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Gonzalez N, Mead KH, Pratt-Chapman ML, Arem H. Healthcare utilization in cancer survivors: six-month longitudinal cohort data. Cancer Causes Control 2022; 33:1005-1012. [PMID: 35576025 DOI: 10.1007/s10552-022-01587-6] [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: 09/29/2021] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe healthcare utilization and reasons for delaying medical care and to identify factors that influence high healthcare utilization and care delay among cancer survivors. METHODS Baseline (n = 991) and 6 month follow-up data (n = 777) were collected among breast, prostate, and colorectal cancer survivors from 32 US cancer centers. Participants completed surveys on healthcare utilization (e.g., number of visits to specific providers) and delay of medical care. We categorized participants as high or low users based on median number of visits. We used logistic regression models to examine factors that predicted high healthcare utilization or delay. RESULTS Survivors reported a median of 10.5 visits to healthcare providers and 28% reported ever delaying medical care over 6 months. Compared to prostate cancer survivors, breast and colorectal survivors were 2.4 times more likely (CI = 1.2-4.8) and 4 times more likely (CI = 2.2-7.3) to be high healthcare users, respectively. A higher quality of life score predicted high healthcare utilization (OR = 2.4, CI = 2.0-2.8) and delay of medical care (OR = 1.8, CI = 1.5-2.2). Black survivors were 1.5 times more likely than White survivors to be high healthcare users (CI = 1.1-2.0) and respondents reporting a race category other than White or Black were 1.8 times more likely to delay care (CI = 1.3-2.5). Lower levels of self-efficacy predicted greater healthcare use (OR = 0.7, CI = 0.6-0.8) and delay (OR = 0.6, CI = 0.5-0.7). CONCLUSION Our findings suggest that race, education, marital status, cancer type, time since diagnosis, quality of life, and self-efficacy are associated with both high healthcare utilization and delay among cancer survivors.
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Affiliation(s)
- Nicole Gonzalez
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - K Holly Mead
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Mandi L Pratt-Chapman
- Department of Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC, 20052, USA.,GW Cancer Center, Washington, DC, 20052, USA
| | - Hannah Arem
- Healthcare Delivery Research Program, MedStar Health Research Institute, Washington, DC, 20008, USA. .,Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA.
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Arem H, Pratt-Chapman ML, Landry M, Berg C, Mead KH. Quality of life among cancer survivors by model of cancer survivorship care. J Psychosoc Oncol 2021; 40:561-573. [PMID: 34348589 DOI: 10.1080/07347332.2021.1947937] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND There were an estimated 16.9 million cancer survivors in the United States in 2019, but there is wide variation in survivorship care. Patient-reported outcomes associated with distinct care models are unknown. Thus, we examined differences in quality of life by cancer survivorship care model. MATERIALS AND METHODS We conducted a comparative effectiveness trial, recruiting 32 Commission on Cancer-accredited centers in 2015-2016. Sites were characterized as one of three models: 1) Single Consultative visit, 2) Specialized Longitudinal care with ongoing visits at predetermined intervals, 3) Oncology-Embedded care with visits as needed. We included breast, prostate, and colorectal cancer survivors who had completed active treatment but had not yet attended a survivorship visit (n = 991). Quality of life was assessed using 20 physical, 14 social/emotional, and 7 practical concerns, adapted from the Quality of Life-Breast Cancer Survivors and Functional Living Index Cancer scales.1,2 We used frequencies to describe prevalent symptoms and ANOVA to test for global differences in concerns by survivorship care model, post-hoc Tukey's test for pairwise comparisons, and mixed-effects models to describe changes in quality of life by care model over six-months. RESULTS While unadjusted results suggested that nearly all concerns worsened over six months, no differences were observed in quality of life concerns by care model for physical or practical concerns. At baseline, social/emotional concerns showed a global difference by model (p = 0.008; pairwise results showed fewer concerns among Oncology-Embedded survivors compared to Specialized Consultative survivors; 12.1 vs 15.2, p < 0.05), but no differences were found at six months (global p = 0.311). Mixed effects models showed no change in quality of life by model over six-months. CONCLUSIONS Our results do not support an association between quality of life and care model over six-months. Still, participants reported many quality of life concerns across domains that must be addressed, regardless of care model.
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Affiliation(s)
- Hannah Arem
- Healthcare Delivery Research Program, Medstar Health Research Institute, Washington, DC, USA
| | - Mandi L Pratt-Chapman
- GW Cancer Center, Washington, DC, USA.,School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Megan Landry
- Milken Institute School of Public Health, Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - Carla Berg
- GW Cancer Center, Washington, DC, USA.,Milken Institute School of Public Health, Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - Katherine Holly Mead
- Milken Institute School of Public Health, Department of Health Policy and Management, George Washington University, Washington, DC, USA
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A telephone-based education and support intervention for Rural Breast Cancer Survivors: a randomized controlled trial comparing two implementation strategies in rural Florida. J Cancer Surviv 2020; 14:494-503. [PMID: 32157608 DOI: 10.1007/s11764-020-00866-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare two implementation telephone-based strategies of an evidence-based educational and support intervention to Rural Breast Cancer Survivors (RBCS) in which education was delivered early or after the support component. METHODS Florida RBCS participated in a 12-month randomized clinical trial (RCT) with two arms: Early Education and Support (EE-S) and Support and Delayed Education (S-DE). Arms differed in the timing of 6 support and 3 education sessions. Main outcome was quality of life (QOL, SF-36 physical and mental composite scores [PCS, MCS]). Secondary outcomes were depressive symptoms (Centers for Epidemiologic Studies Depression Scale, CES-D), mood (Profile of Mood States, POMS), and social support (Medical Outcomes Study Social Support Survey, MOS-SSS). Outcomes were analyzed longitudinally using repeated measures models fitted with linear mixed methods. RESULTS Of 432 RBCS (mean 25.6 months from diagnosis), about 48% were 65+, 73% married/partnered, and 28% with ≤high school education. There were no differences between EE-S and S-DE in demographics or outcomes at baseline (mean (standard deviation): SF-36 PCS, 44.88 (10.6) vs. 45.08 (10.6); MCS, 49.45 (11.1) vs. 48.1 (11.9); CES-D, 10.11 (9.8) vs. 10.86 (10.5); POMS-SF, 23.95 (38.6) vs. 26.35 (38.8); MOS-SSS, 79.2 (21.2) vs. 78.66 (21.2)) or over time. One exception was slightly worse mean scores at month 9 in MCS (Cohen's d, - 0.22; 95% CI, - 0.38, - 0.06) and POMS (Cohen's d, 0.23; 95% CI, 0.07, 0.39) for EE-S vs. S-DE. CONCLUSIONS The implementation strategies were equivalent. IMPLICATIONS FOR CANCER SURVIVORS Enhancing support may be considered before delivering not-in-person interventions to RBCS.
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Zhou K, Li M, Wang W, An J, Huo L, He X, Li J, Zhuang G, Li X. Reliability, validity, and sensitivity of the Chinese Short-Form 36 Health Survey version 2 (SF-36v2) in women with breast cancer. J Eval Clin Pract 2019; 25:864-872. [PMID: 30548365 DOI: 10.1111/jep.13088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The psychometrics of the Short-Form 36 Health Survey version 2 (SF-36v2) in female breast cancer patients remains unknown. This study aimed to test the reliability, validity, and sensitivity of the Chinese SF-36v2 in women with breast cancer. METHODS The sample included 326 eligible participants. The reliability and the item convergent and discriminant validity were estimated using Cronbach α (≥0.70) and the multi-trait multi-item matrix analysis, respectively. The structural validity was tested using confirmatory factor analysis. Sensitivity was determined via an analysis of variance and the relative efficiency for initially diagnosed cases (yes vs no) as well as the time since diagnosis (years) before and after stratifying by initially diagnosed cases. RESULTS The overall Cronbach α was 0.91 (eight scales range: 0.72-0.92). All hypothesized item-scale correlations were greater than the alternatives (r ≥ 0.40). With acceptable model fit indices, the physical functioning, role-physical, bodily pain, and general health subscales had stronger contributions to the physical component summary (goodness-of-fit index [GFI]: 0.92, parsimony goodness-of-fit index [PGFI]: 0.60, comparative fit index [CFI]: 0.91, Tucker-Lewis index [TLI]: 0.93, adjusted goodness-of-fit index [AGFI]: 0.91, root mean square error of approximation [RMSEA]: 0.06, normed chi-squared [NC]: 2.65), while the vitality, social functioning, role-emotional, and mental health subscales contributed more to the mental component summary (GFI: 0.91, PGFI: 0.62, CFI: 0.91, TLI: 0.92, AGFI: 0.91, RMSEA: 0.07, NC: 2.76). The relative efficiencies with significant F-statistics were found for mental health (relative efficiency: 34.28; initially diagnosed cases), physical functioning (12.88; time since diagnosis), and physical functioning (5.80), role-physical (5.15), bodily pain (7.70), social functioning (4.62), role-emotional (4.72), mental health (4.75), and physical component summary (6.96; initially diagnosed cases with time since diagnosis; P < 0.05 for all variables). CONCLUSIONS Chinese SF-36v2 has acceptable psychometric properties and is suitable for women with breast cancer.
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Affiliation(s)
- Kaina Zhou
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Minjie Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Wen Wang
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Jinghua An
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lanting Huo
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Xiaole He
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Jin Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Guihua Zhuang
- School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
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de Mello Ramirez Medina J, de Araujo Trugilho I, Mendes GNB, Silva JG, da Silva Paiva MA, de Aguiar SS, Thuler LCS, Bergmann A. Advanced Clinical Stage at Diagnosis of Breast Cancer Is Associated with Poorer Health-Related Quality of Life: A Cross-Sectional Study. Eur J Breast Health 2018; 15:26-31. [PMID: 30816366 DOI: 10.5152/ejbh.2018.4297] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/12/2018] [Indexed: 12/22/2022]
Abstract
Objective To describe the clinical stage in women diagnosed with breast cancer and the association between clinical stage and Health-related quality of life (HRQoL). Materials and Methods This was a cross-sectional study involving women diagnosed with breast cancer. HRQoL was assessed with European Organization for Research and Treatment of Cancer 30-Item Quality of Life Questionnaire and the Quality of Life Questionnaire Breast Cancer 23. The principal exposure was clinical stage (<IIB versus ≥IIB). Simple linear regression was performed and variables with p<0.20 were selected for the multiple linear regression. The final model was composed of statistically significant variables (p<0.05). Results In total, 302 women were included. The majority (58.9%) had been diagnosed with advanced stage cancer (≥IIB). Those at an advanced clinical stage had poorer role functioning (p=0.029), pain (p<0.001), and symptoms in the breast (p<0.001). Conclusion Advanced clinical stage at diagnosis was found to be associated with worse health-related quality of life in breast cancer patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Anke Bergmann
- Department of Clinical Epidemiology, National Cancer Institute, Rio de Janeiro, Brazil
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Henry BJ. Quality of Life and Resilience: Exploring a Fly Fishing Intervention for Breast Cancer Survivors. Clin J Oncol Nurs 2017; 21:E9-E14. [PMID: 28107325 DOI: 10.1188/17.cjon.e9-e14] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Casting for Recovery® therapeutic intervention provides a positive, nontraditional weekend experience for breast cancer survivors. Participants receive fly fishing instruction and participate in structured and unstructured therapeutic activities. OBJECTIVES The aim of this study was to evaluate whether breast cancer survivors had improved resilience and quality-of-life scores after program participation. METHODS Participants completed the Quality of Life Breast Cancer questionnaire and Connor-
Davidson Resilience Scale two weeks before and three and six months after the retreats. FINDINGS No statistically significant differences between pre- and postintervention quality-of-life or resilience scores were noted. However, qualitative data reflected a high degree of participant satisfaction, healing, and learning. Participants added that peer and volunteer connections, group camaraderie, good nutrition, being in nature, and learning a new skill were all positive aspects of the program.
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Swiger PA, Raju D, Breckenridge‐Sproat S, Patrician PA. Adaptation of the Practice Environment Scale for military nurses: a psychometric analysis. J Adv Nurs 2017; 73:2219-2236. [DOI: 10.1111/jan.13276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Pauline A. Swiger
- School of Nursing University of Alabama at Birmingham (UAB) AL USA
- US Army Nurse Corps Fort Sam Houston TX USA
| | - Dheeraj Raju
- School of Nursing University of Alabama at Birmingham (UAB) AL USA
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