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Tarver WL, Justice Z, Jonnalagadda P, Rahurkar S, Obeng-Gyasi S, Krok-Schoen JL, Petrecca A, Paskett ED. A scoping review of the evidence on survivorship care plans among minority, rural, and low-income populations. J Cancer Surviv 2024:10.1007/s11764-024-01609-z. [PMID: 38907799 DOI: 10.1007/s11764-024-01609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 04/19/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE Despite recent advances in cancer control and the number of cancer survivors increasing substantially over the past years, some cancer survivors continue to experience disparities due to barriers to recommended survivorship care. The use of survivorship care plans (SCPs) may be a way to help care for these individuals and their respective issues after they complete their primary treatment. The purpose of this scoping review is to understand the evidence on SCPs among minority, rural, and low-income populations: groups that experience disproportionately poorer cancer health outcomes. METHODS Computer-based searches were conducted in four academic databases. We included peer-reviewed studies published in the English language and conducted in the USA. We systematically extracted information from each paper meeting our inclusion criteria. RESULTS Our search identified 45 articles. The 4 major themes identified were (1) disparities in the receipt of SCPs where populations experience unmet needs; (2) benefits of SCPs, including improved care coordination and self-management of cancer; (3) needs and preferences for survivorship care; and (4) barriers and facilitators to using SCPs. CONCLUSIONS Despite the potential benefits, underserved cancer survivors experience disparities in the receipt of SCPs and continue to have unmet needs in their survivorship care. Survivorship care may benefit from a risk-stratified approach where SCPs are prioritized to survivors belonging to high-risk groups. IMPLICATIONS FOR CANCER SURVIVORS SCPs are a tool to deliver quality care for cancer survivors. While evidence is mixed on SCPs' benefits among the general population, SCPs show promise for underserved populations when it comes to proximal outcomes that contribute to disparities.
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Affiliation(s)
- Willi L Tarver
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | | | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Abigail Petrecca
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Pichardo MS, Ferrucci LM, Molina Y, Esserman DA, Irwin ML. Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review. Cancer Epidemiol Biomarkers Prev 2023; 32:1498-1507. [PMID: 37650844 PMCID: PMC10872641 DOI: 10.1158/1055-9965.epi-22-1147] [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: 10/27/2022] [Revised: 05/02/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
One in three adults in the United States has obesity; a chronic disease that is implicated in the etiology of at least 14 cancers. Cancer is the leading cause of death among U.S. Hispanic/Latino adults and the second most common cause of death, after cardiovascular disease, for Black adults. Our country's legacy in overt discrimination (e.g., slavery, segregation) generated inequities across all spheres in which people function as defined by the socioecological model-biological, individual, community, structural-and two of the many areas in which it manifests today are the disproportionate burden of obesity and obesity-related cancers in populations of color. Inequities due to environmental, social, and economic factors may predispose individuals to poor lifestyle behaviors by hindering an individual's opportunity to make healthy lifestyles choices. In this review, we examined the evidence on obesity and the lifestyle guidelines for cancer prevention in relation to cancer risk and outcomes for Black and Hispanic/Latino adults. We also discussed the role of structural and societal inequities on the ability of these two communities to adopt and maintain healthful lifestyle behaviors in accordance with the lifestyle guidelines for cancer prevention and control.
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Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA 19104
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| | - Yamile Molina
- School of Public Health, University of Illinois Chicago and Cancer Center University of Illinois Chicago, 60607
| | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
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3
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Goerge A, Sanderson M, Flewellen C, Busen K, Nechuta S. The Role of Spirituality on Physical Activity and Sleep Among African American Long-Term Breast Cancer Survivors. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01791-3. [PMID: 37721666 PMCID: PMC11246726 DOI: 10.1007/s40615-023-01791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND African Americans with chronic conditions have reported the importance of spirituality in their lives. Aspects of spirituality have been shown to be related to physical activity (PA) and sleep, and PA and sleep affect quality of life (QOL). This study examined the association between spirituality, PA, and sleep in long-term African American breast cancer survivors. METHODS This cross-sectional study included 323 breast cancer survivors who previously participated in a case-only study. During 2015-2016, participants completed a questionnaire focused on survivorship that used validated measures for spirituality, PA, and sleep. Adjusted binary and multinomial logistic regression models estimated odds ratios (aORs) and 95% confidence intervals (CIs) for the associations of spirituality with total PA, meeting PA guidelines, sleep duration, and sleep medication. RESULTS The mean age at diagnosis was 54.8 (SD = 9.89) years. The range of spirituality scores was 7-48 (median = 44). Among participants who had a score ≥ 44, 59% had high total PA, 61% met PA guidelines, 59% had high sleep duration, and 55% did not use sleep medication. Higher spirituality score was associated with higher total PA (aOR for ≥ 681 min/week: 1.90, 95% CI: 1.03-3.50), meeting PA guidelines (aOR: 1.78, 95% CI: 1.06-2.98), sleep duration > 7 h/night (aOR: 1.72, 95% CI 1.05-2.83), and lack of sleep medication use (aOR: 0.45, 95% CI: 0.24-0.84). CONCLUSION In African American long-term breast cancer survivors, a higher spirituality score increased the likelihood of greater PA and high sleep duration. These results indicate that interventions surrounding spirituality may benefit the QOL of African American breast cancer survivors.
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Affiliation(s)
- Ally Goerge
- College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA
| | - Maureen Sanderson
- Meharry Medical College, School of Medicine, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Cristen Flewellen
- Meharry Medical College, School of Medicine, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Katherine Busen
- College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA
| | - Sarah Nechuta
- College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA.
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Lyson HC, Haggstrom D, Bentz M, Obeng-Gyasi S, Dixit N, Sarkar U. Communicating Critical Information to Cancer Survivors: an Assessment of Survivorship Care Plans in Use in Diverse Healthcare Settings. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:981-989. [PMID: 32128714 PMCID: PMC7483188 DOI: 10.1007/s13187-020-01725-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Survivorship care plans (SCPs) serve to communicate critical information needed for cancer survivors' long-term follow-up care. The extent to which SCPs are tailored to meet the specific needs of underserved patient populations is understudied. To fill this gap, this study aimed to assess the content and communication appropriateness of SCPs collected from diverse healthcare settings. We analyzed collected SCPs (n = 16) for concordance with Institute of Medicine (IOM) recommendations for SCP content and for communication appropriateness using the Suitability Assessment of Materials (SAM) instrument. All plans failed to incorporate all IOM criteria, with the majority of plans (n = 11) incorporating less than 60% of recommended content. The average reading grade level of all the plans was 14, and only one plan received a superior rating for cultural appropriateness. There is significant variation in the format and content of SCPs used in diverse hospital settings and most plans are not written at an appropriate reading grade level nor tailored for underserved and/or minority patient populations. Co-designing SCPs with diverse patient populations is crucial to ensure that these documents are meeting the needs and preferences of all cancer survivors.
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Affiliation(s)
- Helena C Lyson
- University of California San Francisco, Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, UCSF Box 1364, San Francisco, CA, 94143, USA.
| | - David Haggstrom
- VA Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Health Services Research, Regenstrief Institute, Inc., 1481 West 10th Street, Indianapolis, IN, 46202, USA
| | - Michael Bentz
- University of California Berkeley, School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA
| | - Samilia Obeng-Gyasi
- Indiana University Simon Cancer Center, 535 Barnhill Drive RT 440, Indianapolis, IN, 46202, USA
| | - Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, 995 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Urmimala Sarkar
- University of California San Francisco, Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, UCSF Box 1364, San Francisco, CA, 94143, USA
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Upshaw SJ. Using Communication Theory of Identity to Evaluate Decision Aids: Focus Group Research with African American Prostate Cancer Survivors. HEALTH COMMUNICATION 2021; 36:457-467. [PMID: 31814430 DOI: 10.1080/10410236.2019.1700437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prostate cancer remains a significant health concern for U.S. adults, especially African American men, who have higher rates of diagnosis than other racial/ethnic groups. The current study evaluated five prostate cancer decision aids (PCDAs) focused on diagnosis and treatment via seven focus groups with 30 African American survivors. Consistent with the communication theory of identity, three layers of identity were salient in discussing PCDAs: personal, relational, and communal. African American men perceived existing PCDAs positively, evaluating them as accessible, efficacy inducing, and helpful in managing identity threats (personal layer of identity). Participants also found PCDAs to be central to decision making (relational layer of identity). Yet, there were concerns about the perceived lack of representation of African Americans in PCDAs (communal layers of identity). The findings suggest that PCDAs connect to personal and relational layers of identity but do not match expectations of communal identity.
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Hastert TA, McDougall JA, Strayhorn SM, Nair M, Beebe-Dimmer JL, Schwartz AG. Social needs and health-related quality of life among African American cancer survivors: Results from the Detroit Research on Cancer Survivors study. Cancer 2020; 127:467-475. [PMID: 33225460 DOI: 10.1002/cncr.33286] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Social needs may affect cancer survivors' health-related quality of life (HRQOL) above and beyond sociodemographic and cancer-related factors. The purpose of this study was to estimate associations between social needs and HRQOL. METHODS Results included data from 1754 participants in the Detroit Research on Cancer Survivors cohort, a population-based study of African American survivors of breast, colorectal, lung, and prostate cancer. Social needs included items related to food insecurity, utility shutoffs, housing instability, not getting health care because of cost or a lack of transportation, and perceptions of neighborhood safety. HRQOL was measured with the validated Functional Assessment of Cancer Therapy-General (FACT-G). Linear regression models controlled for demographic, socioeconomic, and cancer-related factors. RESULTS More than one-third of the survivors (36.3%) reported social needs including 17.1% of survivors reported 2 or more. The prevalence of social needs ranged from 14.8% for food insecurity to 8.9% for utility shutoffs. FACT-G score differences associated with social needs were -12.2 (95% confidence interval [CI] to -15.2 to -9.3) for not getting care because of a lack of transportation, -11.3 (95% CI, -14.2 to -8.4) for housing instability, -10.1 (95% CI, -12.7 to -7.4) for food insecurity, -9.8 (95% CI, -12.7 to -6.9) for feeling unsafe in the neighborhood, -8.6 (95% CI, -11.7 to -5.4) for utility shutoffs, and -6.7 (95% CI, -9.2 to -4.1) for not getting care because of cost. CONCLUSIONS Social needs were common in this cohort of African American cancer survivors and were associated with clinically significant differences in HRQOL. Clinical oncology care and survivorship care planning may present opportunities to screen for and address social needs to mitigate their impact on survivors' HRQOL.
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Affiliation(s)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Jean A McDougall
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Shaila M Strayhorn
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Jennifer L Beebe-Dimmer
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
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Krok-Schoen JL, Naughton MJ, Noonan AM, Pisegna J, DeSalvo J, Lustberg MB. Perspectives of Survivorship Care Plans Among Older Breast Cancer Survivors: A Pilot Study. Cancer Control 2020; 27:1073274820917208. [PMID: 32233798 PMCID: PMC7143997 DOI: 10.1177/1073274820917208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The Commission on Cancer’s standard 3.3 represents a paradigm shift in the care
of cancer survivors, recommending that survivors receive a treatment summary and
survivorship care plan (SCPs). A focus on older breast cancer survivors is
needed, as they are the majority of the breast cancer population and their
experiences and perspectives of SCPs is limited in the literature. This pilot
study utilized a mixed methods approach (focus groups and self-report
questionnaire data) to gather information on older (≥65 years) breast cancer
survivors’ perspectives of their SCPs, cancer survivorship, and communication
with their health-care providers. The questionnaire was completed individually
by the participants prior to the focus group and contained items on basic
demographics and their health status following cancer treatment. The focus
groups indicated that only a minority of women actually developed a SCP. Those
who developed a SCP in collaboration with their providers valued the personal
care and attention received. However, some participants reported poor
communication with their providers and within their health-care team, resulting
in frustration and confusion. Participants’ suggestions for ideal SCPs included
better education and personalization, particularly in appropriate nutrition and
exercise, and managing side effects and comorbidities. Lastly, the women
believed that additional long-term care resources, such as health coaches, were
important in improving their survivorship. These findings provide insight into
enhancing the content, communication, and application of SCPs to improve the
survivorship experience of older breast cancer survivors.
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Affiliation(s)
- Jessica L Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Michelle J Naughton
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Anne M Noonan
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Janell Pisegna
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jennifer DeSalvo
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Maryam B Lustberg
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, OH, USA
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8
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The use of survivorship care plans by female racial and ethnic minority breast cancer survivors: a systematic review. J Cancer Surviv 2020; 14:806-825. [PMID: 32514908 DOI: 10.1007/s11764-020-00894-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Racial/ethnic breast cancer survivorship disparities persist as minority breast cancer survivors (MBCSs) report fragmentation in survivorship care, namely in the access and delivery of survivorship care plans (SCPs). To better understand care coordination of MCBS, this review elucidated concerns of female MBCS about their preparation for post-treatment survivorship care, the preferred practices for the delivery of a SCP, and the associated content to improve post-treatment survivorship care understanding. METHODS A systematic search of articles from PubMed, Ovid-Medline, CINAHL databases, and bibliographic reviews included manuscripts using keywords for racial/ethnic minority groups and breast cancer survivorship care coordination terms. Salient themes and article quality were analyzed from the extracted data. RESULTS Fourteen included studies represented 5,854 participants and over 12 racial/ethnic groups. The following themes of post-treatment MBCS were identified from the review: (1) uncertainty about post-treatment survivorship care management is a consequence of sub-optimal patient-provider communication; (2) access to SCPs and related materials are desired, but sporadic; and (3) advancements to the delivery and presentation of SCPs and related materials are desired. CONCLUSIONS Representation of only 14 studies indicates that the MBCSs' perspective post-treatment survivorship care is underrepresented in the literature. Themes from this review support access to, and implementation of, culturally tailored SCP for MBCS. There was multi-ethnic acceptance of SCPs as a tool to help improve care coordination. IMPLICATIONS FOR CANCER SURVIVORS These findings highlight the importance of general education about post-treatment survivorship, post-treatment survivorship needs identification, and the elucidation of gaps in effective SCP delivery among MBCS.
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Truant TLO, Varcoe C, Gotay CC, Thorne S. Les soins aux survivants du cancer : vers une grande qualité, en toute équité. Can Oncol Nurs J 2020; 29:163-169. [PMID: 31966016 DOI: 10.5737/23688076293163169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tracy L O Truant
- Directrice ancienne, Recherche, Éducation et Innovation, BC Cancer, Vancouver BC,
| | - Colleen Varcoe
- Professeure, École des sciences infirmières, University of British Columbia,
| | - Carolyn C Gotay
- Professeure émérite, School of Population and Public Health, University of British Columbia,
| | - Sally Thorne
- Professeure, École des sciences infirmières, University of British Columbia,
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Truant TLO, Varcoe C, Gotay CC, Thorne S. Toward equitably high-quality cancer survivorship care. Can Oncol Nurs J 2019; 29:156-162. [PMID: 31966022 DOI: 10.5737/23688076293156162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although models of cancer survivorship care are rapidly evolving, there is increasing evidence of health disparities among cancer survivors. In the current context, Canada's survivorship care systems privilege some and not others to receive high-quality care and optimize their health outcomes. The aim of this study was to improve survivorship care systems by helping clinicians and decision makers to a better understanding of how various psychosocial/political factors, survivors' health experiences and health management strategies might shape the development of and access to high-quality survivorship care for Canadians with cancer. Using a nursing epistemological approach informed by critical and intersectional perspectives, we conducted a three-phased Interpretive Description study. We engaged in critical textual analysis of documentary sources, a secondary analysis of interview transcripts from an existing database, and qualitative interviews with 34 survivors and 12 system stakeholders. On the basis of these data, we identified individual, group, and system factors that contributed to gaps between survivors' expected and actual survivorship care experiences. By understanding what shapes survivorship care systems and resources, we help illuminate and unravel the complex nature of the issue, supporting clinicians and decision makers to find multi-layered approaches for equitably high-quality survivorship care.
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Affiliation(s)
- Tracy L O Truant
- Former Director, Research, Education and Innovation, BC Cancer, Vancouver BC,
| | - Colleen Varcoe
- Professor, School of Nursing, University of British Columbia,
| | - Carolyn C Gotay
- Professor Emeritus, School of Population and Public Health, University of British Columbia,
| | - Sally Thorne
- Professor, School of Nursing, University of British Columbia,
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11
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Meiklejohn JA, Arley B, Bailie R, Adams J, Garvey G, Martin JH, Walpole ET, Valery PC. Community-identified recommendations to enhance cancer survivorship for Aboriginal and Torres Strait Islander people. Aust J Prim Health 2019; 24:233-240. [PMID: 29804561 DOI: 10.1071/py17127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/07/2018] [Indexed: 12/11/2022]
Abstract
Indigenous Australians diagnosed with cancer experience higher mortality and lower survival rates compared to non-Indigenous Australians. Reasons are multifaceted and complex. Knowledge about Indigenous cancer survivors' perspectives of positive cancer survivorship is a gap in research evidence. The study explored cancer survivorship perspectives of Indigenous cancer survivors, their support people and healthcare workers with a view to developing recommendations for cancer survivorship. Indigenous Australians who completed cancer treatment in the previous 6 months to 5 years, their support people and primary healthcare workers were recruited from primary healthcare centres and a large tertiary Queensland hospital. Semi-structured interviews and focus groups were conducted with written and informed consent obtained prior. Participants emphasised key action areas and recommendations to enhance cancer survivorship, namely: establishing a community cancer advocate and peer support program, availability and use of a cancer-specific Indigenous primary healthcare worker and hospital-based Indigenous patient navigator, as well as adoption of question prompt lists and cancer survivorship care plans. Existing research suggests significant benefits from implementing the key recommendations identified in this study. Greater support and commitment across health sectors and funding bodies is needed to promote institutional change and health system development.
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Affiliation(s)
- Judith A Meiklejohn
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Qld 4006, Australia
| | - Brian Arley
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Qld 4006, Australia
| | - Ross Bailie
- Menzies School of Health Research, Level 1, 147 Wharf Street, Spring Hill, Qld 4000, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia
| | - Gail Garvey
- Menzies School of Health Research, Level 1, 147 Wharf Street, Spring Hill, Qld 4000, Australia
| | - Jennifer H Martin
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW 2308, Australia
| | - Euan T Walpole
- Southside Clinical School, University of Queensland, Level 2, Translational Research Institute, Princess Alexandra Hospital, Brisbane, Qld 4072, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Qld 4006, Australia
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12
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Husain M, Nolan TS, Foy K, Reinbolt R, Grenade C, Lustberg M. An overview of the unique challenges facing African-American breast cancer survivors. Support Care Cancer 2018; 27:729-743. [PMID: 30460398 DOI: 10.1007/s00520-018-4545-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/07/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The existence of cancer disparities is well known. Focus on alleviating such disparities centers on diagnosis, treatment, and mortality. This review surveyed current knowledge of health disparities that exist in the acute survivorship period (immediately following diagnosis and treatment) and their contributors, particularly for African-American breast cancer survivors (AA-BCS). METHODS Utilizing the ASCO four components of survivorship care, we explore disparities in surveillance and effects of cancer and therapies that AA-BCS face within the acute survivorship period (the years immediately following diagnosis). A literature review of PUBMED, Scopus, and Cochrane databases was conducted to identify articles related to AA-BCS acute survivorship. The search yielded 97 articles. Of the 97 articles, 38 articles met inclusion criteria. RESULTS AA-BCS experience disparate survivorship care, which negatively impacts quality of life and health outcomes. Challenges exist in surveillance, interventions for late effects (e.g., quality-of-life outcomes, cardiotoxicity, and cognitive changes), preventing recurrence with promotion of healthy living, and coordinating care among the healthcare team. CONCLUSIONS This overview identified current knowledge on the challenges in survivorship among AA-BCS. Barriers to optimal survivorship care inhibit progress in eliminating breast cancer disparities. Research addressing best practices for survivorship care is needed for this population. Implementation of culturally tailored care may reduce breast cancer disparities among AA-BCS.
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Affiliation(s)
- Marium Husain
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA.
| | - Timiya S Nolan
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Kevin Foy
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Raquel Reinbolt
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Cassandra Grenade
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Maryam Lustberg
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
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Keesing S, Rosenwax L, McNamara B. A call to action: The need for improved service coordination during early survivorship for women with breast cancer and partners. Women Health 2018; 59:406-419. [PMID: 29920180 DOI: 10.1080/03630242.2018.1478362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Survivorship is an under-recognized period in the care of women with breast cancer. This paper aimed to determine if supports provided by health services were adequate in meeting the expressed needs of women and partners during survivorship. A mixed-method study consisted of: (1) in-depth interviews with women (n = 18) and partners (n = 8) (completed June 2014-November 2014) and (2) a questionnaire with health providers (n = 34) (completed April 2015) regarding services offered, needs addressed, and barriers to service delivery. Both were completed in Perth, Western Australia. Findings were determined using thematic analysis and descriptive statistics. Many unmet needs were identified by women and partners, including: pain, fatigue, fear of recurrence, employment, leisure, and social and intimacy difficulties. Participants did not receive a formal plan to assist them. Health providers reported a range of supports, including cancer surveillance and management of physical, psychological, emotional, and relationship concerns. However, many barriers concerning service delivery were identified. Despite services reporting that they provided various supports, interview participants did not appear to use and benefit from these. Coordination of service delivery was identified as requiring improvement. The use of survivorship care plans also needs refinement to determine suitability for use during survivorship.
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Affiliation(s)
- Sharon Keesing
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| | - Lorna Rosenwax
- b Health Sciences , Curtin University , Perth , Australia
| | - Beverley McNamara
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
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Knobf MT, Erdos D. "Being connected" The experience of African American women with breast cancer: A community-based participatory research project: Part I. J Psychosoc Oncol 2018; 36:406-417. [PMID: 29781784 DOI: 10.1080/07347332.2018.1454996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The objective was to understand the breast cancer experience of African American (AA) women using a community-based participatory research framework. Qualitative data were collected from five focus groups with 29 participants in four urban cities. "Being Connected" was the major theme that explained the importance of people in their lives as they coped with the diagnosis, treatment, and life after therapy. Faith, talking, information, support, and living with changes were important factors in the process. The breast cancer experience was situated with the AA culture and community and unique aspects were identified for clinical practice in the care of these women.
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Affiliation(s)
- M Tish Knobf
- a Professor, Acute & Health Systems Division, Yale University School of Nursing , West Campus Drive, Orange , CT , USA
| | - Diane Erdos
- b Courtesy Faculty, Yale University School of Nursing , Orange , CT , USA
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Christian AH, O'Malley D, Barac A, Miller SM, Hudson SV. Cardiovascular risk and communication among early stage breast cancer survivors. PATIENT EDUCATION AND COUNSELING 2017; 100:1360-1366. [PMID: 28215826 PMCID: PMC5568653 DOI: 10.1016/j.pec.2017.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE African American (AA) women have disproportionately high rates of cardiovascular (CV) risk factors that, coupled with potentially cardiotoxic breast cancer (BC) therapies, place them at risk of adverse CV outcomes. The purpose of this study was to assess CV risk factors among white and AA BC survivors and perceptions of patient-provider CV-related communication and post-treatment information needs. METHODS Early-stage, English-speaking BC survivors were recruited through community-based survivorship organizations/clinics in New Jersey. Qualitative, semi-structured interviews and a brief survey of socio-demographics and comorbidities were conducted. RESULTS BC survivors reported high rates of CV risk factors. Most reported their health as good/excellent despite their cancer history and CV risk profile. Approximately half of overweight/obese BC survivors reported no weight-related conversation with their health care team and, among those who reported discussion, 36% indicated it was self-initiated and dismissed. More than half of BC survivors' reported a desire for lifestyle-related information and guidance. CONCLUSION BC survivors may not understand how their separate, yet cumulative, health issues can impact their CV risk. PRACTICE IMPLICATIONS Patient-provider communication on behavioral risk factor modification and CV risk is needed, particularly among at-risk subgroups such as AA and obese BC survivors, to improve BC and CV outcomes.
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Affiliation(s)
- Allison H Christian
- Department of Health Education and Behavioral Science, Rutgers, The State University, School of Public Health, Piscataway, NJ, United States; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States.
| | | | - Ana Barac
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States
| | - Suzanne M Miller
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| | - Shawna V Hudson
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, United States
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16
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Abstract
BACKGROUND Survivorship care plans (SCPs) are internationally endorsed as an important tool to enhance post-treatment survivorship care. To support broad implementation of SCPs, we investigated survivors' preferences regarding SCPs. MATERIAL AND METHODS The study was conducted at a comprehensive cancer center. Eligible patients from 10 clinical services, generally up to 12 months following end of treatment (EOT) were approached in clinics or via telephone. A purpose-designed survey assessed survivors' intended use of a SCP and preferences regarding format and content. Intended minimum sample size of 200. RESULTS Two hundred and thirty surveys were returned (response rate 68%). Of the 230 participants, over 55% had completed treatment within six months, 35% between six and 12 months, and 10% were receiving ongoing treatments. Most (82%) had not received a SCP and more than one third (42%) reported receiving no information resources at EOT. Almost all (98%) desired further information. Most common information elements desired in a SCP: 'list of symptoms to watch out for and report' (76%), 'summary of treatment received' (70%) and 'things I can do to look after myself' (67%). Most common suggested uses were as: 'a record of cancer treatment' (63%), 'a reminder of things to do to look after myself ' (57%) and 'to help me understand my cancer experience' (56%). Over half (52%) would share the information with their general practitioner. Most indicated preference for paper-based SCPs (91%). There was support for both brief (36%) and detailed versions (42%). Over half requested the information be delivered in a face-to-face discussion with a health professional. Regular telephone support from the treating health care team was most commonly suggested as an additional service to support survivors after EOT. CONCLUSIONS Although similar to international findings, results suggest alternate ways of providing the information that survivors desire. Most desired SCP elements have been defined. A flexible approach to SCP interventions is justified.
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Affiliation(s)
- Nicole A. Kinnane
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amanda J. Piper
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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17
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Burke NJ, Napoles TM, Banks PJ, Orenstein FS, Luce JA, Joseph G. Survivorship Care Plan Information Needs: Perspectives of Safety-Net Breast Cancer Patients. PLoS One 2016; 11:e0168383. [PMID: 27992491 PMCID: PMC5161365 DOI: 10.1371/journal.pone.0168383] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/29/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Despite the Institute of Medicine's (IOM) 2005 recommendation, few care organizations have instituted standard survivorship care plans (SCPs). Low health literacy and low English proficiency are important factors to consider in SCP development. Our study aimed to identify information needs and survivorship care plan preferences of low literacy, multi-lingual patients to support the transition from oncology to primary care and ongoing learning in survivorship. METHODS We conducted focus groups in five languages with African American, Latina, Russian, Filipina, White, and Chinese medically underserved breast cancer patients. Topics explored included the transition to primary care, access to information, knowledge of treatment history, and perspectives on SCPs. RESULTS Analysis of focus group data identified three themes: 1) the need for information and education on the transition between "active treatment" and "survivorship"; 2) information needed (and often not obtained) from providers; and 3) perspectives on SCP content and delivery. CONCLUSIONS Our data point to the need to develop a process as well as written information for medically underserved breast cancer patients. An SCP document will not replace direct communication with providers about treatment, symptom management and transition, a communication that is missing in participating safety-net patients' experiences of cancer care. Women turned to peer support and community-based organizations in the absence of information from providers. IMPLICATIONS FOR CANCER SURVIVORS "Clear and effective" communication of survivorship care for safety-net patients requires dedicated staff trained to address wide-ranging information needs and uncertainties.
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Affiliation(s)
- Nancy J. Burke
- University of California, Merced, School of Social Sciences, Humanities, & Arts, Merced, California, United States of America
- University of California, San Francisco, Department of Anthropology, History, and Social Medicine, San Francisco, California, United States of America
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Tessa M. Napoles
- University of California, San Francisco, Department of Anthropology, History, and Social Medicine, San Francisco, California, United States of America
| | - Priscilla J. Banks
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Fern S. Orenstein
- Breast Care Disparities Program, San Francisco General Hospital, San Francisco, California, United States of America
| | - Judith A. Luce
- Breast Care Disparities Program, San Francisco General Hospital, San Francisco, California, United States of America
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Galen Joseph
- University of California, San Francisco, Department of Anthropology, History, and Social Medicine, San Francisco, California, United States of America
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States of America
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18
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Selove R, Foster M, Wujcik D, Sanderson M, Hull PC, Shen-Miller D, Wolff S, Friedman D. Psychosocial concerns and needs of cancer survivors treated at a comprehensive cancer center and a community safety net hospital. Support Care Cancer 2016; 25:895-904. [PMID: 27822710 DOI: 10.1007/s00520-016-3479-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Rebecca Selove
- Tennessee State University, 3500 John A. Merritt Boulevard, Nashville, TN, 37209, USA.
| | - Maya Foster
- Tennessee State University, 3500 John A. Merritt Boulevard, Nashville, TN, 37209, USA
| | - Debra Wujcik
- Vanderbilt University, 2141 Blakemore Avenue, Nashville, TN, 37208, USA
| | - Maureen Sanderson
- Meharry Medical College, 1005 Dr. D.B. Todd Junior Boulevard, Nashville, TN, 37208, USA
| | - Pamela C Hull
- Vanderbilt University, 2525 West End Avenue, Suite 800, Nashville, TN, 37203, USA
| | - David Shen-Miller
- Tennessee State University, 3500 John A. Merritt Boulevard, Nashville, TN, 37209, USA
| | - Steven Wolff
- Meharry Medical College, 1005 Dr. D.B. Todd Junior Boulevard, Nashville, TN, 37208, USA
| | - Debra Friedman
- Vanderbilt University, 2220 Pierce Avenue, Nashville, TN, 37232, USA
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19
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Jones T, Lockhart JS, Mendelsohn-Victor KE, Duquette D, Northouse LL, Duffy SA, Donley R, Merajver SD, Milliron KJ, Roberts JS, Katapodi MC. Use of Cancer Genetics Services in African-American Young Breast Cancer Survivors. Am J Prev Med 2016; 51:427-36. [PMID: 27117712 DOI: 10.1016/j.amepre.2016.03.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/25/2016] [Accepted: 03/22/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION African-American women have higher rates of early-onset breast cancer compared with their Caucasian counterparts; yet, when diagnosed with breast cancer at a young age, they underuse genetic counseling and testing to manage their risk of developing future cancers. METHODS Self-reported baseline data were collected between September 2012 and January 2013 and analyzed in 2014 from a subpopulation of 340 African-American young breast cancer survivors (YBCSs) enrolled in an RCT. YBCSs were diagnosed with invasive breast cancer or ductal carcinoma in situ between ages 20 and 45 years and were randomly selected from a statewide cancer registry. Logistic regression examined predictors of using cancer genetics services. RESULTS Overall, 28% of the sample reported having genetic counseling and 21% reported having genetic testing, which were significantly lower (p≤0.005) compared with white/other YBCSs participating in the parent study. In a multivariate analysis, income was positively associated with counseling (B=0.254, p≤0.01) and testing (B=0.297, p≤0.01), whereas higher education levels (B=-0.328, p≤0.05) and lack of access to healthcare services owing to cost (B=-1.10, p≤0.03) were negatively associated with genetic counseling. Lower income and lack of care because of high out-of-pocket costs were commonly reported barriers. CONCLUSIONS Despite national recommendations for genetic evaluation among women with early-onset breast cancer, few African-American YBCSs reported undergoing genetic counseling and testing. Most reported that their healthcare provider did not recommend these services. Interventions addressing patient, provider, and structural healthcare system barriers to using genetic counseling and testing in this population are needed.
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Affiliation(s)
- Tarsha Jones
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services at Dana-Farber Cancer Institute, Boston, Massachusetts; Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | - Joan S Lockhart
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | | | - Debra Duquette
- Michigan Department of Health and Human Services, Cancer Genomics Program, Lansing, Michigan
| | | | - Sonia A Duffy
- Ohio State University College of Nursing, Columbus, Ohio
| | - Rosemary Donley
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | | | - Kara J Milliron
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - J Scott Roberts
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Maria C Katapodi
- University of Michigan School of Nursing, Ann Arbor, Michigan; University of Basel, Institute of Nursing Science, Basel, Switzerland.
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Barsevick AM, Leader A, Bradley PK, Avery T, Dean LT, DiCarlo M, Hegarty SE. Post-treatment problems of African American breast cancer survivors. Support Care Cancer 2016; 24:4979-4986. [PMID: 27543161 DOI: 10.1007/s00520-016-3359-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE African American breast cancer survivors (AABCS) have a lower survival rate across all disease stages (79 %) compared with White survivors (92 %) and often have more aggressive forms of breast cancer requiring multimodality treatment, so they could experience a larger burden of post-treatment quality of life (QOL) problems. This paper reports a comprehensive assessment of the number, severity, and domains of problems faced by AABCS within 5 years after treatment completion and identifies subgroups at risk for these problems. METHODS A population-based random sample was obtained from the Pennsylvania Cancer Registry of African American females over 18 years of age who completed primary treatment for breast cancer in the past 5 years. A mailed survey was used to document survivorship problems. RESULTS Two hundred ninety-seven AABCS completed the survey. The median number of survivor problems reported was 15. Exploratory factor analysis of the problem scale revealed four domains: emotional problems, physical problems, lack of resources, and sexuality problems. Across problem domains, younger age, more comorbid conditions, and greater medical mistrust were risk factors for more severe problems. CONCLUSIONS The results demonstrated that AABCS experienced significant problem burden in the early years after diagnosis and treatment. In addition to emotional and physical problem domains that were documented in previous research, two problem domains unique to AABCS included lack of resources and sexuality concerns. At risk groups should be targeted for intervention. The study results reported in this manuscript will inform future research to address problems of AABCS as they make the transition from cancer patient to cancer survivor.
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Affiliation(s)
- Andrea M Barsevick
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Amy Leader
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | | | | | | | - Melissa DiCarlo
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Sarah E Hegarty
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
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21
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O'Malley DM, Hudson SV, Ohman-Strickland PA, Bator A, Lee HS, Gundersen DA, Miller SM. Follow-up Care Education and Information: Identifying Cancer Survivors in Need of More Guidance. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:63-9. [PMID: 25524391 PMCID: PMC4475492 DOI: 10.1007/s13187-014-0775-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Cancer survivors engage in cancer screenings and protective health behaviors at suboptimal rates despite their increased risk for future illness. Survivorship care plans and other educational strategies to prepare cancer survivors to adopt engaged roles in managing long-term follow-up care and health risks are needed. In a sample of cancer survivors, we identified patient characteristics and psychosocial predictors associated with increased follow-up care informational needs. Cross-sectional surveys were administered to early-stage breast and prostate survivors (N = 278; 68 % breast) at least 2 years post treatment from four community hospital programs in New Jersey between May 2012 and July 2013. Patient demographics, medical history, psychosocial characteristics (i.e., worries about the future, fear of disease recurrence, and patient activation), and perceptions of oncology and primary care were assessed. African-American survivors (AOR = 2.69, 95 % confidence interval [CI] 1.27-5.68) and survivors with higher comorbidity (AOR =1.16, CI 1.01-1.33) were more likely to want additional information to guide follow-up care. Adjusting for race and comorbidities, survivors who wanted more information to guide their follow-up care reported greater worries about the future (p < 0.05) and fears about disease recurrence (p < 0.05) compared to those who did not want additional information. Results emphasize the need to develop cancer survivorship educational strategies that are both responsive to the needs of specific populations (e.g., African-American survivors and patients with multiple comorbidities) and the psychosocial profiles that motivate requests for more extensive follow-up guidance.
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Affiliation(s)
- Denalee M O'Malley
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA.
- Rutgers, School of Social Work, New Brunswick, NJ, USA.
| | - Shawna V Hudson
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Pamela A Ohman-Strickland
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Biometrics Division, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Alicja Bator
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
| | - Heather S Lee
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
| | - Daniel A Gundersen
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
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22
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Palmer SC, Stricker CT, Panzer SL, Arvey SA, Baker KS, Casillas J, Ganz PA, McCabe MS, Nekhlyudov L, Overholser L, Partridge AH, Risendal B, Rosenstein DL, Syrjala KL, Jacobs LA. Outcomes and satisfaction after delivery of a breast cancer survivorship care plan: results of a multicenter trial. J Oncol Pract 2016; 11:e222-9. [PMID: 25784579 DOI: 10.1200/jop.2014.001404] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Survivorship care plans (SCPs) have been suggested to reduce fragmentation of care experienced by cancer survivors. Acceptance of SCPs is high, but trials in the United States are few. This pilot study used a quasiexperimental design to examine the outcomes achieved by breast cancer survivors receiving a standardized SCP visit at one of seven comprehensive cancer centers. MATERIALS AND METHODS Outcomes were assessed before and again 3 months after delivery of an SCP and included survivors' use of and satisfaction with SCPs, perceived knowledge about survivorship, and assessment of the quality and coordination of survivorship care. RESULTS One hundred thirty-nine survivors of breast cancer completed baseline and follow-up measures and received a standardized SCP visit. Participants most commonly used SCP materials to make decisions about exercise (64%), which tests to receive and when (62%), and dietary changes (62%). Only 21% shared the SCP with their primary care provider during that time. Satisfaction with the SCP was high, with 90% of participants reporting being at least satisfied with the SCP. Perceived knowledge about survivorship improved after SCP delivery, as did perceived care coordination and the provider's knowledge of the effects of cancer on survivors (all P < .001). Individuals closer to the time of diagnosis reported greater satisfaction with and use of SCPs. CONCLUSION This study demonstrates improvements in perceived knowledge and quality of survivorship care after receipt of a comprehensive SCP. Survivors were satisfied with their SCP, and those closer to diagnosis reported greater satisfaction with and use of the materials.
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Affiliation(s)
- Steven C Palmer
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Carrie Tompkins Stricker
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - SarahLena L Panzer
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Sarah A Arvey
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - K Scott Baker
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jackie Casillas
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Patricia A Ganz
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Mary S McCabe
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Larissa Nekhlyudov
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Linda Overholser
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Ann H Partridge
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Betsy Risendal
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Donald L Rosenstein
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Karen L Syrjala
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Linda A Jacobs
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; LIVESTRONG, Austin, TX; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; University of Colorado Cancer Center, Denver, CO; and University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Mayer DK, Birken SA, Chen RC. Avoiding Implementation Errors in Cancer Survivorship Care Plan Effectiveness Studies. J Clin Oncol 2015; 33:3528-30. [DOI: 10.1200/jco.2015.62.6937] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Deborah K. Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Sarah A. Birken
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Ronald C. Chen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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Hill-Kayser C, Vachani C, Hampshire MK, Metz JM. Criteria for evaluation of breast cancer survivorship care plans. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Survivorship care plans are comprehensive, individualized documents that are recommended for all cancer survivors by the Institute of Medicine, and soon to be required by the Commission on Cancer. Breast cancer survivors are in many ways an ideal population for provision of survivorship care plans due to prominence within the survivorship population, relatively well-understood risk for late effects, data supporting improved outcomes with aggressive survivorship management and general interest within the population. Care plans that are provided must be of excellent quality in order to provide benefit, and quality should be measured with regard to content accuracy and language, customized information, completeness, applicability to diverse user groups and feasibility.
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Affiliation(s)
- Christine Hill-Kayser
- Perelman School of Medicine at the University of Pennsylvania, Department of Radiation Oncology, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
| | - Carolyn Vachani
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
| | - Margaret K Hampshire
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
| | - James M Metz
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
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Ashing KT, Lai L, Brown S, McDowell K, Carter D, Smith J, Mitchell E, Santifer RH, Martin V, Betts-Turner B, Fielder O, Miller V. Developing a treatment summary and survivorship care plan responsive to African-American breast cancer survivors. Psychooncology 2015; 25:729-31. [PMID: 26315465 DOI: 10.1002/pon.3939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/18/2015] [Accepted: 07/15/2015] [Indexed: 11/08/2022]
Affiliation(s)
| | - Lily Lai
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Shirley Brown
- African American Cancer Coalition, Altadena, CA, USA
| | | | | | - June Smith
- African American Cancer Coalition, Altadena, CA, USA
| | | | | | | | | | - Odicie Fielder
- Department of Clinical Oncology, City of Hope National Medical Center, Duarte, CA, USA
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27
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Ragas DM, Nonzee NJ, Tom LS, Phisuthikul AM, Luu TH, Dong X, Simon MA. What women want: patient recommendations for improving access to breast and cervical cancer screening and follow-up. Womens Health Issues 2015; 24:511-8. [PMID: 25213744 DOI: 10.1016/j.whi.2014.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/16/2014] [Accepted: 06/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net. METHODS Semi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers, free clinics, or an academic cancer center in the Chicago metropolitan area. FINDINGS Of the 138 women interviewed in the parent study, 52 women provided recommendations for improving access to screening and follow-up care. Most were between 41 and 65 years old (62%) and African American (60%) or White (25%). Recommendations included strengthening community-based health education with more urgent messaging, strategic partnerships, and active learning experiences to increase patient engagement, which women regarded as a key driver of access. Women also suggested increasing access by way of changes to health care delivery systems and policy, including more direct patient-provider and patient-clinic communications, addressing delays caused by high patient volume, combining preventive services, expanding insurance coverage, and adjusting screening guidelines. CONCLUSIONS This exploratory study demonstrates important insights from the patient lens that may help to increase the acceptability and efficacy of community and clinical interventions aimed at improving access to breast and cervical cancer screening and follow-up. Further research is needed to identify appropriate integration of patient input into interventions, practice, and policy change.
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Affiliation(s)
- Daiva M Ragas
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Narissa J Nonzee
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Laura S Tom
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois
| | - Ava M Phisuthikul
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Thanh Ha Luu
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - XinQi Dong
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
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Mayer DK, Birken SA, Check DK, Chen RC. Summing it up: an integrative review of studies of cancer survivorship care plans (2006-2013). Cancer 2015; 121:978-96. [PMID: 25252164 PMCID: PMC4948720 DOI: 10.1002/cncr.28884] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/14/2014] [Accepted: 04/29/2014] [Indexed: 11/06/2022]
Abstract
In 2006, the Institute of Medicine recommended that cancer survivors who are completing primary treatment receive a survivorship care plan (SCP) based on face validity. The state of scientific knowledge regarding the SCP is unclear. The authors conducted an integrative review of existing evidence regarding SCPs. The MEDLINE/PubMed database, the Excerpta Medica Database (EMBASE), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched for relevant studies published between 2006 and 2013 using a combination of keywords: "survivors," "survivorship," "care plans," "care planning," "treatment summaries," and "cancer." Articles were included if they 1) reported results from an empirical study, 2) included cancer survivors who were diagnosed at age ≥ 18 years, 3) related to SCP, and 4) were published in English. In total, 781 records were retrieved; 77 were identified as duplicates, and 665 were abstracts or presentations that did not relate to SCPs for adults or were not empirical, which left 42 articles for inclusion in this review. Studies regarding SCP fell into 3 categories: 1) content (n=14), 2) dissemination and implementation (n=14), and 3) survivor and provider outcomes (n=14). SCPs have been endorsed and are associated with improved knowledge, but SCP use remains sporadic. Only 4 studies were randomized controlled trials (RCTs) that avoided many biases associated with observational studies. Other limitations included cross-sectional or pre-SCP-post-SCP ("pre-post") designs, limited generalizability caused by a lack of sample diversity, and a lack of systematic testing of data-collection tools. The quantity and quality of SCP research are limited. SCPs have been endorsed, but evidence of improved outcomes associated with SCP is limited. Future research that addresses the methodological concerns of extant studies is needed regarding SCP use, content, and outcomes.
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Affiliation(s)
- Deborah K. Mayer
- School of Nursing, University of North Carolina, Chapel Hill, NC 27599
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599
| | - Sarah A. Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599
| | - Devon K. Check
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599
| | - Ronald C. Chen
- Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599
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Palmer NRA, Weaver KE, Hauser SP, Lawrence JA, Talton J, Case LD, Geiger AM. Disparities in barriers to follow-up care between African American and White breast cancer survivors. Support Care Cancer 2015; 23:3201-9. [PMID: 25821145 DOI: 10.1007/s00520-015-2706-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/16/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Despite recommendations for breast cancer survivorship care, African American women are less likely to receive appropriate follow-up care, which is concerning due to their higher mortality rates. This study describes differences in barriers to follow-up care between African American and White breast cancer survivors. METHODS We conducted a mailed survey of women treated for non-metastatic breast cancer in 2009-2011, 6-24 months post-treatment (N = 203). Survivors were asked about 14 potential barriers to follow-up care. We used logistic regression to explore associations between barriers and race, adjusting for covariates. RESULTS Our participants included 31 African American and 160 White survivors. At least one barrier to follow-up care was reported by 62 %. Compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p = 0.01), other health care costs (21.3 vs. 45.2 %, p = 0.01), anxiety/worry (29.4 vs. 51.6 %, p = 0.02), and transportation (4.4 vs. 16.1 %, p = 0.03). After adjustment for covariates, African Americans were three times as likely to report at least one barrier to care (odds ratio (OR) = 3.3, 95 % confidence interval (CI) = 1.1-10.1). CONCLUSIONS Barriers to care are common among breast cancer survivors, especially African American women. Financial barriers to care may prevent minority and underserved survivors from accessing follow-up care. Enhancing insurance coverage or addressing out-of-pocket costs may help address financial barriers to follow-up care among breast cancer survivors. Psychosocial care aimed at reducing fear of recurrence may also be important to improve access among African American breast cancer survivors.
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Affiliation(s)
- Nynikka R A Palmer
- Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
| | - Kathryn E Weaver
- Social Science and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sally P Hauser
- General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Julia A Lawrence
- General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Jennifer Talton
- Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - L Douglas Case
- Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ann M Geiger
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Given BA. Prevention, identification, and management of late effects through risk reduction. Semin Oncol Nurs 2015; 31:31-41. [PMID: 25636393 DOI: 10.1016/j.soncn.2014.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To review the psychosocial factors that affect quality of care and quality of life in cancer survivors, and discuss risk reduction through assessment for the early identification and management of the residual, long-term, and late effects. DATA SOURCES Literature review on survivorship and intervention strategies. CONCLUSION There is limited literature on the psychosocial dimensions of cancer survivorship and even more limited on strategies for care. IMPLICATIONS FOR NURSING PRACTICE Nurses have a major leadership role in assisting survivors and their families. Much research is needed to provide the knowledge needed for care.
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31
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Is there a role for survivorship care plans in advanced cancer? Support Care Cancer 2015; 23:2225-30. [PMID: 25559037 DOI: 10.1007/s00520-014-2586-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The Institute of Medicine (2006) has recommended that cancer survivors completing treatment receive a survivorship care plan (SCP). The survivorship needs in advanced cancer have been overlooked and understudied. The potential role of SCPs for survivors with advanced or metastatic cancer is unknown and was explored in this study. METHODS We conducted two focus groups of survivors with advanced or metastatic cancer. Participants reviewed a sample JourneyForward™ SCP modified for advanced cancer. Sessions were audiotaped and transcribed; transcripts and field notes were evaluated using inductive content analysis. RESULTS Sixteen survivors with metastatic cancer participated: 12 (75 %) were female, 15 (94 %) were white, and median age was 66 (range 55-80); 9 participants had breast cancer, 4 colon, 2 prostate, and 1 ovarian cancer. Participants believed that an SCP would be most helpful after initial diagnosis and treatment, but not as helpful once the cancer progressed. They thought a "cancer care plan" focusing solely on the current management would be better to concisely summarize the treatment plan and time frame for the next segment of care for those with advanced cancer. Most participants endorsed the need to have written information to reinforce verbal information received during medical visits since it was difficult to remember information provided. Participants expected their oncologist to assume primary responsibility for coordination of the care plan, but anticipated an important supportive role for primary care providers. To this end, they emphasized the need for better communication between providers. CONCLUSIONS A cancer care plan developed by the oncologist, similar to an SCP but more focused on current management, may be more useful for survivors with advanced cancer. Exploring this topic in larger groups of more diverse survivors with advanced cancer will help to elucidate the details a written plan of care should contain, and how to promote effective coordination between oncology and primary care providers. IMPLICATIONS FOR CANCER SURVIVORS There are many transitions of care along the cancer journey. A written plan of care, similar to an SCP, may be useful for survivors with advanced cancer.
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Breast Cancer Among Special Populations: Disparities in Care Across the Cancer Control Continuum. IMPROVING OUTCOMES FOR BREAST CANCER SURVIVORS 2015; 862:39-52. [DOI: 10.1007/978-3-319-16366-6_4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Davis CM, Myers HF, Nyamathi AM, Lewis M, Brecht ML. The Meaning of Survivorship as Defined by African American Breast Cancer Survivors. J Transcult Nurs 2014; 27:277-85. [DOI: 10.1177/1043659614561678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: While there is an abundance of cancer survivorship research among various racial/ethnic groups, there is a paucity of research on survivors of African descent. To date, the meaning of survivorship has not been reported exclusively among African American breast cancer survivors (AABCS). Purpose: The purpose was to describe and understand the meaning of survivorship among community-dwelling AABCS, mostly recruited from breast cancer support groups. Method: Using a qualitative descriptive approach, an open-ended questionnaire explored the meaning of survivorship among 155 AABCS. An analysis of the content was performed. Results: Among AABCS, survivorship meant having a strong spiritual base, thriving, being resilient, and being altruistic. The survivors self-identified with and embraced the term survivor.Conclusions: These results provide an important understanding of the perspectives and meaning of survivorship among AABCS and may assist in developing cancer survivorship care plans that are relevant, responsive, patient centered, and culturally appropriate.
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Wen KY, Hu A, Ma GX, Fang CY, Daly MB. Information and communication needs of Chinese American breast cancer patients: perspectives on survivorship care planning. JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY 2014; 12:439-445. [PMID: 25811036 DOI: 10.12788/jcso.0095] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The existing knowledge on the survivorship experiences of Chinese American breast cancer survivors (CABCS) has arisen largely from aggregated data across multiethnic or multicancer studies that have focused on quality of life. Little is known about Chinese American perspectives and preferences for survivorship care. OBJECTIVE To examine the experiences of CABCS to better understand their information and communication needs and their preferences for survivorship care plans (SCPs). METHODS 16 CABCS, aged 37-72 years, were recruited through community-based organizations in the Northeast United States to participate in one-on-one telephone interviews about their breast cancer survivorship experience. The semistructured interviews were conducted in Mandarin, Cantonese, or English. Two investigators transcribed and translated the audio recordings into English and analyzed the interview transcripts using established methods of qualitative content analysis. RESULTS Three main themes were identified through analysis of interview transcripts: the need for evidence-based and culturally and linguistically appropriate health information; the role of language or communication barriers and culture in accessing care and communicating with providers; and preferences for SCP elements and format. LIMITATIONS The sample may not be representative of the entire population of CABCS. CONCLUSIONS The findings provide insight into the information and communication needs and SCP preferences of CABCS. Understanding the cultural nuances that underlie these needs and preferences is critical for improving CABCS's quality of life after treatment for cancer. SCPs that incorporate Chinese-language resources and address the unique cultural needs of this population should be developed and they should include information about diet and nutrition as well as traditional Chinese medicine.
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Affiliation(s)
- Kuang-Yi Wen
- Cancer Prevention and Control Program, Fox Chase Cancer Center
| | - Angela Hu
- Cancer Prevention and Control Program, Fox Chase Cancer Center
| | - Grace X Ma
- Department of Public Health, Center for Asian Health, Temple University, Philadelphia, Pennsylvania
| | - Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center
| | - Mary B Daly
- Cancer Prevention and Control Program, Fox Chase Cancer Center
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Mollica MA, Nemeth LS, Newman SD, Mueller M, Sterba K. Peer navigation in African American breast cancer survivors. PATIENT-RELATED OUTCOME MEASURES 2014; 5:131-44. [PMID: 25404863 PMCID: PMC4230185 DOI: 10.2147/prom.s69744] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose The purpose of this study was to explore the feasibility and acceptability of a peer navigation survivorship program for African American (AA) breast cancer survivors (BCS) and its potential effects on selected short-term outcomes according to the Quality of Life Model Applied to Cancer Survivors. Methods An AA BCS who completed treatment over 1 year prior to the study was trained as a peer navigator (PN), and then paired with AA women completing primary breast cancer treatment (n=4) for 2 months. This mixed-methods, proof of concept study utilized a convergent parallel approach to explore feasibility and investigate whether changes in scores are favorable using interviews and self-administered questionnaires. Results Results indicate that the PN intervention was acceptable by both PN and BCS, and was feasible in outcomes of recruitment, cost, and time requirements. Improvements in symptom distress, perceived support from God, and preparedness for recovery outcomes were observed over time. Qualitative analysis revealed six themes emerging from BCS interviews: “learning to ask the right questions”, “start living life again”, “shifting my perspective”, “wanting to give back”, “home visits are powerful”, and “we both have a journey”: support from someone who has been there. Conclusion Results support current literature indicating that AA women who have survived breast cancer can be an important source of support, knowledge, and motivation for those completing breast cancer treatment. Areas for future research include standardization of training and larger randomized trials of PN intervention. Implications for cancer survivors The transition from breast cancer patient to survivor is a period when there can be a loss of safety net concurrent with persistent support needs. AA cancer survivors can benefit from culturally tailored support and services after treatment for breast cancer. With further testing, this PN intervention may aid in decreasing general symptom distress and increase readiness for recovery post-treatment.
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Affiliation(s)
- Michelle A Mollica
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Susan D Newman
- South Carolina Clinical and Translation Research Center for Community Health Partnerships, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Ashing KT, Miller AM, Mitchell E, Martin V, McDowell K, Santifer R, Smith J, Brown S, Ragin C, Carrington A. Nurturing Advocacy Inclusion to Bring Health Equity in Breast Cancer among African American Women. BREAST CANCER MANAGEMENT 2014; 3:487-495. [PMID: 26913082 DOI: 10.2217/bmt.14.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This paper will present the multiple roles and the impact of cancer advocates. The emerging literature provides evidence for the consideration and integration of African American BC survivors as advocates in practice, policy and research relevant to cancer prevention and control. We present a practical outline for organizational assessment for the inclusion of advocates in these arenas. This assessment can be conducted by all levels of partners, including community advocacy and scientific organizations.
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Affiliation(s)
- Kimlin Tam Ashing
- Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
| | - Aria M Miller
- Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
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Keesing S, McNamara B, Rosenwax L. Cancer survivors' experiences of using survivorship care plans: a systematic review of qualitative studies. J Cancer Surviv 2014; 9:260-8. [PMID: 25343971 PMCID: PMC4441735 DOI: 10.1007/s11764-014-0407-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 10/07/2014] [Indexed: 01/16/2023]
Abstract
Purpose Cancer survivorship care plans (SCPs) are currently used in care settings to assist survivors during the transition from treatment to survivorship. In this paper, the experiences of cancer survivors are examined to provide their perspective of how survivorship care plans are used in practice. Methods A systematic review and critical review of the qualitative literature regarding the experiences of cancer survivors using survivorship care plans was completed. Databases reviewed included CINAHL, AMED, Embase, MEDLINE, Informit, ProQuest, PsycINFO, ScienceDirect, Wiley Online Library, Scopus and Web of Science from 2000 to 2014. Results Eleven qualitative studies were appraised for methodological quality and content. They revealed four key themes: stakeholders agreed that SCPs should be used as a key strategy for cancer survivors; there was a lack of consensus on the format, content and who should develop the SCP; cancer survivors do not consistently receive SCPs; and there was a lack of evidence to support the use of SCPs in practice. Conclusions There is great potential for SCPs to assist cancer survivors and this is supported by the range of qualitative literature examined in this study. Further research is required to examine the many practical issues relating to the delivery of SCPs and how they may be used across a variety of care contexts as well as providing further evidence to support their use. Implications for Cancer Survivors With further research, refinement and contributions made by survivors, health researchers and health care professionals, the survivorship care plan is proposed to be a useful and practical tool aimed at supporting the survivorship continuum of care.
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Affiliation(s)
- Sharon Keesing
- School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia,
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O'Brien M, Stricker CT, Foster JD, Ness K, Arlen AG, Schwartz RN. Navigating the Seasons of Survivorship in Community Oncology. Clin J Oncol Nurs 2014; 18 Suppl:9-14. [DOI: 10.1188/14.cjon.s1.9-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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