve LTFU, such as national co-operation with Epidemiology Registers to promote homogenous LTFU care.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- 1 Cancer and Radiation team, Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, University Paris-Sud, UVSQ, University Paris-Saclay , Villejuif , France.,2 Department of Pediatric Onco-hematology, CHU Angers , Angers , France
| | | | - Valérie Bernier
- 4 Department of Radiation Oncology, Institut de Cancérologie de Lorraine , Nancy , France
| | - Florent de Vathaire
- 1 Cancer and Radiation team, Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, University Paris-Sud, UVSQ, University Paris-Saclay , Villejuif , France
| | - Claire Berger
- 5 Department of hemato-oncology pediatric, Chu nord st Etienne , Saint-Etienne , France
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Kurtin S. Living with Multiple Myeloma: A Continuum-Based Approach to Cancer Survivorship. Semin Oncol Nurs 2017; 33:348-361. [DOI: 10.1016/j.soncn.2017.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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O'Caoimh R, Cornally N, O'Sullivan R, Hally R, Weathers E, Lavan AH, Kearns T, Coffey A, McGlade C, Molloy DW. Advance care planning within survivorship care plans for older cancer survivors: A systematic review. Maturitas 2017; 105:52-57. [PMID: 28687135 DOI: 10.1016/j.maturitas.2017.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/17/2017] [Accepted: 06/22/2017] [Indexed: 12/24/2022]
Abstract
Advances in the medical treatment of cancer have increased the number of survivors, particularly among older adults, who now represent the majority of these. Survivorship care plans (SCPs) are documents that cancer patients receive summarising their care, usually at the end of treatment but preferably from initial diagnosis. These may increase patient satisfaction and represent an opportunity to initiate preventative strategies and address future care needs. Advance care planning (ACP), incorporating advance healthcare decision-making, including formal written directives, increases satisfaction and end-of-life care. This paper systematically reviews evaluations of ACP within SCPs among older (≥65 years) cancer survivors. No studies meeting the inclusion criteria were identified by search strategies conducted in PubMed/MEDLINE and the Cochrane databases. One paper examined cancer survivors' mainly positive views of ACP. Another discussed the use of a SCP supported by a 'distress inventory' that included an advance care directive (living will) as an issue, though no formal evaluation was reported. Although ACP is important for older adults, no study was found that evaluated its role within survivorship care planning. Despite the risk of recurrence and the potential for morbidity and mortality, especially among older cancer survivors, ACP is not yet a feature of SCPs.
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Affiliation(s)
- Rónán O'Caoimh
- Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland; Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland.
| | - Nicola Cornally
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland; School of Nursing and Midwifery, University College Cork, College Road, Cork City, Ireland
| | - Ronan O'Sullivan
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - Ruth Hally
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - Elizabeth Weathers
- Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland; School of Nursing and Midwifery, University College Cork, College Road, Cork City, Ireland
| | - Amanda H Lavan
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - Tara Kearns
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - Alice Coffey
- School of Nursing and Midwifery, University College Cork, College Road, Cork City, Ireland
| | - Ciara McGlade
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland
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Hébert J, Fillion L. Assessment of the feasibility and acceptability, and pre-test of the utility of an individualized survivorship care plan (ISCP) for women with endometrial cancers during the transition of the end of active treatment to cancer survivorship. Can Oncol Nurs J 2017; 27:153-163. [PMID: 31148628 PMCID: PMC6516223 DOI: 10.5737/23688076272153163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The transition from the end of active treatment to survivorship holds many challenges for women with endometrial cancer (WEC) and for the organization of health services. The feasibility and acceptability of implementing an individualized survivorship care plan (ISCP) at the end of treatment are documented as potential solutions. The utility of an ISCP on three indicators (SUNS, FCRI, and HeiQ) was pre-tested by comparing two groups of WEC (control and exposed to the ISCP). The WEC exposed to the ISCP had fewer needs, a lesser intensity of fear of cancer recurrence, and better health-related empowerment skills three months after the end of treatment, as compared to the control group. Obstacles of time, resources, and organization were raised. BACKGROUND The transition from the end of active treatment to cancer survivorship is a time of imbalance and turbulence for women with endometrial cancer (WEC). The transition to survivorship continues to be uncoordinated and the need for information about the side effects to watch for and the health risks is unmet. The implementation of an individualized survivorship care plan (ISCP) is suggested as an information and communication tool that could be a solution for facilitating the transition from the end of treatment to the beginning of survivorship. RESEARCH OBJECTIVE AND METHOD To assess and document the feasibility and acceptability of implementing an ISCP, qualitative data were gathered from WEC, oncology nurse navigators (ONN), and family doctors. A pre-experimental research design with a non-equivalent control group, an end of treatment (T0), and a three-month follow-up (T1) allowed us to pre-test its utility according to three indicators: (1) overall needs (SUNS); (2) fear of cancer recurrence (FCRI); and (3) empowerment (HeiQ) according to exposure to ISCP (control versus exposed) and to the time of measurement in the transition period (T0 versus T1). RESULTS The sample was made up of 18 WEC for the group exposed to the ISCP and 13 WEC for the control group, 12 general practitioners, and two ONN. After ONN training, the ISCP completion time varied between 60 and 75 minutes, and the meeting for providing the ISCP lasted 45-60 minutes. The WEC supported the idea that meetings with the ONN and the ISCP were useful in meeting their needs for information and support. The family doctors supported its relevancy in favouring follow-up and better subsequent healthcare management, as well as in reassuring patients and avoiding a sense of abandonment at the end of treatment. Comparing the group exposed to the ISCP versus the control group, fewer reported needs can be observed: information: 35% versus 74%, p = .030; professional and financial: 6% versus 19%, p = .057; access and continuity: 9% versus 25%, p = .078; support: 18% versus 50%, p = .007, emotional: 13% versus 28%, p = .044). Moreover, at T1, empowerment according to the skill and technique acquisition sub-scale shows a higher trend (M = 75.00 (10.21) versus M = 64.06 (10.67), p = .097). The level of fear of recurrence remains above the clinically significant score of 13 for both groups at the two times of measurement. DISCUSSION The ISCP is an informational tool that seeks to facilitate care-related communication and coordination between specialized and primary care. It is intended to facilitate the transition from the end of treatment to survivorship and survivors' commitment to health-related empowerment behaviours. The feasibility and utility of implementing an ISCP are supported if additional professional, organizational, and financial resources are specified and mobilized.
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Affiliation(s)
- Johanne Hébert
- Professor, Department of Nursing, Université du Québec à Rimouski (UQAR)
| | - Lise Fillion
- Full professor, Faculty of Nursing, Université Laval
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Hébert J, Fillion L. Évaluation de la faisabilité, de l’acceptabilité et pré-test de l’utilité d’un plan de soins de suivi (PSS) auprès de femmes atteintes du cancer de l’endomètre lors de la transition de la fin du traitement actif vers la survie au cancer. Can Oncol Nurs J 2017; 27:142-152. [PMID: 31148643 PMCID: PMC6516233 DOI: 10.5737/23688076272142152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
La transition de la fin des traitements vers la survie représente de nombreux défis pour les femmes atteintes du cancer de l’endomètre (FACE) et pour l’organisation des services de santé. La faisabilité et l’acceptabilité d’implanter un plan de soins de suivi (PSS) à la fin du traitement sont documentées comme pistes de solution. L’utilité du PSS sur trois indicateurs (SUNS, IPRC et HeiQ) est pré-testée en comparant deux groupes de FACE (exposé ou non au PSS). Les FACE exposées au PSS ont moins de besoins, une intensité inférieure de peur de récidive du cancer et de meilleurs comportements d’autogestion de santé trois mois après la fin du traitement comparativement au groupe non exposé. Des barrières de temps, de ressources et d’organisation sont soulevées.
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Affiliation(s)
- Johanne Hébert
- Professeure, Département des sciences infirmières, Université du Québec à Rimouski, UQA
| | - Lise Fillion
- Professeure titulaire, Faculté des sciences infirmières, Université Laval
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Dossett LA, Hudson JN, Morris AM, Lee MC, Roetzheim RG, Fetters MD, Quinn GP. The primary care provider (PCP)-cancer specialist relationship: A systematic review and mixed-methods meta-synthesis. CA Cancer J Clin 2017; 67:156-169. [PMID: 27727446 PMCID: PMC5342924 DOI: 10.3322/caac.21385] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Although they are critical to models of coordinated care, the relationship and communication between primary care providers (PCPs) and cancer specialists throughout the cancer continuum are poorly understood. By using predefined search terms, the authors conducted a systematic review of the literature in 3 databases to examine the relationship and communication between PCPs and cancer specialists. Among 301 articles identified, 35 met all inclusion criteria and were reviewed in-depth. Findings from qualitative, quantitative, and disaggregated mixed-methods studies were integrated using meta-synthesis. Six themes were identified and incorporated into a preliminary conceptual model of the PCP-cancer specialist relationship: 1) poor and delayed communication between PCPs and cancer specialists, 2) cancer specialists' endorsement of a specialist-based model of care, 3) PCPs' belief that they play an important role in the cancer continuum, 4) PCPs' willingness to participate in the cancer continuum, 5) cancer specialists' and PCPs' uncertainty regarding the PCP's oncology knowledge/experience, and 6) discrepancies between PCPs and cancer specialists regarding roles. These data indicate a pervasive need for improved communication, delineation, and coordination of responsibilities between PCPs and cancer specialists. Future interventions aimed at these deficiencies may improve patient and physician satisfaction and cancer care coordination. CA Cancer J Clin 2017;67:156-169. © 2016 American Cancer Society.
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Affiliation(s)
- Lesly A Dossett
- Assistant Professor, Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Janella N Hudson
- Postdoctoral Fellow, Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Arden M Morris
- Associate Professor, Department of Surgery and Center for Health Outcomes and Policy, University of Michigan Health System, Ann Arbor, MI
| | - M Catherine Lee
- Associate Member, Comprehensive Breast Program, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Richard G Roetzheim
- Professor, Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL
- Senior Member, Department of Health Outcomes and Behavior and Comprehensive Breast Program, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Michael D Fetters
- Professor, Department of Family Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Gwendolyn P Quinn
- Senior Member, Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, Tampa, FL
- Professor, Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
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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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Melisko ME, Gradishar WJ, Moy B. Issues in Breast Cancer Survivorship: Optimal Care, Bone Health, and Lifestyle Modifications. Am Soc Clin Oncol Educ Book 2017; 35:e22-9. [PMID: 27249727 DOI: 10.1200/edbk_159203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There are an estimated 3.1 million survivors of breast cancer in the United States. The predominant reasons for this substantially large population are that breast cancer is the most common noncutaneous malignancy among women and that 5-year survival rates after breast cancer treatment are approximately 90%. These patients have many medical considerations, including the need to monitor for disease recurrence and to manage complications of their previous cancer treatments. Most patients remain at risk indefinitely for local and systemic recurrences of their breast cancers and have an increased risk of developing contralateral new primary breast cancers. Therefore, optimizing care for this patient population is critical to the overall health care landscape in the United States. Here, we summarize survivorship care delivery and its challenges, the optimization of bone health in breast cancer survivors, and opportunities for risk reduction through lifestyle modifications.
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Affiliation(s)
- Michelle E Melisko
- From the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Massachusetts General Hospital Cancer Center, Boston, MA
| | - William J Gradishar
- From the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Massachusetts General Hospital Cancer Center, Boston, MA
| | - Beverly Moy
- From the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Massachusetts General Hospital Cancer Center, Boston, MA
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Walsh K. Addressing psychosocial issues in cancer survivorship: past, present and future. Future Oncol 2016; 12:2823-2834. [PMID: 27467398 DOI: 10.2217/fon-2016-0138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
With a burgeoning population of cancer survivors, organizations in the USA and around the world are considering how to address the many long-term and late psychosocial effects of cancer and cancer treatment. This article reviews the changing landscape of survivorship care over the past 50 years, from the time when there were relatively few survivors to the future, when the number of cancer survivors in the USA alone is expected to reach close to 20 million. Institute of Medicine Reports, intra-organizational summits and accrediting standards that have influenced the development of survivorship care plans and programs and the roles of the Internet and smartphone applications along with oncology specialist and primary care providers are discussed.
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Salz T, McCabe MS, Oeffinger KC, Corcoran S, Vickers AJ, Salner AL, Dornelas E, Schnall R, Raghunathan NJ, Fortier E, Baxi SS. A head and neck cancer intervention for use in survivorship clinics: a protocol for a feasibility study. Pilot Feasibility Stud 2016; 2:23. [PMID: 27965842 PMCID: PMC5153865 DOI: 10.1186/s40814-016-0061-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/19/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Head and neck cancer survivors commonly experience severe long-term toxicities, late-occurring symptoms, and significant risks of the second primary malignancy and comorbid illnesses. With multiple simultaneous health issues, these complex cancer survivors often do not receive comprehensive health care that addresses their needs. A tool is needed to streamline and standardize comprehensive care for this cohort. METHODS/DESIGN We designed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR) to address health care challenges for head and neck cancer survivors. HN-STAR is an electronic platform that aims to simplify the provision of personalized care in cancer survivorship clinics. It uses an algorithmic approach to integrate patient-reported outcomes, clinical details, and evidence-based guidelines to standardize comprehensive care provided in routine survivorship visits. It has four integrated components: (1) a simplified treatment summary, which pulls treatment details from a clinical database or can be completed manually using a streamlined form; (2) an online self-assessment for patients to report their own symptoms; (3) an interactive discussion guide presenting all relevant information to the provider during the clinic visit; and (4) a survivorship care plan generated at the end of each visit that reflects decisions made during the visit. By using a modifiable electronic platform, HN-STAR provides a method for incorporating survivorship care plans into clinical practice and for disseminating evidence on symptom management and preventive care. This is a study to assess the feasibility of a future multi-site, randomized clinical trial of HN-STAR. We will enroll head and neck cancer survivors who are followed in one of two nurse practitioner-led survivorship clinics. We will implement HN-STAR for one routine survivorship visits. We will assess (1) usability and feasibility outcomes of HN-STAR from the perspective of key stakeholders and (2) the planned outcomes intended for the larger trial. We will collect usability and feasibility data from online surveys of survivors and their providers. Our findings will inform whether it is feasible to advance HN-STAR to trial. If so, we will adapt HN-STAR and the study design of the trial in response to feedback from survivors and providers. The long-term goal is to determine if such an intervention will lead to improved and simplified comprehensive survivorship care. DISCUSSION This feasibility study will evaluate implementation of HN-STAR into clinical practice in terms of usability, practicality, and clinical flow in two distinct clinical settings. This study will also provide critical baseline data to characterize this vulnerable population. Findings from this study will inform a multicenter randomized trial of HN-STAR, aimed at standardizing and streamlining the delivery of evidence-guided comprehensive care for head and neck cancer survivors. Ultimately, if found effective, the modular structure of HN-STAR could permit its expansion to survivors of other complex cancers. TRIAL REGISTRATION ClinicalTrials.gov, NCT02571673.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Mary S. McCabe
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Kevin C. Oeffinger
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Stacie Corcoran
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Andrew J. Vickers
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | | | - Ellen Dornelas
- Hartford Hospital, 80 Seymour St, Hartford, CT 06102 USA
| | - Rebecca Schnall
- Columbia University School of Nursing, 617 W 168th St, New York, NY 10032 USA
| | | | - Elizabeth Fortier
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Shrujal S. Baxi
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
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Salz T, Baxi S. Moving survivorship care plans forward: focus on care coordination. Cancer Med 2016; 5:1717-22. [PMID: 27075650 PMCID: PMC4944899 DOI: 10.1002/cam4.733] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/19/2016] [Accepted: 03/18/2016] [Indexed: 11/08/2022] Open
Abstract
After completing treatment for cancer, the coordination of oncology and primary care presents a challenge for cancer survivors. Many survivors need continued oncology follow-up, and all survivors require primary care. Coordinating the shared care of a cancer survivor, or facilitating an informed handoff from oncology to primary care, is essential for cancer survivors. Survivorship care plans are personalized documents that summarize cancer treatment and outline a plan of recommended ongoing care, with the goal of facilitating the coordination of post-treatment care. Despite their face validity, five trials have failed to demonstrate the effectiveness of survivorship care plans. We posit that these existing trials have critical shortcomings and do not adequately address whether survivorship care plans improve care coordination. Moving forward, we propose four criteria for future trials of survivorship care plans: focusing on high-needs survivor populations, tailoring the survivorship care plan to the care setting, facilitating implementation of the survivorship care plan in clinical practice, and selecting appropriate trial outcomes to assess care coordination. When trials meet these criteria, we can finally assess whether survivorship care plans help cancer survivors receive optimal oncology and primary care.
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Affiliation(s)
- Talya Salz
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shrujal Baxi
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weil Medical College of Cornell University, New York, New York
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Rushton M, Morash R, Larocque G, Liska C, Stoica L, DeGrasse C, Segal R. Wellness Beyond Cancer Program: building an effective survivorship program. ACTA ACUST UNITED AC 2015; 22:e419-34. [PMID: 26715879 DOI: 10.3747/co.22.2786] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Wellness Beyond Cancer Program (wbcp) was launched in 2012, first accepting patients with colorectal cancer (crc) and, subsequently, those with breast cancer (bca), with the aim of standardizing and streamlining the discharge process from our cancer centre. Patients are discharged either to the wbcp nurse practitioner or to their primary care provider (pcp). The program incorporates survivorship care plans (scps) and education classes; it also has a rapid re-entry system in case of recurrence. The objective of this paper is to describe the process by which a cancer survivorship program was developed at our institution and to present preliminary evaluation results. METHODS Qualitative surveys were mailed to patients and pcps 1 year after patients had been referred to the wbcp. The surveys addressed knowledge of the program content, satisfaction on the part of patients and providers, and whether scp recommendations were followed. Questions were scored on the level of agreement with each of a list of statements (1 = strongly disagree to 5 = strongly agree). RESULTS From March 2012 to November 2014, 2630 patients were referred to the wbcp (809 with crc, 1821 with bca). Surveys were received from 289 patients and 412 pcps. Patients and pcps gave similar scores (average: 4) to statements about satisfaction; pcps gave scores below 4 to statements about communication with the wbcp. CONCLUSIONS At 1 year after discharge, patients and pcps were satisfied with program content, but there is an opportunity to improve on communication and provision of cancer-specific information to the pcps. Using the wbcp to ensure a safe transition to the most appropriate health care provider, we have standardized the discharge process for crc and bca patients.
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Affiliation(s)
| | - R Morash
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - G Larocque
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - C Liska
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - L Stoica
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - C DeGrasse
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - R Segal
- The Ottawa Hospital Cancer Centre, Ottawa, ON
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Coughlin SS, Yoo W, Whitehead MS, Smith SA. Advancing breast cancer survivorship among African-American women. Breast Cancer Res Treat 2015; 153:253-61. [PMID: 26303657 DOI: 10.1007/s10549-015-3548-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022]
Abstract
Advances have occurred in breast cancer survivorship but, for many African-American women, challenges and gaps in relevant information remain. This article identifies opportunities to address disparities in breast cancer survival and quality of life, and thereby to increase breast cancer survivorship among African-American women. For breast cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, difficulty sleeping, and sexual dysfunction. For addressing physical and mental health concerns, a variety of interventions have been evaluated, including exercise and weight training, dietary interventions, yoga and mindfulness-based stress reduction, and support groups or group therapy. Obesity has been associated with breast cancer recurrence and poorer survival. Relative to white survivors, African-American breast cancer survivors are more likely to be obese and less likely to engage in physical activity, although exercise improves overall quality of life and cancer-related fatigue. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among breast cancer survivors, but few studies have focused specifically on African-American women with a breast cancer diagnosis. Studies have identified a number of personal factors that are associated with resilience, increased quality of life, and positive adaptation to a breast cancer diagnosis. There is a need for a better understanding of breast cancer survivorship among African-American women. Additional evaluations of interventions for improving the quality of life and survival of African-American breast cancer survivors are desirable.
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Affiliation(s)
- Steven S Coughlin
- Department of Community Health and Sustainability, Division of Public Health, University of Massachusetts, Lowell, MA, USA,
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46
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Kunthur A, Xiang Z, Kaur H, Jewell S, Mehta P. Updates on Cancer Survivorship Care Planning. Fed Pract 2015; 32:64S-69S. [PMID: 30766131 PMCID: PMC6375428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer organizations have developed guides and tools to help build cancer survivorship programs and survivorship care plans.
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Affiliation(s)
- Anuradha Kunthur
- , , and are staff hematology/oncologists, all at the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. is a resident, is a hematology/oncology fellow, Dr. Kunthur and Dr. Xiang are assistant professors of hematology/oncology, and Dr. Mehta is a professor of hematology/oncology, all at the University of Arkansas for Medical Sciences in Little Rock
| | - Zhifu Xiang
- , , and are staff hematology/oncologists, all at the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. is a resident, is a hematology/oncology fellow, Dr. Kunthur and Dr. Xiang are assistant professors of hematology/oncology, and Dr. Mehta is a professor of hematology/oncology, all at the University of Arkansas for Medical Sciences in Little Rock
| | - Harjot Kaur
- , , and are staff hematology/oncologists, all at the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. is a resident, is a hematology/oncology fellow, Dr. Kunthur and Dr. Xiang are assistant professors of hematology/oncology, and Dr. Mehta is a professor of hematology/oncology, all at the University of Arkansas for Medical Sciences in Little Rock
| | - Sarah Jewell
- , , and are staff hematology/oncologists, all at the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. is a resident, is a hematology/oncology fellow, Dr. Kunthur and Dr. Xiang are assistant professors of hematology/oncology, and Dr. Mehta is a professor of hematology/oncology, all at the University of Arkansas for Medical Sciences in Little Rock
| | - Paulette Mehta
- , , and are staff hematology/oncologists, all at the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. is a resident, is a hematology/oncology fellow, Dr. Kunthur and Dr. Xiang are assistant professors of hematology/oncology, and Dr. Mehta is a professor of hematology/oncology, all at the University of Arkansas for Medical Sciences in Little Rock
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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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48
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The Challenges of the Integration of Cancer Survivorship Care Plans with Electronic Medical Records. Semin Oncol Nurs 2015; 31:73-8. [DOI: 10.1016/j.soncn.2014.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Warner JL, Maddux SE, Hughes KS, Krauss JC, Yu PP, Shulman LN, Mayer DK, Hogarth M, Shafarman M, Stover Fiscalini A, Esserman L, Alschuler L, Koromia GA, Gonzaga Z, Ambinder EP. Development, implementation, and initial evaluation of a foundational open interoperability standard for oncology treatment planning and summarization. J Am Med Inform Assoc 2015; 22:577-86. [PMID: 25604811 DOI: 10.1093/jamia/ocu015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/28/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Develop and evaluate a foundational oncology-specific standard for the communication and coordination of care throughout the cancer journey, with early-stage breast cancer as the use case. MATERIALS AND METHODS Owing to broad uptake of the Health Level Seven (HL7) Consolidated Clinical Document Architecture (C-CDA) by health information exchanges and large provider organizations, we developed an implementation guide in congruence with C-CDA. The resultant product was balloted through the HL7 process and subsequently implemented by two groups: the Health Story Project (Health Story) and the Athena Breast Health Network (Athena). RESULTS The HL7 Implementation Guide for CDA, Release 2: Clinical Oncology Treatment Plan and Summary, DSTU Release 1 (eCOTPS) was successfully balloted and published as a Draft Standard for Trial Use (DSTU) in October 2013. Health Story successfully implemented the eCOTPS the 2014 meeting of the Healthcare Information and Management Systems Society (HIMSS) in a clinical vignette. During the evaluation and implementation of eCOPS, Athena identified two practical concerns: (1) the need for additional CDA templates specific to their use case; (2) the many-to-many mapping of Athena-defined data elements to eCOTPS. DISCUSSION Early implementation of eCOTPS has demonstrated successful vendor-agnostic transmission of oncology-specific data. The modularity enabled by the C-CDA framework ensures the relatively straightforward expansion of the eCOTPS to include other cancer subtypes. Lessons learned during the process will strengthen future versions of the standard. CONCLUSION eCOTPS is the first oncology-specific CDA standard to achieve HL7 DSTU status. Oncology standards will improve care throughout the cancer journey by allowing the efficient transmission of reliable, meaningful, and current clinical data between the many involved stakeholders.
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Affiliation(s)
- Jeremy L Warner
- Department of Medicine, Division of Hematology & Oncology, Vanderbilt University, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Suzanne E Maddux
- Quality and Guidelines Division, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Kevin S Hughes
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John C Krauss
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Deborah K Mayer
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Mike Hogarth
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, USA
| | | | | | - Laura Esserman
- Department of Surgery, University of California, San Francisco, CA, USA Department of Radiology, University of California, San Francisco, CA, USA
| | | | | | | | - Edward P Ambinder
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Partridge AH, Jacobsen PB, Andersen BL. Challenges to Standardizing the Care for Adult Cancer Survivors: Highlighting ASCO's Fatigue and Anxiety and Depression Guidelines. Am Soc Clin Oncol Educ Book 2015:188-194. [PMID: 25993156 DOI: 10.14694/edbook_am.2015.35.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There are over 14 million survivors of cancer living in the United States alone and tens of millions more worldwide, with this population expected to nearly double in the next decade. The successes of prevention, early detection, and better therapies have lead to an emerging understanding of the substantial medical and psychosocial issues for this growing population that must be tackled for individuals and from the health care system and societal perspectives.
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Affiliation(s)
- Ann H Partridge
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Moffitt Cancer Center, Tampa, FL; Department of Psychology, The Ohio State University, Columbus, OH
| | - Paul B Jacobsen
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Moffitt Cancer Center, Tampa, FL; Department of Psychology, The Ohio State University, Columbus, OH
| | - Barbara L Andersen
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Moffitt Cancer Center, Tampa, FL; Department of Psychology, The Ohio State University, Columbus, OH
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