Institute of medicine recommendations for improving the quality of cancer care: what do they mean for the general internist?

Integrated Moving on After Breast Cancer and Culturally Adapted Cognitive Behavior Therapy intervention for depression and anxiety among Pakistani women with breast cancer: Protocol of a randomized controlled trial

Objective

The diagnosis and treatment of breast cancer is associated with significant distress that has huge impact on survivors' quality of life. The objective of this study is to assess the effectiveness of an integrated intervention "Moving on After Breast Cancer (ABC) Plus culturally adapted Cognitive Behavior Therapy" (Moving on ABC Plus).

Method

This is a randomized controlled trial that aims to recruit 354 breast cancer survivors from the inpatient and outpatient oncology departments in public and private hospitals in Karachi, Hyderabad, Lahore, Multan, and Rawalpindi in Pakistan. Patients scoring 10 or above on either the Patient Health Questionnaire-9 and/or the Generalized Anxiety Disorder scale (GAD-7) will be recruited. Baseline assessments will include Functional Assessment of Cancer Therapy-Breast; EuroQol-5D; Multidimensional Scale for Perceived Social Support; Intrusive Thoughts Scale; and Rosenberg Self-Esteem Scale. Participants randomized into intervention arm, Moving on ABC Plus, will receive 12 individual therapy sessions over 4 months. Follow-up will be completed at 4- and 6-month post-randomization, using all baseline instruments along with the Client Satisfaction Questionnaire (CSQ-8). We will also explore the participants', their family members', and the therapists' experiences of the trial and intervention.

Results

We will be assessing the effectiveness of intervention in reducing depression and anxiety in breast cancer survivors as a primary outcome of the trial. The secondary outcomes will include effectiveness of intervention in terms of reduction in intrusive thoughts and improvement in health-related quality of life, self-esteem, and perceived social support.

Conclusion

The results of the study will inform the design of a future larger randomized control trial with long-term follow-up.

Continuity of Care in Swiss Cancer Patients Using Claims Data

BACKGROUND

Continuity of care is positively associated with beneficial patient outcomes. Data on the level of continuity of care in the ambulatory setting in Switzerland are lacking.

AIM

The aim of this study was to evaluate continuity of care in Swiss cancer patients based on routine data of mandatory health insurance using four established continuity scales.

METHODS

Retrospective analysis of Swiss claims data (N=23'515 patients with incident use of antineoplastics). The Usual Provider Continuity score, the Modified Modified Continuity Index, the Continuity of Care index, and the Sequential Continuity Index were analyzed based on consultations with general practitioners (GPs), physician specialists and ambulatory hospital wards.

RESULTS

Using information of health insurance claims, the number of consultations and the general level of continuity of care in Swiss cancer patients are high. Continuity of care scores were significantly associated with sociodemographic and regional factors. When focusing on consultations with GPs only, all four scores consistently showed high values indicating high levels of continuity. Continuity with general practitioners was associated with lower costs and lower risks for hospitalization and death.

CONCLUSION

This is the first study giving insight into continuity of care in Swiss cancer patients. The present study shows that continuity of care is measurable using health insurance claims data. It indicates that continuity with general practitioners is associated with a beneficial outcome.

A narrative synthesis of the quality of cancer care and development of an integrated conceptual framework

The general paradigms that exist to guide measures in quality of care do not sufficiently deal with the changing needs of cancer management. The aim of this study was to review the literature regarding the quality of cancer care and develop a conceptual framework relevant to current practice. A textual narrative review of the literature was conducted by searching electronic databases from the last 10 years. Articles were then screened and included if they were both relevant to the management of cancer and standards in quality of care. Thematic analysis of the included articles was performed. Eighty-three articles were included and 12 domains identified and integrated with current models to develop a conceptual framework. These included: healthcare delivery system; timeliness; access; appropriateness of care; multidisciplinary and coordinated care; patient experience; technical aspects; safety; patient-centred outcomes; disease-specific outcomes; innovation and improvement and value. We propose a conceptual framework for the quality of cancer care based on relevant and current oncology practice. This presents a more practical and comprehensive approach than general models, and can be used by healthcare providers, managers and policy makers to guide and identify the need for metrics for quality improvements.

The primary health care physician and the cancer patient: tips and strategies for managing sexual health

There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples.

Identifying Predictors of Longitudinal Decline in the Level of Medical Care Received by Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study

OBJECTIVES

Characterize longitudinal changes in the use of medical care in adult survivors of childhood cancer.

DATA SOURCES

The Childhood Cancer Survivor Study, a retrospective cohort study of 5+ year survivors of childhood cancer.

STUDY DESIGN

Medical care was assessed at entry into the cohort (baseline) and at most recent questionnaire completion. Care at each time point was classified as no care, general care, or survivor-focused care.

DATA COLLECTION

There were 6,176 eligible survivors. Multivariable models evaluated risk factors for reporting survivor-focused care or general medical care at baseline and no care at follow-up; and survivor-focused care at baseline and general care at follow-up.

PRINCIPAL FINDINGS

Males (RR, 2.3; 95 percent CI 1.8-2.9), earning <$20,000/year (RR, 1.6; 95 percent CI 1.2-2.3) or ≤ high school education (RR, 2.5; 95 percent CI 1.6-3.8 and RR 2.0; 95 percent CI 1.5-2.7 for

CONCLUSIONS

While the incidence of late effects increases over time for survivors, the likelihood of receiving survivor-focused care decreases for vulnerable populations.

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Key Words

• Childhood cancer survivors
• delivery of health care
• health care access
• health insurance
• survivorship

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MESH Headings

• Adolescent
• Adult
• Age Factors
• Female
• Health Services/statistics & numerical data
• Health Status
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Neoplasms/epidemiology
• Neoplasms/therapy
• Retrospective Studies
• Sex Factors
• Socioeconomic Factors
• Survivors/statistics & numerical data
• Young Adult

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Grants

• U24 CA055727 NCI NIH HHS
• CA21765 NCI NIH HHS
• P30 CA008748 NCI NIH HHS
• P30 CA021765 NCI NIH HHS
• CA55727 NCI NIH HHS

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Affiliation(s)

Jacqueline Casillas Address correspondence to Jacqueline Casillas, M.D., M.S.H.S., Department of Pediatrics, University of California, 10833 Le Conte Ave. Room A2-312 MDCC, Los Angeles, CA 90095; e-mail:
Kevin C Oeffinger Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Melissa M Hudson Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Mark L Greenberg Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Mark W Yeazel Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Kirsten K Ness Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Tara O Henderson Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Leslie L Robison Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Gregory T Armstrong Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Qi Liu Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Wendy Leisenring Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Yutaka Yasui Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Paul C Nathan Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA

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