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Sheng JY, Snyder CF, Smith KC, DeSanto J, Mayonado N, Rall S, White S, Blackford AL, Johnston FM, Joyner RL, Mischtschuk J, Peairs KS, Thorner E, Tran PT, Wolff AC, Choi Y. Evaluating potential overuse of surveillance care in cancer survivors. Cancer Med 2023; 12:6139-6147. [PMID: 36369671 PMCID: PMC10028154 DOI: 10.1002/cam4.5346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Survivorship care plans (SCPs) communicate cancer-related information from oncology providers to patients and primary care providers. SCPs may limit overuse testing by specifying necessary follow-up care. From a randomized, controlled trial of SCP delivery, we examined whether cancer-related tests not specified in SCPs, but conducted after SCP receipt, were appropriate or consistent with overuse. METHODS Survivors of breast, colorectal, or prostate cancer treated at urban-academic or rural-community health systems were randomized to one of three SCP delivery arms. Tests during 18 months after SCP receipt were classified as consistent with overuse if they were (1) not included in SCPs and (2) on a guideline-based predetermined list of "not recommended surveillance." After chart abstraction, physicians performed review and adjudication of potential overuse. Descriptive analyses were conducted of tests consistent with overuse. Negative binomial regression models determined if testing consistent with overuse differed across study arms. RESULTS Among 316 patients (137 breast, 67 colorectal, 112 prostate), 140 individual tests were identified as potential overuse. Upon review, 98 were deemed to be consistent with overuse: 78 tumor markers and 20 imaging tests. The majority of overuse testing was breast cancer-related (95%). Across sites, 27 patients (9%) received ≥1 test consistent with overuse; most were breast cancer patients (22/27). Exploratory analyses of overuse test frequency by study arm showed no significant difference. CONCLUSIONS This analysis identified practice patterns consistent with overuse of surveillance testing and can inform efforts to improve guideline-concordant care. Future interventions may include individual practice patterns and provider education.
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Affiliation(s)
- Jennifer Y. Sheng
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Claire F. Snyder
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Katherine C. Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jennifer DeSanto
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Nancy Mayonado
- TidalHealth Richard A. Henson Research InstituteSalisburyMarylandUSA
| | - Susan Rall
- TidalHealth Richard A. Henson Research InstituteSalisburyMarylandUSA
| | - Sharon White
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Amanda L. Blackford
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | | | - Robert L. Joyner
- TidalHealth Richard A. Henson Research InstituteSalisburyMarylandUSA
| | - Joan Mischtschuk
- TidalHealth Richard A. Henson Research InstituteSalisburyMarylandUSA
| | - Kimberly S. Peairs
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Elissa Thorner
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Phuoc T. Tran
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Antonio C. Wolff
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Youngjee Choi
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
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Tsui J, Hudson SV, Rubinstein EB, Howard J, Hicks E, Kieber-Emmons A, Bator A, Lee HS, Ferrante J, Crabtree BF. A mixed-methods analysis of the capacity of the Patient-Centered Medical Home to implement care coordination services for cancer survivors. Transl Behav Med 2018; 8:319-327. [PMID: 29800396 DOI: 10.1093/tbm/ibx059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
There are currently 15.5 million cancer survivors in USA who are increasingly relying on primary care providers for their care. Patient-Centered Medical Homes (PCMHs) have the potential to meet the unique needs of cancer survivors; but, few studies have examined PCMH attributes as potential resources for delivering survivorship care. This study assesses the current care coordination infrastructure in advanced PCMHs, known to be innovative, and explores their capacity to provide cancer survivorship care. We conducted comparative case studies of a purposive sample (n = 9) of PCMHs to examine current care coordination infrastructure and capacity through a mixed- methods analysis. Data included qualitative interviews, quantitative surveys, and fieldnotes collected during 10- to 12-day onsite observations at each practice. Case studies included practices in five states with diverse business models and settings. Eight of the nine practices had National Committee for Quality Assurance Level 3 PCMH recognition. No practices had implemented a systematic approach to cancer survivorship care. We found all practices had a range of electronic population health management tools, care coordinator roles in place for chronic conditions, and strategies or protocols for tracking and managing complex disease groups. We identified potential capacity, as well as barriers, to provide cancer survivorship care using existing care coordination infrastructure developed for other chronic conditions. This existing infrastructure suggests the potential to translate care coordination elements within primary care settings to accelerate the implementation of systematic survivorship care.
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Affiliation(s)
- Jennifer Tsui
- Division of Population Science, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Shawna V Hudson
- Division of Population Science, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Ellen B Rubinstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Jenna Howard
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Elisabeth Hicks
- Department of Family Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Autumn Kieber-Emmons
- Lehigh Valley Health Network/University of Southern Florida Morsani School of Medicine, Allentown, PA, USA
| | - Alicja Bator
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Heather S Lee
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Jeanne Ferrante
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Benjamin F Crabtree
- Division of Population Science, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
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Health-related quality of life and psychological distress among cancer survivors in Southeast Asia: results from a longitudinal study in eight low- and middle-income countries. BMC Med 2017; 15:10. [PMID: 28081724 PMCID: PMC5234136 DOI: 10.1186/s12916-016-0768-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/08/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A better understanding of health-related quality of life (HRQoL) and psychological distress in cancer survivors can raise awareness, promote the development of policies in cancer survivorship care, and facilitate better targeted use of limited resources in low- and middle-income countries (LMICs). The main objectives of this paper were therefore to assess HRQoL and the prevalence of psychological distress amongst cancer survivors in Southeast Asia and identify risk factors of these outcomes. METHODS The ACTION study was a longitudinal study in eight LMICs in Southeast Asia with 5249 first time cancer survivors followed up at 1 year after diagnosis. HRQoL was assessed using the EORTC QLQ-C30 and EQ-5D. Psychological distress (anxiety and depression) was assessed using the Hospital Anxiety and Depression Scale. General linear models and multiple logistic regression were used to identify independent predictors of HRQoL and psychological distress. RESULTS One year after diagnosis, the mean EORTC QLQ-C30 global health score for survivors was 66.2 out of 100 (SD 22.0), the mean index score on the EQ-5D was 0.74 (SD 0.23), 37% of survivors had at least mild levels of anxiety, and 46% showed at least mild levels of depression. Poorest HRQoL and highest prevalence of anxiety and depression were seen in patients with lung cancer and lymphomas, while highest scores and least psychological distress were seen in female patients with breast and cervical cancer. The most significant predictor of poor HRQoL and psychological distress outcomes was cancer stage at diagnosis. Age, co-morbidities, treatment, and several socioeconomic factors were associated with HRQoL and psychological distress. CONCLUSIONS Cancer survivors in LMICs in Southeast Asia have impaired HRQoL and substantial proportions have psychological distress. Patients with advanced cancer stages at diagnosis and those in a poor socioeconomic position were most at risk of such poor outcomes. Supportive interventions for cancer patients that address wider aspects of patient wellbeing are needed, as well as policies that address financial and other barriers to timely treatment.
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Greenlee H, Molmenti CLS, Crew KD, Awad D, Kalinsky K, Brafman L, Fuentes D, Shi Z, Tsai WY, Neugut AI, Hershman DL. Survivorship care plans and adherence to lifestyle recommendations among breast cancer survivors. J Cancer Surviv 2016; 10:956-963. [PMID: 27100859 DOI: 10.1007/s11764-016-0541-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/31/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE The effectiveness of survivorship care plans has not been widely tested. We evaluated whether a one-time brief lifestyle consultation as part of a broader survivorship care plan was effective at changing diet and lifestyle patterns. METHODS A diverse sample of women with stage 0-III breast cancer were randomized to control or intervention groups within 6 weeks of completing adjuvant treatment. Both groups received the National Cancer Institute publication, "Facing Forward: Life after Cancer Treatment." The intervention group also met with a nurse (1 h) and a nutritionist (1 h) to receive personalized lifestyle recommendations based upon national guidelines. Diet, lifestyle, and perceived health were assessed at baseline, 3 and 6 months. Linear regression analyses evaluated the effects of the intervention adjusted for covariates. RESULTS A total of 126 women completed the study (60 control/66 intervention, 61 Hispanic/65 non-Hispanic). At 3 months, the intervention group reported greater knowledge of a healthy diet (P = 0.047), importance of physical activity (P = 0.03), and appropriate use of dietary supplements (P = 0.006) and reported lower frequency of alcohol drinking (P = 0.03) than controls. At 6 months, only greater knowledge of a healthy diet (P = 0.01) persisted. The intervention was more effective among non-Hispanics than Hispanics on improving attitude towards healthy eating (P = 0.03) and frequency of physical activity (P = 0.006). CONCLUSIONS The intervention changed lifestyle behaviors and knowledge in the short-term, but the benefits did not persist. IMPLICATIONS FOR CANCER SURVIVORS Culturally competent long-term behavioral interventions should be tested beyond the survivorship care plan to facilitate long-term behavior change among breast cancer survivors.
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Affiliation(s)
- Heather Greenlee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.
| | - Christine L Sardo Molmenti
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Katherine D Crew
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Danielle Awad
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Kevin Kalinsky
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lois Brafman
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Deborah Fuentes
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Zaixing Shi
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA
| | - Wei-Yann Tsai
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alfred I Neugut
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dawn L Hershman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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