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Spring B, Garcia SF, Daly E, Jacobs M, Jayeoba M, Jordan N, Kircher S, Kocherginsky M, Mazzetta R, Pollack T, Scanlan L, Scherr C, Hitsman B, Phillips SM. Scalable Telehealth Cancer Care: integrated healthy lifestyle program to live well after cancer treatment. J Natl Cancer Inst Monogr 2024; 2024:83-91. [PMID: 38924795 PMCID: PMC11207740 DOI: 10.1093/jncimonographs/lgae020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/13/2024] [Accepted: 04/16/2024] [Indexed: 06/28/2024] Open
Abstract
Northwestern University's Center for Scalable Telehealth Cancer Care (STELLAR) is 1 of 4 Cancer Moonshot Telehealth Research Centers of Excellence programs funded by the National Cancer Institute to establish an evidence base for telehealth in cancer care. STELLAR is grounded in the Institute of Medicine's vision that quality cancer care includes not only disease treatment but also promotion of long-term health and quality of life (QOL). Cigarette smoking, insufficient physical activity, and overweight and obesity often co-occur and are associated with poorer treatment response, heightened recurrence risk, decreased longevity, diminished QOL, and increased treatment cost for many cancers. These risk behaviors are prevalent in cancer survivors, but their treatment is not routinely integrated into oncology care. STELLAR aims to foster patients' long-term health and QOL by designing, implementing, and sustaining a novel telehealth treatment program for multiple risk behaviors to be integrated into standard cancer care. Telehealth delivery is evidence-based for health behavior change treatment and is well suited to overcome access and workflow barriers that can otherwise impede treatment receipt. This paper describes STELLAR's 2-arm randomized parallel group pragmatic clinical trial comparing telehealth-delivered, coach-facilitated multiple risk behavior treatment vs self-guided usual care for the outcomes of reach, effectiveness, and cost among 3000 cancer survivors who have completed curative intent treatment. This paper also discusses several challenges encountered by the STELLAR investigative team and the adaptations developed to move the research forward.
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Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Sofia F Garcia
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University, Chicago, IL 60611, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Elyse Daly
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Maia Jacobs
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Department of Computer Science, Northwestern University, Evanston, IL 60208, USA
| | - Monisola Jayeoba
- Department of Communication Studies, Northwestern University, Evanston, IL 60208, USA
| | - Neil Jordan
- Department of Psychiatry & Behavioral Sciences, Northwestern University, Chicago, IL 60611, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Sheetal Kircher
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Medicine, Northwestern University, Chicago, IL 60611, USA
- Hematology Oncology, Northwestern Medicine, Chicago, IL 60611, USA
| | - Masha Kocherginsky
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
| | - Rana Mazzetta
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Teresa Pollack
- Quality Division, Northwestern Medicine, Chicago, IL 60611, USA
| | - Laura Scanlan
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Courtney Scherr
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Communication Studies, Northwestern University, Evanston, IL 60208, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
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Melariri HI, Kalinda C, Chimbari MJ. Patients' views on health promotion and disease prevention services provided by healthcare workers in a South African tertiary hospital. BMC Health Serv Res 2023; 23:368. [PMID: 37061700 PMCID: PMC10105350 DOI: 10.1186/s12913-023-09351-5] [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: 01/11/2022] [Accepted: 05/13/2022] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Patients' views and experiences in healthcare institutions provide a means of assessing the quality of services patients receive from healthcare workers (HCWs). However, the views of patients on the health promotion (HP) and disease prevention (DP) services offered by HCWs and the delivery mode have not been adequately studied. AIM This study assessed the views of patients on HP and DP services provided by various categories of HCWs. SETTING The study was conducted at a tertiary hospital in the Nelson Mandela Bay Municipality, South Africa. METHOD An exploratory cross-sectional study was conducted among 500 patients. The questionnaire elicited responses from patients regarding the HP and DP services received from the different cadres of HCWs at three different admission phases: pre-admission phase (PAP), admission phase (ADP), and post-admission phase (POP). Descriptive, bivariate, and multivariate analysis was conducted. RESULTS In the PAP, most patients (83.33%, n = 5; 87.85%, n = 217; and 76.14%, n = 150) seen by the rehabilitation health workers, medical doctors, and nurses respectively were empowered to manage their health. Patients attended to by nurses were 0.45 (95% CI 0.27-0.74) times less likely than those attended to by medical doctors to receive information that that will help them address the physical and environmental needs. In the ADP, patients attended to by nurses were less likely, compared to those attended to by medical doctors to be empowered to have good control over their health. In the POP, patients attended to by nurses are more likely to have their health behaviours change for better compared to those not seen by any HCW. CONCLUSION Patients attending tertiary hospital received greater HP and DP services during the PAP and ADP of patient care. Greatest influence for behavioural change of patients on HP and DP were achieved from the medical doctors, nurses and rehabilitation service staff. Improving structural factors may prove beneficial in enhancing patients' experience from all HCW groups and phases of patient care.
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Affiliation(s)
- Herbert I Melariri
- College of Health Sciences, Disipline of Public Health Medicine, University of KwaZulu-Natal, Howard College Campus, Durban, 4041, South Africa.
- Eastern Cape Department of Health, Port Elizabeth Provincial Hospital, Buckingham Rd, Mount Croix, Gqeberha, 6001, South Africa.
| | - Chester Kalinda
- College of Health Sciences, Disipline of Public Health Medicine, University of KwaZulu-Natal, Howard College Campus, Durban, 4041, South Africa
- University of Global Health Equity (UGHE), Bill and Joyce Cummings Institute of Global Health, PO Box 6955, Kigali, 20093, Rwanda
| | - Moses J Chimbari
- College of Health Sciences, Disipline of Public Health Medicine, University of KwaZulu-Natal, Howard College Campus, Durban, 4041, South Africa
- Great Zimbabwe University, PO Box 1235, Masvingo, Zimbabwe
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Pariser AC, Brita J, Harrigan M, Capozza S, Khairallah A, Sanft TB. Delivery of Cancer Survivorship Education to Community Healthcare Professionals. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:625-631. [PMID: 35394562 PMCID: PMC8991658 DOI: 10.1007/s13187-022-02164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 05/20/2023]
Abstract
Our pilot study aimed to evaluate the needs of community oncology providers with regard to cancer survivorship education, develop a survivorship curriculum based on the needs assessment, and evaluate the acceptability of the Project ECHO® (Extension for Community Healthcare Outcomes) model for delivery of the survivorship curriculum. A needs assessment was delivered to participants in suburban community cancer practices, and a curriculum was developed based on the results. Participants were enrolled in an ECHO curriculum consisting of 6 sessions from October to December 2019. Participants included registered nurses (RN), registered dietitians (RD), clinical social workers (LCSW), advanced practice providers (APP), radiation oncologists, and medical oncologists (MD). Participants were invited to participate in exit interviews designed to better evaluate the participant experience. Ninety percent of needs assessment participants (n = 37) expressed an interest in cancer survivorship education. Eight participants from 3 community practices in suburban Connecticut enrolled in the ECHO curriculum. Four participants (50%) agreed to participate in exit interviews. Five themes emerged from the exit interviews: interest in survivorship, time, positive experience, empowerment, and community. Our Survivorship ECHO pilot demonstrated the acceptability of the Project ECHO® model for delivering cancer survivorship education to oncology providers. Further research confirming the feasibility of this model in additional oncology provider settings is needed.
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Affiliation(s)
- Ashley C Pariser
- Division of Medical Oncology, Wexner Medical Center, The Ohio State University, 1800 Cannon Drive, Lincoln Tower Suite 1300L, Columbus, OH, 43210, USA.
| | - Javin Brita
- Yale New Haven Hospital, PO Box 208028, New Haven, CT, 06520-8028, USA
| | - Maura Harrigan
- Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA
| | - Scott Capozza
- Yale New Haven Hospital, 20 York St, EP 10-635, New Haven, CT, 06510, USA
| | - Angela Khairallah
- Yale New Haven Hospital, 20 York St, EP 10-635, New Haven, CT, 06510, USA
| | - Tara B Sanft
- Section of Medical Oncology, Yale School of Medicine, PO Box 208028, New Haven, CT, 06520-8028, USA
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Hashmi F, Haroon M, Ullah S, Asif S, Javed S, Tayyab Z. Stress at Home and Female Gender Are Significantly Associated With Non-adherence and Poor Illness Perception Among Patients With Rheumatoid Arthritis. Cureus 2022; 14:e25835. [PMID: 35836440 PMCID: PMC9273195 DOI: 10.7759/cureus.25835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 01/26/2023] Open
Abstract
Aims We aimed to assess the level of non-adherence and poor illness perception among rheumatoid arthritis (RA) patients. Additionally, we examined their associations with clinical indicators and outcomes. Methods This was a cross-sectional study conducted using data collected at the time of patient enrolment in the Pakistan Registry of Rheumatic Diseases (PRIME) registry. A wide range of clinical variables was studied. To measure adherence, we used the Urdu version of the General Medication Adherence Scale (GMAS), which has recently been validated in RA patients. A Brief Illness Perception Questionnaire (BIPQ) was used to measure illness perception. Results The data of consecutive 320 RA patients were reviewed. Thirty-six percent of the cohort (n=116) was noted to have non-adherence. On multiple logistic regression analysis, a significant association of non-adherence was noted with moderate-to-severe stress (odds ratio {OR}: 1.85, confidence interval {CI}: 1.04-3.2), DAS-28 scores (OR: 1.83, CI: 1.52-2.21), Health Assessment Questionnaire (HAQ) scores (OR: 1.77, CI: 1.07-2.92), and deformed joint counts (OR: 1.30, CI: 1.15-1.46). Additionally, non-adherence due to "patient behavior" had a significant association with the male gender (OR: 0.48, CI: 0.26-0.87), unemployment (OR: 1.82, CI: 1.07-3.10), and stress at home (OR: 2.17, CI: 1.35-3.49). Twenty-six percent of the cohort (n=86) was noted to have the most negative illness perception, and on multiple logistic regression analysis, it was significantly associated with male gender (OR: 0.24, CI: 0.11-0.53), age of onset of arthritis (OR: 0.96, CI: 0.94-0.99), and worse HAQ scores (OR: 3.7, CI: 2.2-6.1). Conclusions Important adverse factors contributing to non-adherence and negative illness perception highlighted in this study were stress at home, female gender, and younger age of patients.
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Gori S, Modena A, Foglietta J, Verzè M, Inno A, Casarin A, Russo A, Nicolis F. Adherence to oral hormonal anticancer agents in breast cancer. TUMORI JOURNAL 2022:3008916221096183. [PMID: 35603579 DOI: 10.1177/03008916221096183] [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] [Indexed: 11/15/2022]
Abstract
There is an increasing trend towards using oral antitumoral agents in oncological patients. Compared to parenteral therapy, oral treatment offers convenience for both the patient and the healthcare system, with similar efficacy. However, the benefit deriving from oral drugs will be obtained only if patients adhere strictly to the treatment. Medical oncologists must therefore seek to optimize patient adherence. Breast cancer patients, particularly, are often treated with oral hormonal anticancer agents. In this review, we summarized evidence about adherence of breast cancer patients to oral hormonal anticancer agents and the consequences of poor compliance, the barriers to oral treatment and strategies to overcome them.
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Affiliation(s)
- Stefania Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Alessandra Modena
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | | | - Matteo Verzè
- Health Direction, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Alessandro Inno
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Alessandra Casarin
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Antonio Russo
- Department of Surgical, Oncological & Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Fabrizio Nicolis
- Health Direction, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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Influence of physician's lifestyle on the prescription of healthy habits to breast cancer patients (LACOG 1218). Support Care Cancer 2022; 30:4399-4406. [PMID: 35102451 DOI: 10.1007/s00520-022-06864-3] [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: 09/15/2021] [Accepted: 01/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Healthy lifestyle is capable of positively modifying the survival of breast cancer (BC) patients. We aimed to evaluate how physician's lifestyle influences on the prescription of healthy habits to BC patients. METHODS An online questionnaire to evaluate physician lifestyle and prescription of healthy habits to BC patients was developed and circulated by e-mail to physicians dedicated to treat BC patients. A multivariate Poisson regression analysis assessed which factors of physician lifestyle could influence on prescription of healthy habits. RESULTS A total of 267 physicians answered the questionnaire from October to November 2018. In terms of physician lifestyle, 228 (85.4%) had healthy eating habits and 236 (88.4%) practiced physical activity. Overall, 84.3% of the physicians advised their BC patients on the importance of lifestyle modification. Physicians who did not exercise regularly have a higher probability of not advising for health lifestyle (RR 2.48; p = 0.0265) as opposite to physicians ≥ 50 years-old (RR 0.37; p = 0.0118). Obesity treatment and management was performed by 45.3% of physicians. Being a breast surgeon (RR 1.29; p = 0.0025) or radiation oncologists (RR 1.82; p = 0.0025) were associated with not performing obesity treatment and management. About 53.4% of physicians referred overweight or obese patients to a dietitian and/or endocrinologist. Male gender (RR 1.35; p = 0.0296), breast surgeons (RR 1.99; p = 0.0001), and clinical practice in public health system (RR 1.53; p = 0.0012) were associated with not referring as opposed to physicians ≥ 50 years-old (RR 0.46; p = 0.0005). CONCLUSION Our survey showed some influence of physician's lifestyle on the prescription of healthy habits to BC patients. Physicians who practice physical activity regularly had a higher probability of advising lifestyle modification and about half of physicians did some type of overweight and obese management.
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Kang DW, Wilson RL, Christopher CN, Normann AJ, Barnes O, Lesansee JD, Choi G, Dieli-Conwright CM. Exercise Cardio-Oncology: Exercise as a Potential Therapeutic Modality in the Management of Anthracycline-Induced Cardiotoxicity. Front Cardiovasc Med 2022; 8:805735. [PMID: 35097024 PMCID: PMC8796963 DOI: 10.3389/fcvm.2021.805735] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/23/2021] [Indexed: 12/19/2022] Open
Abstract
Anthracyclines are one of the most effective chemotherapy agents and have revolutionized cancer therapy. However, anthracyclines can induce cardiac injuries through ‘multiple-hits', a series of cardiovascular insults coupled with lifestyle risk factors, which increase the risk of developing short- and long-term cardiac dysfunction and cardiovascular disease that potentially lead to premature mortality following cancer remission. Therefore, the management of anthracycline-induced cardiotoxicity is a serious unmet clinical need. Exercise therapy, as a non-pharmacological intervention, stimulates numerous biochemical and physiologic adaptations, including cardioprotective effects, through the cardiovascular system and cardiac muscles, where exercise has been proposed to be an effective clinical approach that can protect or reverse the cardiotoxicity from anthracyclines. Many preclinical and clinical trials demonstrate the potential impacts of exercise on cardiotoxicity; however, the underlying mechanisms as well as how to implement exercise in clinical settings to improve or protect against long-term cardiovascular disease outcomes are not clearly defined. In this review, we summarize the current evidence in the field of “exercise cardio-oncology” and emphasize the utilization of exercise to prevent and manage anthracycline-induced cardiotoxicities across high-risk and vulnerable populations diagnosed with cancer.
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Affiliation(s)
- Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Rebekah L. Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Cami N. Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, United States
| | - Amber J. Normann
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Health Sciences, Boston University, Boston, MA, United States
| | - Oscar Barnes
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Jordan D. Lesansee
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | | | - Christina M. Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- *Correspondence: Christina M. Dieli-Conwright
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Exercise as a supportive care strategy in men with prostate cancer receiving androgen deprivation therapy at a regional cancer centre: a survey of patients and clinicians. Support Care Cancer 2021; 30:1379-1389. [PMID: 34519868 PMCID: PMC8438551 DOI: 10.1007/s00520-021-06512-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/21/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE To understand how frequently exercise is discussed and/or prescribed as a supportive care measure and the barriers and facilitators to exercise uptake for men with prostate cancer receiving androgen deprivation therapy (ADT) at a regional cancer centre. METHODS An observational, cross-sectional study was conducted at a regional cancer centre in three stages: (1) Retrospective chart review of men with prostate cancer undergoing ADT to identify the frequency of discussion and/or prescription of supportive care measures; (2) prospective patient survey exploring barriers and facilitators to exercise; and (3) prospective clinician survey exploring barriers, facilitators and awareness of exercise guidelines in men with prostate cancer. RESULTS Files of 100 men receiving ADT (mean age 73 years; mean ADT duration =12 months) in the medical oncology (n = 50) and radiation oncology (n = 50) clinics were reviewed. Exercise was discussed with 16% of patients and prescribed directly to 5%. Patient survey (n = 49). 44.2% of patients reported participating in exercise at a high level. Common barriers to exercise participation included fatigue (51.0%), cancer/treatment-related weakness (46.9%) and joint stiffness (44.9%). 36.7% of patients reported interest in a supervised exercise program. Clinician survey (n = 22). 36.4% identified one or more exercise guidelines, and 40.9% correctly identified national exercise guidelines. Clinicians reported low knowledge of referral pathways to a supervised exercise program (27.3%). Clinicians believe physiotherapists (95.5%) are most suited to exercise prescription and 72.7% stated that exercise counselling should be part of supportive care. Limited time (63.6%) and patient safety (59.1%) were the two most common barriers to discussing exercise with patients. Clinicians reported that only 21.9% of their patients asked about exercise. The most endorsed facilitators to increase exercise uptake were patient handouts (90.9%) and integration of exercise specialists into the clinical team (86.4%). CONCLUSION Despite a third of patient respondents indicating an interest in a supervised exercise program, only 16% of patients with prostate cancer undergoing ADT at a regional cancer centre engaged in a discussion about exercise with their treating clinicians. Physical limitations and fatigue were the greatest barriers for patients. Clinicians indicated a need for more clinician education and better integration of exercise specialists into clinical care. A tailored, integrated approach is needed to improve the uptake of exercise in men with prostate cancer.
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Implementation barriers to integrating exercise as medicine in oncology: an ecological scoping review. J Cancer Surviv 2021; 16:865-881. [PMID: 34510366 PMCID: PMC9300485 DOI: 10.1007/s11764-021-01080-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/24/2021] [Indexed: 11/21/2022]
Abstract
Purpose While calls have been made for exercise to become standard practice in oncology, barriers to implementation in real-world settings are not well described. This systematic scoping review aimed to comprehensively describe barriers impeding integration of exercise into routine oncology care within healthcare systems. Methods A systematic literature search was conducted across six electronic databases (since 2010) to identify barriers to implementing exercise into real-world settings. An ecological framework was used to classify barriers according to their respective level within the healthcare system. Results A total of 1,376 results were retrieved; 50 articles describing implementation barriers in real-world exercise oncology settings were reviewed. Two hundred and forty-three barriers were identified across all levels of the healthcare system. Nearly 40% of barriers existed at the organizational level (n = 93). Lack of structures to support exercise integration and absence of staff/resources to facilitate its delivery were the most common issues reported. Despite the frequency of barriers at the organizational level, organizational stakeholders were largely absent from the research. Conclusions Implementing exercise into routine cancer care is hindered by a web of interrelated barriers across all levels of the healthcare system. Organizational barriers are central to most issues. Future work should take an interdisciplinary approach to explore best practices for overcoming implementation barriers, with organizations as a central focus. Implications for Cancer Survivors This blueprint of implementation barriers highlights critical issues that need to be overcome to ensure people with cancer have access to the therapeutic benefits of exercise during treatment and beyond. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01080-0.
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Altena R, Hubbert L, Kiani NA, Wengström Y, Bergh J, Hedayati E. Evidence-based prediction and prevention of cardiovascular morbidity in adults treated for cancer. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2021; 7:20. [PMID: 34049593 PMCID: PMC8161987 DOI: 10.1186/s40959-021-00105-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/04/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cancer treatment-related morbidity relevantly compromises health status in cancer survivors, and efforts to optimise health-related outcomes in this population are vital to maximising healthy survivorship. A pre-treatment assessment - and possibly preventive management strategies - of cancer patients at increased risk for cardiovascular disease (CVD) seems a rational approach in this regard. Definitive evidence for such strategies is largely lacking, thereby impeding the formulation of firm recommendations. RESULTS The current scoping review aims to summarise and grade the evidence regarding strategies for prediction and prevention of CVD in adults in relation to oncological treatments. We conducted a scoping literature search for different strategies for primary prevention, such as medical and lifestyle interventions, as well as the use of predictive risk scores. We identified studies with moderate to good strength and up to now limited evidence to recommend primary preventive strategies in unselected patients treated with potentially cardiotoxic oncologic therapies. CONCLUSION Efforts to minimize the CVD burden in cancer survivors are needed to accomplish healthy survivorship. This can be done by means of robust models predictive for CVD events or application of interventions during or after oncological treatments. Up to now there is insufficient evidence to implement preventive strategies in an unselected group of patients treated with potential cardiotoxic oncological treatments. We conclude that randomised controlled trials are needed that evaluate medical and lifestyle interventions in groups at increased risk for complications, in order to be able to influence chronic illness risks, such as cardiovascular complications, for cancer survivors.
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Affiliation(s)
- Renske Altena
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.
- Medical Unit breast, endocrine tumours and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden.
| | - Laila Hubbert
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Narsis A Kiani
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
- Medical Unit breast, endocrine tumours and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden
| | - Elham Hedayati
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
- Medical Unit breast, endocrine tumours and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden
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Gallicchio L, Tonorezos E, de Moor JS, Elena J, Farrell M, Green P, Mitchell SA, Mollica MA, Perna F, Gottlieb Saiontz N, Zhu L, Rowland J, Mayer DK. Evidence Gaps in Cancer Survivorship Care: A Report from the 2019 National Cancer Institute Cancer Survivorship Workshop. J Natl Cancer Inst 2021; 113:1136-1142. [PMID: 33755126 DOI: 10.1093/jnci/djab049] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022] Open
Abstract
Today, there are more than 16.9 million cancer survivors in the United States; this number is projected to grow to 22.2 million by 2030. While much progress has been made in understanding cancer survivors needs and in improving survivorship care since the seminal 2006 Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition, there is a need to identify evidence gaps and research priorities pertaining to cancer survivorship. Thus, in April 2019, the National Cancer Institute convened grant-funded extramural cancer survivorship researchers, representatives of professional organizations, cancer survivors, and advocates for a one-day in-person meeting. At this meeting, and in a subsequent webinar aimed at soliciting input from the wider survivorship community, evidence gaps and ideas for next steps in the following six areas, identified from the 2006 Institute of Medicine report, were discussed: surveillance for recurrence and new cancers, management of long-term and late physical effects, management of long-term and late psychosocial effects, health promotion, care coordination, and financial hardship. Identified evidence gaps and next steps across the areas included the need to understand and address disparities among cancer survivors, to conduct longitudinal studies as well as longer-term (>5 years post-diagnosis) follow-up studies, to leverage existing data, and to incorporate implementation science strategies to translate findings into practice. Designing studies to address these broad evidence gaps, as well as those identified in each area, will expand our understanding of cancer survivors' diverse needs, ultimately leading to the development and delivery of more comprehensive evidence-based quality care.
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Affiliation(s)
- Lisa Gallicchio
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Emily Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Janet S de Moor
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Joanne Elena
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Margaret Farrell
- Division of Communications and Marketing, Office of the Director, National Institutes of Health
| | - Paige Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Sandra A Mitchell
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Michelle A Mollica
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Frank Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Nicole Gottlieb Saiontz
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Li Zhu
- Statistical Research and Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Julia Rowland
- Smith Center for Healing and the Arts, Washington DC
| | - Deborah K Mayer
- School of Nursing, University of North Carolina at Chapel Hill; University of North Carolina Lineberger Comprehensive Cancer Center
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12
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Weaver KE, Klepin HD, Wells BJ, Dressler EV, Winkfield KM, Lamar ZS, Avery TP, Pajewski NM, Hundley WG, Johnson A, Davidson EC, Lopetegui M, Foraker RE. Cardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability Study. JMIR Cancer 2021; 7:e18396. [PMID: 33475511 PMCID: PMC7861995 DOI: 10.2196/18396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiovascular health is of increasing concern to breast cancer survivors and their health care providers, as many survivors are more likely to die from cardiovascular disease than cancer. Implementing clinical decision support tools to address cardiovascular risk factor awareness in the oncology setting may enhance survivors' attainment or maintenance of cardiovascular health. OBJECTIVE We sought to evaluate survivors' awareness of cardiovascular risk factors and examine the usability of a novel electronic health record enabled cardiovascular health tool from the perspective of both breast cancer survivors and oncology providers. METHODS Breast cancer survivors (n=49) recruited from a survivorship clinic interacted with the cardiovascular health tool and completed pre and posttool assessments about cardiovascular health knowledge and perceptions of the tool. Oncologists, physician assistants, and nurse practitioners (n=20) who provide care to survivors also viewed the cardiovascular health tool and completed assessments of perceived usability and acceptability. RESULTS Enrolled breast cancer survivors (84% White race, 4% Hispanic ethnicity) had been diagnosed 10.8 years ago (SD 6.0) with American Joint Committee on Cancer stage 0, I, or II (45/49, 92%). Prior to viewing the tool, 65% of survivors (32/49) reported not knowing their level for one or more cardiovascular health factors (range 0-4). On average, only 45% (range 0%-86%) of survivors' known cardiovascular health factors were at an ideal level. More than 50% of survivors had ideal smoking status (45/48, 94%) or blood glucose level (29/45, 64%); meanwhile, less than 50% had ideal blood pressure (12/49, 24%), body mass index (12/49, 24%), cholesterol level (17/35, 49%), diet (7/49, 14%), and physical activity (10/49. 20%). More than 90% of survivors thought the tool was easy to understand (46/47, 98%), improved their understanding (43/47, 91%), and was helpful (45/47, 96%); overall, 94% (44/47 survivors) liked the tool. A majority of survivors (44/47, 94%) thought oncologists should discuss cardiovascular health during survivorship care. Most (12/20, 60%) oncology providers (female: 12/20, 60%; physicians: 14/20, 70%) had been practicing for more than 5 years. Most providers agreed the tool provided useful information (18/20, 90%), would help their effectiveness (18/20, 90%), was easy to use (20/20, 100%), and presented information in a useful format (19/20, 95%); and 85% of providers (17/20) reported they would use the tool most or all of the time when providing survivorship care. CONCLUSIONS These usability data demonstrate acceptability of a cardiovascular health clinical decision support tool in oncology practices. Oncology providers and breast cancer survivors would likely value the integration of such apps in survivorship care. By increasing awareness and communication regarding cardiovascular health, electronic health record-enabled tools may improve survivorship care delivery for breast cancer and ultimately patient outcomes.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Heidi D Klepin
- Section on Hematology-Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Department of Family Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Karen M Winkfield
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Zanetta S Lamar
- Section on Hematology-Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Tiffany P Avery
- Section on Hematology-Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - W Gregory Hundley
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Aimee Johnson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Eleanor C Davidson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Marcelo Lopetegui
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Randi E Foraker
- Institute for Informatics, Washington University in St Louis School of Medicine, St Louis, MO, United States
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13
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Lin AW, Baik SH, Aaby D, Tello L, Linville T, Alshurafa N, Spring B. eHealth Practices in Cancer Survivors With BMI in Overweight or Obese Categories: Latent Class Analysis Study. JMIR Cancer 2020; 6:e24137. [PMID: 33156810 PMCID: PMC7746487 DOI: 10.2196/24137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background eHealth technologies have been found to facilitate health-promoting practices among cancer survivors with BMI in overweight or obese categories; however, little is known about their engagement with eHealth to promote weight management and facilitate patient-clinician communication. Objective The objective of this study was to determine whether eHealth use was associated with sociodemographic characteristics, as well as medical history and experiences (ie, patient-related factors) among cancer survivors with BMI in overweight or obese categories. Methods Data were analyzed from a nationally representative cross-sectional survey (National Cancer Institute’s Health Information National Trends Survey). Latent class analysis was used to derive distinct classes among cancer survivors based on sociodemographic characteristics, medical attributes, and medical experiences. Logistic regression was used to examine whether class membership was associated with different eHealth practices. Results Three distinct classes of cancer survivors with BMI in overweight or obese categories emerged: younger with no comorbidities, younger with comorbidities, and older with comorbidities. Compared to the other classes, the younger with comorbidities class had the highest probability of identifying as female (73%) and Hispanic (46%) and feeling that clinicians did not address their concerns (75%). The older with comorbidities class was 6.5 times more likely than the younger with comorbidities class to share eHealth data with a clinician (odds ratio [OR] 6.53, 95% CI 1.08-39.43). In contrast, the younger with no comorbidities class had a higher likelihood of using a computer to look for health information (OR 1.93, 95% CI 1.10-3.38), using an electronic device to track progress toward a health-related goal (OR 2.02, 95% CI 1.08-3.79), and using the internet to watch health-related YouTube videos (OR 2.70, 95% CI 1.52-4.81) than the older with comorbidities class. Conclusions Class membership was associated with different patterns of eHealth engagement, indicating the importance of tailored digital strategies for delivering effective care. Future eHealth weight loss interventions should investigate strategies to engage younger cancer survivors with comorbidities and address racial and ethnic disparities in eHealth use.
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Affiliation(s)
- Annie Wen Lin
- Department of Nutrition, Benedictine University, Lisle, IL, United States.,Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Sharon H Baik
- Department of Supportive Care Medicine, City of Hope Medical Cancer Center, Duarte, CA, United States.,Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - David Aaby
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Leslie Tello
- Department of Nutrition, Benedictine University, Lisle, IL, United States
| | - Twila Linville
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Nabil Alshurafa
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
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14
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Kennedy MA, Bayes S, Galvão DA, Singh F, Spry NA, Davis M, Chee R, Zissiadis Y, Hart NH, Taaffe DR, Newton RU. If you build it, will they come? Evaluation of a co-located exercise clinic and cancer treatment centre using the RE-AIM framework. Eur J Cancer Care (Engl) 2020; 29:e13251. [PMID: 32495410 DOI: 10.1111/ecc.13251] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/20/2019] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Employ the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the effectiveness of a co-located exercise clinic model in increasing access to exercise for people undergoing cancer treatment in a private clinic in Western Australia. METHODS This retrospective evaluation utilised a mixed-method approach to gather feedback from key stakeholder groups involved with the exercise clinic. Questionnaires and workout summary sheets were gathered from 237 exercise clinic participants over the 50-month evaluation period. These were supplemented by survey results from 119 patients who received cancer treatment at the facility, and semi-structured interviews from seven radiation oncologists, eight nurses, and three accredited exercise physiologists involved with the exercise clinic. RESULTS The co-located clinic demonstrated positive outcomes related to effectiveness and adoption. Participant feedback indicated satisfaction with the exercise programming (effectiveness), and clinicians were receptive to referring patients to the clinic (adoption). However, no clear implementation or maintenance plan was employed and overall reach (12%) remained suboptimal throughout the evaluation period. CONCLUSION Co-locating an exercise clinic into a treatment facility does not in itself overcome the logistical challenges of providing integrated exercise services to people during cancer treatment. To enhance its utilisation, an implementation plan needs to accompany the intervention.
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Affiliation(s)
- Mary A Kennedy
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Sara Bayes
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Favil Singh
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Nigel A Spry
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,GenesisCare, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Perth, WA, Australia
| | | | - Raphael Chee
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,GenesisCare, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Perth, WA, Australia
| | - Yvonne Zissiadis
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,GenesisCare, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Perth, WA, Australia
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,School of Exercise and Nutrition Sciences, University of Queensland, Brisbane, Qld, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,School of Exercise and Nutrition Sciences, University of Queensland, Brisbane, Qld, Australia
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15
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Rates of underuse of statins among cancer survivors versus controls: NHANES 2011-2016. J Cancer Surviv 2020; 14:434-443. [PMID: 32076992 DOI: 10.1007/s11764-020-00865-z] [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: 11/17/2019] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Cardiovascular disease (CVD) is a major non-cancer cause of mortality among cancer survivors, and statin therapy is the mainstay of cardiovascular risk management. However, little is known about adherence to statin therapy relative to current guidelines for the management of cholesterol among cancer survivors. We investigated the prevalence of statin-eligible but untreated individuals among cancer survivors and factors associated with underuse of statins. METHODS We used US National Health and Nutrition Examination Survey data (2011-2016) and identified 706 cancer survivors and matched controls (1:2) by age and sex. We identified participants who met the American College of Cardiology/American Heart Association (2018) guidelines but were not currently in treatment. We estimated the proportion of patients who were statin-eligible but untreated and performed multivariable logistic regression analysis to identify the factors associated with underuse of statins. RESULTS The mean age of the total sample was 62.2 years (standard deviation, 9.1). Among the total participants, 37.5% of cancer survivors and 37.2% of controls were statin-eligible but untreated. The crude statin-eligible untreated proportion was 41.2% among cancer survivors who had received a cancer diagnosis within 3 years and 40.3% among long-term survivors of 10 years or more. In multivariate analysis, old age, male sex, lack of a usual source of care, current smoking, and low household income were significantly associated with statin-eligible untreated status. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS More than one-third of cancer survivors were statin-eligible but untreated under current guidelines. There is room for improvement to reduce the burden of non-cancer mortality by managing traditional cardiovascular risk factors.
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