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Radhakrishnan A, Haymart MR. Team-Based Care for Thyroid Cancer: What Is the Role of the Primary Care Physician? Endocr Pract 2024; 30:476-478. [PMID: 38325628 DOI: 10.1016/j.eprac.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Archana Radhakrishnan
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Megan R Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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2
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Hayes BD, Young HG, Atrchian S, Vis-Dunbar M, Stork MJ, Pandher S, Samper S, McCorquodale S, Loader A, Voss C. Primary care provider-led cancer survivorship care in the first 5 years following initial cancer treatment: a scoping review of the barriers and solutions to implementation. J Cancer Surviv 2024; 18:352-365. [PMID: 36376712 DOI: 10.1007/s11764-022-01268-y] [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: 06/02/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To synthesize the barriers to primary care provider (PCP)-led cancer survivorship care (≤ 5 years after initial cancer treatment) experienced by healthcare systems around the world, and to explore potential solutions that would succeed within a developed country. METHODS A scoping review of peer-reviewed articles and grey literature was conducted. Four electronic databases (Medline, Embase, Web of Science Core Collection, and Google Scholar) were searched for articles prior to April 2021. RESULTS Ninety-seven articles published across the globe (USA, Canada, Australia, European Union, and UK) met the review inclusion/exclusion criteria. The four most frequently discussed barriers to PCP-led survivorship care in healthcare systems were as follows: (1) insufficient communication between PCPs and cancer specialists, (2) limited PCP knowledge, (3) time restrictions for PCPs to provide comprehensive survivorship care, and (4) a lack of resources (e.g., survivorship care guidelines). Potential solutions to combat these barriers were as follows: (1) improving interdisciplinary communication, (2) bolstering PCP education, and (3) providing survivorship resources. CONCLUSIONS This scoping review identified and summarized key barriers and solutions to the provision of PCP-led cancer survivorship care. Importantly, the findings from this review provide insight and direction to guide optimization of cancer care practice within BC's healthcare system. IMPLICATIONS FOR CANCER SURVIVORS Optimizing the PCP-led survivorship care model will be a valuable contribution to the field of cancer survivorship care and will hopefully lead to more widespread use of this model, ultimately lessening the growing demand for cancer-specific care by cancer specialists.
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Affiliation(s)
- Brian D Hayes
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Hannah G Young
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Siavash Atrchian
- BC Cancer, Kelowna, Canada
- Department of Surgery, Division of Radiation Oncology and Developmental Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Matthew J Stork
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Satvir Pandher
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sofia Samper
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Sarah McCorquodale
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | | | - Christine Voss
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada.
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada.
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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3
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Halpern M, Mollica MA, Han PK, Tonorezos ES. Myths and Presumptions About Cancer Survivorship. J Clin Oncol 2024; 42:134-139. [PMID: 37972343 PMCID: PMC10824378 DOI: 10.1200/jco.23.00631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
Identifying cancer survivorship myths and presumptions perpetuated in survivorship circles.
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Affiliation(s)
- Michael Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Michelle A. Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Paul K.J. Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Emily S. Tonorezos
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
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4
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Obeid LA, Dhillon HM, Tan SY, Vardy JL. Is there a need for change in cancer survivorship care? A qualitative exploration of survivor experiences and needs at the Sydney Cancer Survivorship Centre Clinic. Support Care Cancer 2023; 31:642. [PMID: 37851274 PMCID: PMC10584705 DOI: 10.1007/s00520-023-08102-w] [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: 01/13/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Effective cancer survivorship care is contingent on a comprehensive understanding and management of the dynamic needs of cancer survivors. The Sydney Cancer Survivorship Centre (SCSC) clinic established a holistic, multidisciplinary model of survivorship care. We aimed to explore survivors' experiences and perceptions of the clinic, and to identify their unmet needs. METHODS Semi-structured focus groups (FGs) involving participants recruited from the SCSC clinic were conducted by an experienced facilitator and observer using a guide covering: survivor perceptions of first SCSC clinic visit, services accessed, ongoing unmet needs, and how needs changed over time. FGs were audio-recorded and transcribed. Interpretive description using a Framework approach was undertaken and participant characteristics summarised descriptively. RESULTS Eight FGs were conducted involving a total of 26 participants (mean age: 60), most were female (n = 20), born in Australia (n = 14), and with breast cancer diagnoses (n = 16). Four overarching themes were identified: (i) perceptions of the SCSC clinic; (ii) patient-centred care; (iii) adjustment to illness; and (iv) external supports and resources. Participants valued the centralisation of multidisciplinary survivorship care at the SCSC clinic, which helped their recovery. Mitigating ongoing treatment sequelae, reassurance of good-health, normalisation of survivorship experiences, and handling caregiver stress represent some needs identified. CONCLUSIONS The SCSC clinic offers holistic, specialised care and reassurance to cancer survivors. Adjustment to the survivorship journey, inter-survivor shared experiences, and management of physical treatment sequelae were perceived as important in their recovery. Managing survivor needs is integral to improving long-term survivorship care.
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Affiliation(s)
- Liam Anthony Obeid
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2137, Australia
| | - Haryana M Dhillon
- Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-Based Decision-Making, The University of Sydney, Camperdown, NSW, Australia
| | - Sim Y Tan
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2137, Australia
- Nutrition and Dietetics Department, Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, Australia
- Sydney Cancer Survivorship Centre, Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, Australia
| | - Janette L Vardy
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2137, Australia.
- Sydney Cancer Survivorship Centre, Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, Australia.
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5
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De Ravin E, Armache M, Campbell F, Rising KL, Worster B, Handley NR, Fundakowski CE, Cognetti DM, Mady LJ. Feasibility and Cost of Telehealth Head and Neck Cancer Survivorship Care: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:1312-1323. [PMID: 36939546 DOI: 10.1002/ohn.213] [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: 08/19/2022] [Revised: 10/28/2022] [Accepted: 11/12/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Evaluate the feasibility and cost-effectiveness of telehealth head and neck cancer (HNC) survivorship care. DATA SOURCES Ovid MEDLINE, Embase, Scopus, CINAHL. REVIEW METHODS A systematic search for peer-reviewed feasibility studies on telehealth models for HNC survivorship care published between 2005 and 2021 was conducted using the terms "head and neck cancer" and "telehealth" and their synonyms. Inclusion criteria were studies on telehealth survivorship program interventions for HNC patients with quantitative feasibility outcome measures (eg, enrollment, retention, attrition/dropout rate, adherence/task completion rate, patient satisfaction, cost). RESULTS Thirty-eight studies out of 1557 identified met inclusion criteria and were included for analysis. Feasibility outcomes evaluated were enrollment and attrition rates, adherence/task completion rates, patient satisfaction, and user feedback surveys in different survivorship domains. Patient enrollment ranged from 20.8% to 85.7%, while attrition ranged from 7% to 47.7%. Overall, adherence was 30.2% higher in the intervention group than in the control group (46.8% vs 16.6%). Studies with cost analysis found telehealth models of care to be statistically significantly less expensive and more cost-efficient than the standard model of care, with a $642.30 saving per patient (n = 3). Telehealth models also substantially reduced work time saving per visit (on average, 7 days per visit). CONCLUSION While telehealth survivorship programs are feasible and cost-effective and are associated with improved patient outcomes, they might not be ideal for every patient. Further investigations are needed to understand the role of telehealth in survivorship care, given the variability in study design, reporting, measures, and methodological quality.
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Affiliation(s)
- Emma De Ravin
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria Armache
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Frank Campbell
- Penn Libraries, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin L Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brooke Worster
- Department of Hospice and Palliative Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nathan R Handley
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher E Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leila J Mady
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Koot A, Soares P, Robenshtok E, Locati LD, de la Fouchardiere C, Luster M, Bongiovanni M, Hermens R, Ottevanger P, Geenen F, Bartѐs B, Rimmele H, Durante C, Nieveen-van Dijkum E, Stalmeier P, Dedecjus M, Netea-Maier R. Position paper from the Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) on the management and shared decision making in patients with low-risk micro papillary thyroid carcinoma. Eur J Cancer 2023; 179:98-112. [PMID: 36521335 DOI: 10.1016/j.ejca.2022.11.005] [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: 09/23/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
The incidence of differentiated thyroid cancer (DTC) has been increasing worldwide, mostly, as an increase in the incidental detection of micro papillary thyroid carcinomas (microPTCs), many of which are potentially overtreated, as suggested by the unchanged mortality. Several international guidelines have suggested a less aggressive approach. More recently, it has been shown that active surveillance or minimally invasive treatments (MIT) are good alternatives for the management of these patients. In this context, patient participation in the decision-making process is paramount. The Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) has undertaken the task to establish consensus and define its position based on the scientific evidence concerning, 1) the current state of diagnostic and management options in microPTCs, including the current opinion of physicians about shared decision making (SDM), 2) the available evidence concerning patients' needs and the available decision instruments, and 3) to provide practical suggestions for implementation of SDM in this context. To improve SDM and patients' participation, knowledge gaps and research directions were highlighted.
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Affiliation(s)
- Anna Koot
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands.
| | - Paula Soares
- Institute for Research and Innovation in Health - i3S/Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal; Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Eyal Robenshtok
- Endocrinology and Metabolism Institute, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Laura D Locati
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Translational Oncology Unit, IRCCS Instituti Clinici Scientifici Maugeri, Pavia, Italy
| | | | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Massimo Bongiovanni
- Internal Medicine Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
| | - Frans Geenen
- Schildklierorganisatie Nederland (SON), the Netherlands
| | | | - Harald Rimmele
- Bundesverband Schilddrüsenkrebs - Ohne Schilddrüse Leben e.V., Germany
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Els Nieveen-van Dijkum
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
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Irurita-Morales P, Soto-Ruiz N, San Martín-Rodríguez L, Escalada-Hernández P, García-Vivar C. Use of Telehealth Among Cancer Survivors: A Scoping Review. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Leticia San Martín-Rodríguez
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Paula Escalada-Hernández
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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8
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Survivors' preferences for the organization and delivery of supportive care after treatment: An integrative review. Eur J Oncol Nurs 2021; 54:102040. [PMID: 34571444 DOI: 10.1016/j.ejon.2021.102040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Quality supportive care during cancer survivorship contributes to positive physical and psychosocial health. However, the potential positive impacts are influenced by survivors' perceptions of and ability to access the supportive care services that they deem important to their well-being. The purpose of this integrative review was to examine cancer survivors' preferences for the organization and delivery of supportive care services in the post-treatment period. METHODS We conducted a systematic search for relevant quantitative, qualitative and mixed methods studies. Included studies were analyzed using directed content analysis, focused on models of care and type of provider, site of care, specialized services, structural supports through transitions, and sources of information. RESULTS Sixty-nine studies were included. Overall, survivors' preferences are not static and fluctuate over time based on their perceived health needs, concerns and points of transition in care. While specialist supportive care led by consultant oncologists is often identified as the preferred model of care, survivors' also express preferences for integrated and shared models of care, involving oncology nurses, primary care and multidisciplinary professionals to optimise coordination and impact of supportive care. Flexibility in care delivery, leveraging technology and expertise, was preferred to ensure convenient and timely access to supportive care. CONCLUSIONS Cancer survivors express preferences for the organization and delivery of supportive care in the post-treatment phase that fluctuate based on their perceived health needs. The development of novel survivorship health services must consider survivors' preferences and allow flexibility in care delivery to facilitate engagement, uptake, and effectiveness.
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9
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Granberg RE, Heyer A, Rising KL, Handley NR, Gentsch AT, Binder AF. Medical Oncology Patient Perceptions of Telehealth Video Visits. JCO Oncol Pract 2021; 17:e1333-e1343. [PMID: 34288697 DOI: 10.1200/op.21.00086] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Telehealth in medical oncology has expanded secondary to the COVID-19 pandemic. However, quantitative research on medical oncology telehealth use shows conflicting results on patient satisfaction, whereas qualitative data are sparse. Our qualitative study aimed to identify the factors influencing patient acceptability of video visits for medical oncology care before and at the onset of the expansion of telehealth because of the COVID-19 pandemic. METHODS Semi-structured interviews were conducted between November 2019 and April 2020 with 20 patients who participated in a telehealth visit with a medical oncology provider at Thomas Jefferson University. RESULTS Of the 20 participants, 13 (65%) were female and 15 (75%) were White, with a mean (standard deviation) age of 60.5 years (11.8). Patients identified convenience, anxiety, COVID-19, and provider preference as positively influencing the acceptability of video visits; however, some patients noted limitations in provider connection, physical examinations, and visit length as disadvantages. Regarding receipt of serious or bad news, some preferred video visits for privacy, immediacy of results, news processing, and family comfort. Others preferred in-person encounters for provider support and the ability to receive written information and in-person referrals. CONCLUSION Patient-perceived factors influencing general acceptability, appropriateness of serious and bad news delivery, and future uses of telehealth were unique to each individual, but shared common themes. Understanding each patient's perspective of telehealth acceptability and tailoring use to their preferences is critical for continued utilization. Further research is needed to understand and address reasons for lack of telehealth uptake among certain patients.
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Affiliation(s)
| | | | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.,Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.,College of Nursing, Thomas Jefferson University, Philadelphia, PA
| | - Nathan R Handley
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Alexzandra T Gentsch
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.,Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Adam F Binder
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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10
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Canadian Resources, Programs, and Models of Care to Support Cancer Survivors' Transition beyond Treatment: A Scoping Review. ACTA ACUST UNITED AC 2021; 28:2134-2145. [PMID: 34207635 PMCID: PMC8293069 DOI: 10.3390/curroncol28030198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 12/01/2022]
Abstract
(1) Background: One in two Canadians will be diagnosed with cancer in their lifetime, but as a result of the progress in diagnosis and treatment, more individuals are surviving cancer than ever before. However, the impact of cancer does not end with treatment. The objectives of this review are to (1) provide a broad overview of the supportive care interventions and models of care that have been researched to support Canadian post-treatment cancer survivors; and (2) analyze how these supportive care interventions and/or care models align with the practice recommendations put forth by Cancer Care Ontario (CCO) and the Canadian Association of Psychosocial Oncology/Canadian Partnership Against Cancer (CAPO/CPAC). (2) Methods: An electronic search was completed in MEDLINE, Embase, PsycINFO, and CINAHL in January 2021. Included studies described supportive care interventions or models of care utilized by adult Canadian cancer survivors. (3) Results: Forty-two articles were included. Survivors utilized a multitude of supportive care interventions, with peer support and physical activity programs being most frequently cited. Four models of follow-up care were identified: primary care, oncology care, shared-care, and transition clinics. The supportive care interventions and models of care variably aligned with the recommendations set by CCO and CAPO/CPAC. The most commonly followed recommendation was the promotion of self-management and quality resources for patients. (4) Conclusions: Results indicate an inconsistency in access to supportive care interventions and the delivery of survivorship care for cancer survivors across Canada. Current efforts are being made to implement the recommendations by CCO and CAPO/CPAC; however, provision of these guidelines remains varied.
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Janmohamed N, Segal P, Corrado AM, Lofters A, Nguyen P, Townsley C, Zahedi A. Endocrinologist-Perceived Factors Affecting the Transition of Thyroid Cancer Patients from Specialist to Primary Care Postcancer Treatment in Ontario, Canada. Thyroid 2021; 31:895-901. [PMID: 33121388 DOI: 10.1089/thy.2020.0413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Thyroid cancer patient discharge patterns from specialists are heterogeneous, with some specialists following patients for a longer period of time than others. With no well-established transitional plan, such as in breast and colorectal cancer, primary care physicians play a variable role in long-term thyroid cancer care. The objective of this study was to examine endocrinologist-perceived factors affecting the transition of care for thyroid cancer patients through a qualitative and quantitative survey of practicing endocrinologists in Ontario, Canada. Methods: All eligible practicing endocrinologists in Ontario were invited to participate in the study, via an email with an embedded survey link. Consent was assumed if the physician completed the survey. The survey collected physician demographics and asked a series of Likert-scale and open-ended questions on their views regarding transitioning care of their thyroid cancer patients. Quantitative analysis was based on mode and variability. Qualitative analysis was completed using inductive thematic analysis. Results: Seventy physicians completed the survey, with a response rate of 35.5%. Based on the responses to the Likert-scale questions, there was a lack of consensus in terms of discharging criteria for patients who had low-risk papillary thyroid cancer, stable thyrotropin levels, multiple nonthyroid-related comorbidities, and hemithyroidectomy with no disease recurrence. The majority of endocrinologists responded that the main factors affecting discharge included whether the primary care physician was able to follow their recommendations, whether the primary care physician could appropriately adjust levothyroxine doses, and whether the patient was confident that their primary care physician could manage their thyroid cancer follow-up. Themes extracted from the open-ended question also indicated that the main factors affecting the transition of care were related to the primary care physician, the patient, the imaging interpretation, and the discharge guidelines. Conclusion: The lack of consensus among endocrinologists affects the transition of patient care, and there is a need to provide clear and accurate information to primary care physicians and thyroid cancer patients on postcancer treatment care. Efforts should be sought to standardize discharge and long-term care.
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Affiliation(s)
- Neha Janmohamed
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Phillip Segal
- Department of Medicine, University Health Network, Toronto, Canada
| | - Ann Marie Corrado
- The Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Aisha Lofters
- Department of Family Practice, The Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Patricia Nguyen
- The Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Carol Townsley
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Canada
| | - Afshan Zahedi
- Thyroid Program, Women's College Hospital, Toronto, Canada
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12
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Radhakrishnan A, Reyes-Gastelum D, Gay B, Hawley ST, Hamilton AS, Ward KC, Wallner LP, Haymart MR. Primary Care Provider Involvement in Thyroid Cancer Survivorship Care. J Clin Endocrinol Metab 2020; 105:5868790. [PMID: 32639557 PMCID: PMC7379904 DOI: 10.1210/clinem/dgaa437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/07/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT While prior research has examined how primary care providers (PCPs) can care for breast and colon cancer survivors, little is known about their role in thyroid cancer survivorship. OBJECTIVE To understand PCP involvement and confidence in thyroid cancer survivorship care. DESIGN/SETTING/PARTICIPANTS We surveyed PCPs identified by thyroid cancer patients from the Georgia and LA SEER registries (n = 162, response rate 56%). PCPs reported their involvement in long-term surveillance and confidence in handling survivorship care (role of random thyroglobulin levels and neck ultrasound, and when to end long-term surveillance and refer back to the specialist). We examined: 1) PCP-reported factors associated with involvement using multivariable analyses; and 2) bivariate associations between involvement and confidence in handling survivorship care. MAIN OUTCOME MEASURES PCP involvement (involved vs not involved) and confidence (high vs low). RESULTS Many PCPs (76%) reported being involved in long-term surveillance. Involvement was greater among PCPs who noted clinical guidelines as the most influential source in guiding treatment (OR 4.29; 95% CI, 1.56-11.82). PCPs reporting high confidence in handling survivorship varied by aspects of care: refer patient to specialist (39%), role of neck ultrasound (36%) and random thyroglobulin levels (27%), and end long-term surveillance (14%). PCPs reporting involvement were more likely to report high confidence in discussing the role of random thyroglobulin levels (33.3% vs 7.9% not involved; P < 0.01). CONCLUSIONS While PCPs reported being involved in long-term surveillance, gaps remain in their confidence in handling survivorship care. Thyroid cancer survivorship guidelines that delineate PCP roles present one opportunity to increase confidence about their participation.
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Affiliation(s)
- Archana Radhakrishnan
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - David Reyes-Gastelum
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brittany Gay
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sarah T Hawley
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lauren P Wallner
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Megan R Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Correspondence and Reprint Requests: Megan R. Haymart, MD, Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Bldg 16, Rm 408E, Ann Arbor, MI 48109.
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13
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Griffith ML, Bischoff LA, Baum HBA. Approach to the Patient With Thyrotoxicosis Using Telemedicine. J Clin Endocrinol Metab 2020; 105:5856156. [PMID: 32525973 PMCID: PMC7454600 DOI: 10.1210/clinem/dgaa373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022]
Abstract
CONTEXT The potential for endocrine care via telemedicine has been recognized since the early 2000s when clinical outcome data demonstrated improvements in glycemic control with telemedicine. The widespread use of telemedicine during the COVID-19 pandemic has pushed telemedicine beyond diabetes care and into clinical areas with a paucity of published data. The evaluation and treatment of thyrotoxicosis heavily relies on laboratory assessment and imaging with physical exam playing a role to help differentiate the etiology and assess the severity of thyrotoxicosis. CASE DESCRIPTION We describe a patient presenting for evaluation of new thyrotoxicosis via telemedicine, and describe modifications to consider for thorough, safe evaluation via telemedicine. CONCLUSION Telemedicine may be an ideal way to assess and treat patients with thyrotoxicosis who are not able to physically attend a visit with an endocrinologist but still have access to a laboratory for blood draws. Potential challenges include access to imaging and high-volume surgeons if needed. Clinical and economic outcomes of telemedicine care of thyrotoxicosis should be studied so that standards of care for endocrine telemedicine can be established.
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Affiliation(s)
- Michelle L Griffith
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lindsay A Bischoff
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Howard B A Baum
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee
- Correspondence and Reprint Requests: Howard B.A. Baum, MD, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, MCE 8210, 1215 21st Avenue South, Nashville, TN 37232. E-mail:
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14
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An exploratory study in breast cancer of factors involved in the use and communication with health professionals of Internet information. Support Care Cancer 2020; 28:4989-4996. [PMID: 32034515 DOI: 10.1007/s00520-020-05335-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/30/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To study the impact of the spontaneous use of Internet on breast cancer patients and on their relationship with health professionals. METHODS A mixed methodology was used. Two questionnaires were designed through three focus groups, and then administered to 186 patients and 59 professionals in order to assess: (1) patients' use of Internet for health-related information and (2) the impact of this information on patients' psychological outcomes and on their relationship with professionals. RESULTS Patients spent more time looking for illness-related information after diagnosis, using interactive communities more than static information websites. Patients and professionals disagreed about the use of Internet in terms of the knowledge it provides, and its psychological impact. The main barrier reported by patients regarding the sharing of online information with their professionals was the belief that it would damage their relationship. CONCLUSIONS Both professionals and patients have a protectionist conception of the therapeutic relationship. This attitude tends to dismiss the positive impact that the use of Internet and the new communication tools may have in cancer patients. New resources should provide an "Internet Prescription" and modes of interaction to facilitate a more open digital communication.
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15
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Lleras de Frutos M, Casellas-Grau A, Sumalla EC, de Gracia M, Borràs JM, Ochoa Arnedo C. A systematic and comprehensive review of internet use in cancer patients: Psychological factors. Psychooncology 2019; 29:6-16. [PMID: 31385400 DOI: 10.1002/pon.5194] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/19/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Affiliation(s)
- María Lleras de Frutos
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain.,Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain
| | - Anna Casellas-Grau
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain.,Observatorio de Atención Psicosocial en Cáncer, Insitut Català d'Oncologia, Barcelona, Spain
| | - Enric C Sumalla
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain
| | - Marta de Gracia
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain
| | - Josep M Borràs
- Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain.,Psycho-Oncology Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Cristian Ochoa Arnedo
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain.,Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain.,Psycho-Oncology Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
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16
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Kwan JYY, Croke J, Panzarella T, Ubhi K, Fyles A, Koch A, Dinniwell R, Levin W, McCready D, Chung C, Liu F, Bender JL. Personalizing post-treatment cancer care: a cross-sectional survey of the needs and preferences of well survivors of breast cancer. ACTA ACUST UNITED AC 2019; 26:e138-e146. [PMID: 31043819 DOI: 10.3747/co.26.4131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Improved treatments resulting in a rising number of survivors of breast cancer (bca) calls for optimization of current specialist-based follow-up care. In the present study, we evaluated well survivors of bca with respect to their supportive care needs and attitudes toward follow-up with various care providers, in varying settings, or mediated by technology (for example, videoconference or e-mail). Methods A cross-sectional paper survey of well survivors of early-stage pT1-2N0 bca undergoing posttreatment follow-up was completed. Descriptive and univariable logistic regression analyses were performed to examine associations between survivor characteristics, supportive care needs, and perceived satisfaction with follow-up options. Qualitative responses were analyzed using conventional content analysis. Results The 190 well survivors of bca who participated (79% response rate) had an average age of 63 ± 10 years. Median time since first follow-up was 21 months. Most had high perceived satisfaction with in-person specialist care (96%, 177 of 185). The second most accepted model was shared care involving specialist and primary care provider follow-up (54%, 102 of 190). Other models received less than 50% perceived satisfaction. Factors associated with higher perceived satisfaction with non-specialist care or virtual follow-up by a specialist included less formal education (p < 0.01) and more met supportive care needs (p < 0.05). Concerns with virtual follow-up included the perceived impersonal nature of virtual care, potential for inadequate care, and confidentiality. Conclusions Well survivors of bca want specialists involved in their follow-up care. Compared with virtual follow-up, in-person follow-up is perceived as more reassuring. Certain survivor characteristics (for example, met supportive care needs) might signal survivor readiness for virtual or non-specialist follow-up. Future work should examine multi-stakeholder perspectives about barriers to and facilitators of shared multimodal follow-up care.
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Affiliation(s)
- J Y Y Kwan
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - J Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - T Panzarella
- Departments of Oncology and Biostatistics, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON
| | - K Ubhi
- ellicsr Health, Wellness and Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - A Fyles
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - A Koch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - R Dinniwell
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - W Levin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - D McCready
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON
| | - C Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - F Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - J L Bender
- ellicsr Health, Wellness and Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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17
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Gray JL, Singh G, Uttley L, Balasubramanian SP. Routine thyroglobulin, neck ultrasound and physical examination in the routine follow up of patients with differentiated thyroid cancer-Where is the evidence? Endocrine 2018; 62:26-33. [PMID: 30128957 PMCID: PMC6153587 DOI: 10.1007/s12020-018-1720-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/10/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Patients with differentiated thyroid cancer (DTC) typically have a favourable prognosis and recurrence as late as 45 years after diagnosis has been reported. International clinical guidelines for monitoring recommend routine thyroglobulin, ultrasound and physical examination for the detection of recurrence. The aim of this review was to systematically review whether routine monitoring using thyroglobulin (Tg), neck ultrasound and physical examination for recurrence in differentiated thyroid cancer patients is effective in improving patient survival and/or quality of life. METHODS Primary studies were retrieved via a comprehensive search of three electronic bibliographic databases (PubMed, Web of Science Core Collection and Cochrane Library) without time restriction. Eligible studies must have reported on disease-free patients with DTC subject to long-term routine surveillance. The primary and secondary outcomes of interest were overall survival (or other survival parameters) and quality of life, respectively. RESULTS Literature searches yielded 5529 citations, which were screened by two reviewers. 241 full texts were retrieved. No randomised controlled trials or two-arm cohort studies on the effectiveness of any of the three specified interventions were identified. However, three 'single-arm' studies reporting long-term follow-up outcomes in patients undergoing regular surveillance were identified and appraised. CONCLUSIONS This review highlights a lack of empirical evidence to support current use of routine surveillance in DTC. Although early detection is possible, routine surveillance may lead to unnecessary intervention.
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Affiliation(s)
- Jessica L Gray
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Gautam Singh
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Lesley Uttley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Saba P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK.
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18
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Bender JL, Cyr AB, Arbuckle L, Ferris LE. Ethics and Privacy Implications of Using the Internet and Social Media to Recruit Participants for Health Research: A Privacy-by-Design Framework for Online Recruitment. J Med Internet Res 2017; 19:e104. [PMID: 28385682 PMCID: PMC5399223 DOI: 10.2196/jmir.7029] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/10/2017] [Accepted: 03/16/2017] [Indexed: 11/17/2022] Open
Abstract
Background The Internet and social media offer promising ways to improve the reach, efficiency, and effectiveness of recruitment efforts at a reasonable cost, but raise unique ethical dilemmas. We describe how we used social media to recruit cancer patients and family caregivers for a research study, the ethical issues we encountered, and the strategies we developed to address them. Objective Drawing on the principles of Privacy by Design (PbD), a globally recognized standard for privacy protection, we aimed to develop a PbD framework for online health research recruitment. Methods We proposed a focus group study on the dietary behaviors of cancer patients and their families, and the role of Web-based dietary self-management tools. Using an established blog on our hospital website, we proposed publishing a recruitment post and sharing the link on our Twitter and Facebook pages. The Research Ethics Board (REB) raised concern about the privacy risks associated with our recruitment strategy; by clicking on a recruitment post, an individual could inadvertently disclose personal health information to third-party companies engaged in tracking online behavior. The REB asked us to revise our social media recruitment strategy with the following questions in mind: (1) How will you inform users about the potential for privacy breaches and their implications? and (2) How will you protect users from privacy breaches or inadvertently sharing potentially identifying information about themselves? Results Ethical guidelines recommend a proportionate approach to ethics assessment, which advocates for risk mitigation strategies that are proportional to the magnitude and probability of risks. We revised our social media recruitment strategy to inform users about privacy risks and to protect their privacy, while at the same time meeting our recruitment objectives. We provide a critical reflection of the perceived privacy risks associated with our social media recruitment strategy and the appropriateness of the risk mitigation strategies that we employed by assessing their alignment with PbD and by discussing the following: (1) What are the potential risks and who is at risk? (2) Is cancer considered “sensitive” personal information? (3) What is the probability of online disclosure of a cancer diagnosis in everyday life? and (4) What are the public’s expectations for privacy online and their views about online tracking, profiling, and targeting? We conclude with a PbD framework for online health research recruitment. Conclusions Researchers, REBs, ethicists, students, and potential study participants are often unaware of the privacy risks of social media research recruitment and there is no official guidance. Our PbD framework for online health research recruitment is a resource for these wide audiences.
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Affiliation(s)
- Jacqueline Lorene Bender
- Electronic Living Laboratory for Interdisciplinary Cancer Survivorship Research (ELLICSR) Health, Wellness, and Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alaina B Cyr
- Cancer Education, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Luk Arbuckle
- Electronic Health Information Lab, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Lorraine E Ferris
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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19
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Huibertse LJ, van Eenbergen M, de Rooij BH, Bastiaens MT, Fossion LMCL, de la Fuente RB, Kil PJM, Koldewijn EL, Meier AHP, Mommers RJM, Niemer AQ, Oddens JR, Oomens EHGM, Prins M, de Roos KP, Thissen MRTM, Timmermans MWH, Wijsman BP, van de Poll-Franse LV, Ezendam NPM. Cancer survivors' preference for follow-up care providers: a cross-sectional study from the population-based PROFILES-registry. Acta Oncol 2017; 56:278-287. [PMID: 28068157 DOI: 10.1080/0284186x.2016.1267398] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The best practice for the organization of follow-up care in oncology is under debate, due to growing numbers of cancer survivors. Understanding survivors' preferences for follow-up care is elementary for designing patient-centred care. Based on data from prostate cancer and melanoma survivors, this study aims to identify: 1) preferences for follow-up care providers, for instance the medical specialist, the oncology nurse or the general practitioner; 2) characteristics associated with these preferences and 3) the preferred care provider to discuss cancer-related problems. MATERIAL AND METHODS Survivors diagnosed with prostate cancer (N = 535) and melanoma (N = 232) between 2007 and 2013 as registered in The Netherlands Cancer Registry returned a questionnaire (response rate was 71% and 69%, respectively). A latent class cluster model analysis was used to define preferences and a multinomial logistic regression analysis was used to identify survivor-related characteristics associated with these preferences. RESULTS Of all survivors, 29% reported no preference, 40% reported a preference for the medical specialist, 20% reported a preference for both the medical specialist and the general practitioner and 11% reported a preference for both the medical specialist and the oncology nurse. Survivors who were older, lower/intermediate educated and women were more likely to have a preference for the medical specialist. Lower educated survivors were less likely to have a preference for both the medical specialist and the general practitioner. Overall, survivors prefer to discuss diet, physical fitness and fatigue with the general practitioner, and hereditary and recurrence with the medical specialist. Only a small minority favored to discuss cancer-related problems with the oncology nurse. CONCLUSION Survivors reported different preferences for follow-up care providers based on age, education level, gender and satisfaction with the general practitioner, showing a need for tailored follow-up care in oncology. The results indicate an urgency to educate patients about transitions in follow-up care.
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Affiliation(s)
- Lotte J. Huibertse
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Mies van Eenbergen
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Belle H. de Rooij
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Maarten T. Bastiaens
- Department of Dermatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | | | - Paul J. M. Kil
- Department of Urology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | - A. H. P. Meier
- Department of Urology, VieCuri Hospital, Venlo, The Netherlands
| | | | - A. Q. Niemer
- Department of Urology, Bernhoven Hospital, Uden, The Netherlands
| | - Jorg R. Oddens
- Department of Urology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | | | - Mandy Prins
- Department of Dermatology, Maxima Medical Center, Eindhoven, The Netherlands
| | | | - Monique R. T. M. Thissen
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Dermatology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Bart P. Wijsman
- Department of Urology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Lonneke V. van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nicole P. M. Ezendam
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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20
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Robertson MC, Tsai E, Lyons EJ, Srinivasan S, Swartz MC, Baum ML, Basen-Engquist KM. Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study. JMIR Mhealth Uhealth 2017; 5:e3. [PMID: 28119278 PMCID: PMC5296620 DOI: 10.2196/mhealth.6970] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/15/2022] Open
Abstract
Background Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term. Objective The aim of this study was to take a qualitative approach to provide practical insight regarding this population’s preferences for the features and messages of an app to increase PA. Methods A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes. Results Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69%) and mostly white (25/35, 71%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values. Conclusions Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors’ preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors.
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Affiliation(s)
- Michael C Robertson
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States.,Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Edward Tsai
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States.,Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, United States
| | - Sanjana Srinivasan
- Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Maria C Swartz
- Center for Recovery, Physical Activity and Nutrition, Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Miranda L Baum
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States
| | - Karen M Basen-Engquist
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States
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