Health information needs and preferences in relation to survivorship care plans of long-term cancer survivors in the American Cancer Society's Study of Cancer Survivors-I

A scoping review of the evidence on survivorship care plans among minority, rural, and low-income populations

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.

Availability of cancer survivorship support services across the National Cancer Institute Community Oncology Research Program network

BACKGROUND

National cancer organizations recommend provision of nutrition, physical activity, and mental health supportive services to cancer survivors. However, the availability of these services across diverse community oncology settings remains unclear.

METHODS

The National Cancer Institute Community Oncology Research Program (NCORP) is a national network of community oncology practices engaged in cancer research. The 2022 NCORP Landscape Assessment (5UG1CA189824) assessed individual practices' establishment of survivorship clinics and nutrition, physical activity, and mental health services, resources, and/or referrals. Descriptive statistics summarized and logistic regression quantified the association between services, practice, and patient characteristics.

RESULTS

Of 46 NCORP community sites, 45 (98%) responded to the survey, representing 259 adult practice groups. A total of 41% had a survivorship clinic; 96% offered mental health, 94% nutrition, and 53% physical activity services, resources, and/or referrals. All 3 services were offered in various formats (eg, in-house, referrals, education) by 51% and in-house only by 25% of practices. Practices with advanced practice providers were more likely to have a survivorship clinic (odds ratio [OR] = 3.19, 95% confidence interval [CI] = 1.04 to 9.76). Practices with at least 30% Medicare patients (OR = 2.54, 95% CI = 1.39 to 4.66) and more oncology providers (OR = 1.02, 95% CI = 1.01 to 1.04) were more likely to have all 3 services in any format. Practices with at least 30% Medicare patients (OR = 3.41, 95% CI = 1.50 to 7.77) and a survivorship clinic (OR = 2.84, 95% CI = 1.57 to 5.14) were more likely to have all 3 services in-house.

CONCLUSIONS

Larger oncology practices and those caring for more survivors on Medicare provided more supportive services, resources, and/or referrals. Smaller practices and those without survivorship clinics may need strategies to address potential gaps in supportive services.

Survivorship wellness: a multidisciplinary group program for cancer survivors

PURPOSE

National mandates require cancer centers provide comprehensive survivorship care. We created an 8-session, group intervention, the Survivorship Wellness Group Program (SWGP), that covered 8 topics: nutrition, physical activity, stress, sleep/fatigue, sexuality/body image, emotional wellbeing/fear of cancer recurrence, spirituality/meaning, and health promotion/goal setting. This study examined the acceptability and preliminary outcomes of SWGP.

METHODS

We evaluated SWGP using questionnaire data collected at program entry and 15-week follow-up. Questionnaires assessed acceptability and impact on anxiety, depression, quality of life, and perceived knowledge of topics. Enrollees who consented to participate in research and completed the baseline and 15-week follow-up were included in the analysis (N = 53). We assessed acceptability and preliminary outcomes using paired-samples t-tests. Due to the COVID-19 pandemic, SWGP transitioned to telehealth partway through data collection. Post-hoc analyses compared outcomes by intervention delivery.

RESULTS

Participants completed an average of 7.44/8 classes. Participants reported a mean response of 3.42/4 regarding overall program satisfaction and 90.6% reported being "very likely" to recommend SWGP. SWGP was associated with decreases in anxiety and depression; increases in physical, emotional, functional, and overall quality of life; and increases in knowledge of all health behavior domains. No outcomes differed significantly between delivery in person versus telehealth.

CONCLUSIONS

SWGP offers an acceptable and replicable model for cancer centers to meet national survivorship care guidelines.

IMPLICATION FOR CANCER SURVIVORS

SWGP provides a comprehensive service for cancer survivors post-treatment, and was associated with better quality of life, fewer mental health symptoms, and increased knowledge in multiple domains of wellness.

Improving Uptake of Cancer Genetic Risk Assessment in a Remote Tailored Risk Communication and Navigation Intervention: Large Effect Size but Room to Grow

PURPOSE

Cancer genetic risk assessment (CGRA) is recommended for women with ovarian cancer or high-risk breast cancer, yet fewer than 30% receive recommended genetic services, with the lowest rates among underserved populations. We hypothesized that compared with usual care (UC) and mailed targeted print (TP) education, CGRA uptake would be highest among women receiving a phone-based tailored risk counseling and navigation intervention (TCN).

METHODS

In this three-arm randomized trial, women with ovarian or high-risk breast cancer were recruited from statewide cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TP received a mailed educational brochure. Participants assigned to TCN received the mailed educational brochure, an initial phone-based psychoeducational session with a health coach, a follow-up letter, and a follow-up navigation phone call.

RESULTS

Participants' average age was 61 years, 25.4% identified as Hispanic, 5.9% identified as non-Hispanic Black, and 17.5% lived in rural areas. At 6 months, more women in TCN received CGRA (18.7%) than those in TP (3%; odds ratio, 7.4; 95% CI, 3.0 to 18.3; P < .0001) or UC (2.5%; odds ratio, 8.9; 95% CI, 3.4 to 23.5; P < .0001). There were no significant differences in CGRA uptake between TP and UC. Commonly cited barriers to genetic counseling were lack of provider referral (33.7%) and cost (26.5%), whereas anticipated difficulty coping with test results (14.0%) and cost (41.2%) were barriers for genetic testing.

CONCLUSION

TCN increased CGRA uptake in a group of geographically and ethnically diverse high-risk breast and ovarian cancer survivors. Remote personalized interventions that incorporate evidence-based health communication and behavior change strategies may increase CGRA among women recruited from statewide cancer registries.

Scoping review of the preferences of older adults for patient education materials

OBJECTIVE

To provide an overview of studies that describe the preferred mode and format of delivery of patient education materials to older adults.

METHODS

A scoping review was used to identify relevant literature published between January 2010 and June 2021, with specific attention given to studies conducted in high income countries with similar health systems.

RESULTS

A total of 3245 titles were identified, and 20 met the inclusion criteria and were included in this scoping review. Older adults preferred written information that could be accessed via health professionals or downloaded online. Other key features were identified including logical layout, signposted information, larger text size, labelled visual aids, and use of images appropriate and relevant to the target group were preferred. Audio visual resources were also considered valuable when well designed. Formats for patient education such as apps, group classes and online courses were less popular with older adults.

CONCLUSIONS

Patient education materials for older adults should be carefully designed, with attention to layout and content. Older adults indicated a preference for hard copy handouts or in a format that can be downloaded.

PRACTICE IMPLICATIONS

Regular engagement with older consumers about their preferences is important as technology for delivery of patient education materials evolve. Key features for specific attention during the design process include a logical layout (tested with consumers), signposted information, text size, labelled visual aids and appropriate images. The perspectives of other key groups of older adults such as those from minority populations or other disadvantaged groups are largely unexplored.

Improving community and healthcare services for young adults living with cancer: Suggestions from a multiple stakeholder workshop

Background and objectives

Despite the availability of healthcare and community services dedicated to cancer survivors, these remain underutilized by young adults living with cancer (YAC; aged 18-39). A workshop was organized in Montréal, Canada, to identify the needs of YAC during their post-treatment transition period and explore existing services dedicated to YAC.

Methods

We recruited seventeen stakeholders (N = 17), including seven YAC, to participate in a one-day workshop to consult about best approaches and practices to meet the needs of YAC, post-treatment. All discussions were transcribed, and a thematic qualitative analysis was performed.

Results

Two main findings were identified: differences and similarities among stakeholders about perceptions of post-treatment needs; and suggestions to meet YAC needs following treatment.

Conclusions

Results demonstrate the importance of collaboration among multiple stakeholders, including YAC, when designing services for YAC. Results include suggestions to improve services available through community or healthcare centres.

Comment améliorer les services communautaires et les soins de santé aux jeunes adultes atteints du cancer: suggestions présentées au cours d’un atelier multipartite

Contexte et objectifs

Bien qu’il existe des soins de santé et des services communautaires aux survivants, ceux-ci sont sous-utilisés par les jeunes adultes atteints du cancer (c’est-à-dire âgés de 18 à 39 ans). Un atelier a été organisé à Montréal (Canada) visant à cerner les besoins des JAC signalés par cette population au cours de la transition post-thérapeutique et à examiner les services qui leur sont offerts actuellement.

Méthodologie

Dix-sept intervenants (n = 17) ont été recrutés, dont 7 jeunes adultes ayant eu le cancer (JAC), et nous leur avons demandé de prendre part à un atelier d’une journée visant à examiner les meilleures approches et pratiques qui permettraient de combler les besoins des JAC après le traitement. Toutes les discussions ont été transcrites, puis une analyse qualitative des thèmes a été effectuée.

Résultats

Deux grands constats ressortent: les différences et les similitudes entre les parties prenantes concernant les perceptions des besoins post-traitement; et des suggestions pour répondre aux besoins des JAC, après le traitement.

Conclusions

Les résultats montrent l’importance de la collaboration entre les différents intervenants, y compris les JAC, lorsqu’il s’agit de concevoir des services destinés aux JAC. Les résultats comprennent des suggestions visant à améliorer la qualité des services offerts dans la collectivité et les établissements de soins de santé.

The Value of 320-Slice Spiral Computed Tomography Perfusion Imaging in Staging and Long-Term Dynamic Evaluation of Breast Cancer

The value of 320-slice spiral computed tomography (CT) perfusion imaging in staging and long-term dynamic evaluation of breast cancer was explored. 120 breast cancer patients who underwent preoperative CT examination and were confirmed by surgery and pathology were selected. All patients underwent preoperative TNM staging of breast cancer, with 120 cases in each stage. According to the results of 320-slice spiral CT, the postoperative pathology and surgical methods were compared and analyzed. CT diagnosis of breast cancer showed that T1 sensitivity was 71% and accuracy was 61%, T2 sensitivity was 74% and accuracy was 64%, T3 sensitivity was 94% and the accuracy was 84%, and the T4 sensitivity was 100% and the accuracy was 91%. The sensitivity of N1 stage was 71%, and the accuracy was 61%; and the sensitivity of N2 ~ N3 stage was 81%, and the accuracy was 76%. There were 7 cases of M1 with distant metastasis, the sensitivity was 71%, and the accuracy was 71%. At T1 stage, blood flow (BF) was 39.2 ± 16.7 mL/min/100 g, blood volume (BV) was 2.66 ± 1.4 mL/100 g, mean transit time (MTT) was 8.16 ± 2.7 s, and permeability surface (PS) was 16.6 ± 9.7 mL/min/100 g. 320-slice spiral CT perfusion imaging technology provided a new diagnostic mode for everyone, which can quantitatively identify breast cancer with multiple parameters, which was of great significance for clinical auxiliary diagnosis.

User-Centered Development and Patient Acceptability Testing of a Health-Coaching Intervention to Enhance Cancer Survivorship Follow-up in Primary Care

We describe an iterative three-phase approach used to develop a cancer survivorship health-coaching intervention to guide self-management and follow-up care for post-treatment breast, colorectal, and prostate cancer survivors. Informed by theory (e.g., Cognitive-Social Health Information Processing Model (C-SHIP)), relevant literature, and clinical guidelines, we engaged in a user-centered design process. In phase I, we conducted depth interviews with survivors of breast (n = 34), prostate (n = 4), and colorectal (n = 6) cancers to develop a health coaching prototype. In phase II, we utilized user-testing interviews (n = 9) to test and refine the health coaching prototype. For both phases, we used a template analysis independently coding each interview. In phase I, majority (n = 34, 81%) of survivors were positive about the utility of health coaching. Among these survivors (n = 34), the top areas of identified need were emotional support (44%), general health information (35.3%), changes in diet and exercise (29.3%), accountability and motivation (23.5%), and information about treatment effects (17.7%). The prototype was developed and user-tested and refined in phase III to address the following concerns: (1) the amount of time for calls, (2) density of reading materials, (3) clarity about health coaches' role, (4) customization. Collectively, this resulted in the development of the Extended Cancer Educational for Long-Term Cancer Survivors health-coaching (EXCELS_HC) program, which represents the first cancer survivorship follow-up program to support follow-up care designed-for-dissemination in primary care settings. EXCELS_HC is being tested in a clinical efficacy trial. Future research will focus on program refinement and testing for effectiveness in primary care.

Information needs and preferences among rural cancer survivors in Queensland, Australia: a qualitative examination

OBJECTIVE

This study aimed to understand how cancer survivors in rural Queensland seek and receive information, as well as their preferences regarding the content and delivery of health-related information.

METHODS

This study explored cancer survivors' experiences in seeking and comprehending health information using a qualitative descriptive approach. Semi-structured interviews were conducted with 24 participants. Data were analysed using reflexive thematic analysis.

RESULTS

Two major themes and six sub-themes were identified including 1) information content and gaps - a) information about diagnosis and treatment, b) survivorship information gaps and c) practical support needs and 2) delivery and acceptance of information - a) sources of information, b) personalised information needs and c) information seeking or avoidance. Findings suggested that health information provision was inconsistent; survivors' attitudes towards seeking information varied greatly; and survivors' had difficulty processing information due to emotional distress.

CONCLUSION

The role of the health professional is critical in providing information and support to rural cancer survivors. Information provided should be tailored to meet the needs and preferences of individuals taking into consideration demographic factors and attitudes. Implications for public health: The current findings imply that quality information provision after cancer treatment would facilitate improvements in satisfaction among rural cancer survivors.

Integrative analysis of multi-omics data highlighted TP53 as a potential diagnostic and prognostic biomarker of survival in breast invasive carcinoma patients

The global incidence of breast invasive carcinoma (BRIC) has risen significantly in recent years, so it is important to identify the novel biomarkers for the early detection and treatment of BRIC. The role of the TP53 gene is well studied in the pathogenesis of BRIC but still, observations are conflicting. Therefore, this study was initiated to have a consolidated overview of TP53 contributions in the BRIC initiation and progression by analyzing its mutatome, expression variations, promoter methylation level, clinical outcome, and drug sensitivity analysis in BRIC using cBioPortal, UALCAN, KM plotter, and CCLE GDSC toolkit database. Mutatome analysis revealed that TP53 was mutated in 30 % BRIC cases and among all the noted mutations, missense and truncation mutation were noticed as the most frequent mutations and thought to be involved in the up-regulation of TP53 expression. TP53 transcription, translation, and promoter methylation levels in BRIC patients of various clinicopathological features were high relative to the normal controls. Kaplan Meier overall survival (OS) analysis revealed a good prognostic value of TP53 overexpression for the survival in BRIC patients. Moreover, TP53 overexpression was found to alter the effectiveness of various drugs used in the chemotherapy of BRIC. Collectively, our findings suggested that TP53 might be a potential diagnostic and prognostic marker for the survival in BRIC patients of various clinicopathological features.

Educational interventions using a primer and motivational interviewing: randomized clinical trial

BACKGROUND

Many educational technologies have been used to promote the health of the population. Thus, the objective was to assess the effect of using an individual educational primer along with the Brief Motivational Interviewing (BMI) for increasing maternal self-efficacy for preventing childhood diarrhoea.

METHODS

Randomized clinical trial, conducted in Fortaleza/Ceará-Brazil, composed of 181 mothers and/or guardians of children under five years, who were randomized into three groups: experimental group A (EG A)-who read the primer, experimental group B (EG B)-application of the primer and BMI and the control group (CG). The participants' assessment was based on the Maternal Self-Efficacy Scale for Preventing Childhood Diarrhoea and the diarrhoea Investigation Form at the beginning of the intervention and then 30 and 60 days after the first contact with the participants.

RESULTS

There were 60 participants in EG A and CG and 61 in EG B. It was noted a greater incidence of participants with high self-efficacy in EG B after applying the technologies. All groups manifested diarrhoea among children after the interventions, although with a lower number in EG B, one-month post-intervention (P = 0.025).

CONCLUSIONS

The combined use of the primer and the BMI contributed significantly over time to increase maternal self-efficacy in preventing childhood diarrhoea and reduce cases of this disease.

Learning through the experience of cancer survivorship: differences across age groups

OBJECTIVE

To identify and describe challenges that contribute to experiential learning among cancer survivors across different age groups.

RESEARCH APPROACH

Qualitative collaborative study.

PARTICIPANTS

27 cancer survivors.

METHODOLOGICAL APPROACH

Participants were invited to explain the after-cancer challenges they learned from during six focus groups. Five were organized by age-group (15-18, 19-34, 35-44, 45-59, ≥ 60) and a mixed group was held to ensure the co-construction of findings with participants. Inductive content analysis was performed.

FINDINGS

While learning to live with a chronic disease, participant's experiential learning appeared through four challenges: Searching for one's identity, Autonomy, Disruption of social roles and responsibilities, Reclaiming one's life. Particular aspects of challenges were identified across ages-groups and life courses.

INTERPRETATION

Results indicate that psychosocial and health professionals should be sensitive to the fact that life courses are now diverse and not always associated with biological age. This has the potential to improve care by informing how these challenges affect the experience of cancer survivorship over time.

A Multidisciplinary Approach to Implement Personalized Breast Cancer Treatment and Care Plans

Implementation of survivorship care plans remain a challenge. This quality improvement initiative aims to integrate personalized treatment plans (PTP) and care plans (PCP) into the existing workflow for breast cancer (BC) patients. Methods: Phase 1 was to identify multidisciplinary team members to generate and deliver PTP and PCP. Concurrently, Phase 2 was to deliver PTP and PCP to newly diagnosed invasive BC patients at chemotherapy initiation and completion, respectively. Iterative plan, do, study, act (PDSA) cycles were applied to refine the process. The proportion of information completed for PTP and PCP generation and its delivery by the care team were measured. Patient and provider satisfaction were also assessed. Implementation Process and Results: The care transfer facilitator (CTF) was identified to complete and deliver PTP, and their data entry increased from 0% to 76%, 80%, 92% consecutively during the last 4 PDSA cycles. PTP and PCP were provided to 85% of eligible BC patients. Patients agreed that PTP helped them to actively participate in their care (88%) and communicate with the oncology care team (86%). Primary care physicians agreed that PTP and PCP had the information needed to “stay in the loop” (80%), and oncologists agreed they should be incorporated into oncology clinics (100%). Conclusions: Integrating PTP and PCP generation and delivery into existing workflow has led to an increase in uptake, sustainability and provider buy-in. With limited resources, it remains difficult to find care team members to complete the forms. A dedicated personnel or survivorship clinic is required to successfully implement PTP and PCP as the standard of care.

A systematic review and qualitative synthesis of the experience of living with colorectal cancer as a chronic illness

OBJECTIVE

Advances in detection and treatment mean that over 50% of people diagnosed with colorectal cancer can expect to live for more than ten years following treatment. Studies show that colorectal cancer patients can experience numerous physical and psychological late effects. The aim of this study was to conduct a systematic review and qualitative synthesis on the experiences of living with colorectal cancer as a chronic illness.

METHODS

Electronic searches of online databases were undertaken of peer reviewed and grey literature. Forty-seven papers were eligible for inclusion in the review, capturing the experiences of over 700 participants, the findings from which were analysed using thematic synthesis.

RESULTS

Three higher order concepts were identified which were prevalent across studies and countries and which related to the supportive care needs of patients; common physical and psychological late effects of cancer; and methods of psychosocial adjustment to living with and beyond colorectal cancer.

CONCLUSION

The results are considered in the context of existing theoretical approaches to chronic illness and the need to develop a theoretical approach which fully encapsulates the experience of living with colorectal cancer as a chronic illness in order to inform interventions to support patient adjustment.

Information needs of breast cancer patients and how educational status influence their information needs in Ghana

Health information literacy plays a critical role in self-management practices among patients living with chronic health conditions. However, there are limited studies on information needs among breast cancer patients in Ghana. This paper therefore investigated the information needs of women living with breast cancer in Ghana and how educational status influenced their information needs. The study was conducted in two health facilities in Accra, Ghana (37 Military Hospital and Sweden Ghana Medical Centre). A total of 75 breast cancer patients were conveniently selected from the two health facilities for the study. The instrument used to elicit relevant data for this study was a questionnaire using the survey design. Data was analysed descriptively. The findings of the study revealed that the information needs of the breast cancer patients investigated were centred mainly around treatment and management information and less around preventive information. The patients also ranked diagnostic information as their highest need, followed by physical care information, treatment information, psychosocial information and disease-specific information in that order. Patients with higher education reported higher information need on all the five domains compared to those with lower education. The study therefore recommended that management of health facilities make health information literacy an integral component of their treatment and management of breast cancer.

Designing an exercise intervention for adult survivors of childhood cancers

BACKGROUND

This study examined current physical activity levels and preferences for exercise settings and activities among adult survivors of childhood cancers as a strategy to inform the feasibility and design of such programs.

METHODS

A mixed-methods design was used to investigate current activity levels as well as barriers to and preferences for physical activity among 20 adult survivors of pediatric cancer.

RESULTS

One-half of participants reported engaging in regular physical activity, although the frequency, intensity, and duration varied. Overall, 17 of the 20 participants (85%) stated they would be interested in participating in a structured exercise intervention, and they expressed a strong interest in walking (76%), bicycling (53%), and weight training (53%). Common barriers to participation in a potential structured exercise program were insufficient time, current health issues, and program location/distance. Nearly all participants agreed that information on nutrition and diet should be included as part of an exercise intervention.

CONCLUSIONS

These findings will help inform the design and implementation of future exercise programs to enhance physical activity among this high-risk group of cancer survivors.

General and Health-Related Internet Use Among Cancer Survivors in the United States: A 2013-2018 Cross-Sectional Analysis

BACKGROUND

A significant proportion of cancer survivors endorse ongoing health information needs and may use the internet to access information. We assessed patterns and predictors of general and health-specific internet use among cancer survivors.

METHODS

Using data from the National Health Interview Survey (NHIS), which was administered in 2013 through 2018, for adults reporting a cancer diagnosis, sample weight-adjusted estimates defined prevalence and multivariable logistic regressions defined adjusted odds ratios (aORs) of general and health-specific internet use, adjusting for relevant sociodemographic covariates, including healthcare satisfaction as the primary independent variable. The analysis for health-specific internet use was also repeated including a sex (female vs male)*healthcare satisfaction (very satisfied/somewhat satisfied vs somewhat dissatisfied/very dissatisfied) interaction term.

RESULTS

Among 12,970 survivors of cancer, general and health-specific internet use increased from 2013 to 2018 (from 63.2% to 70.8% and from 46.8% to 52.2%, respectively; P<.05 for both). Survivors who were very dissatisfied with healthcare were more likely to use the internet for health information compared with those who were very satisfied (59.5% vs 48.0%; aOR, 1.78; 95% CI, 1.20-2.64; P=.004). Younger age, female sex, higher educational attainment, and higher socioeconomic status were all associated with increased reported use of the internet for both general and health-specific purposes (P<.001 for all). There was a significant sex*healthcare satisfaction interaction (P=.009) such that for female survivors, healthcare dissatisfaction was associated with higher odds of health-specific internet use (61.4% vs 52.5%; P<.001; men, P=.97). No association was found between healthcare satisfaction and general internet use (P=.42).

CONCLUSIONS

The increasing proportion of survivors of cancer using the internet for health-specific information may be associated with self-reported dissatisfaction with healthcare. Efforts are needed to improve both access to the internet and the quality of cancer-relevant online health information, and to enhance patients' online health literacy.

Rural cancer survivors' health information needs post-treatment

OBJECTIVE

This study describes the most common cancer-related health information needs among rural cancer survivors and characteristics associated with reporting more information needs.

METHODS

Rural breast, prostate, and colorectal cancer survivors, two to five years post-diagnosis, identified from an institutional cancer registry, completed a mailed/telephone-administered survey. Respondents were asked about 23 health information needs in eight domains (tests and treatment, side effects and symptoms, health promotion, fertility, interpersonal, occupational, emotional, and insurance). Poisson regression models were used to assess relationships between number of health information needs and demographic and cancer characteristics.

RESULTS

Participants (n = 170) reported an average of four health information needs, with the most common domains being: side effects and symptoms (58 %), health promotion (54 %), and tests and treatment (41 %). Participants who were younger (compared to 5-year increase, rate ratio [RR] = 1.11, 95 % CI = 1.02-1.21), ethnic minority (RR = 1.89, 95 % CI = 1.17-3.06), less educated (RR = 1.49, 95 % CI = 1.00-2.23), and financially stressed (RR = 1.87, 95 % CI = 1.25-2.81) had a greater number of information needs.

CONCLUSIONS

Younger, ethnic minority, less educated, and financially strained rural survivors have the greatest need for informational support.

PRACTICE IMPLICATIONS

The provision of health information for rural cancer survivors should consider type of cancer, treatments received, and sociocultural differences to tailor information provided.

Sources of health information among U.S. cancer survivors: results from the health information national trends survey (HINTS)

Background

Health information is crucial for preservation of health and maintenance of healthy practices among cancer survivors. This study examines the sources and factors associated with choice of health information source among cancer survivors and those without a cancer history.

Methods

We examined health information sources utilized by cancer history between 2011–2014 and 2017–2018 using the Health Information National Trends Survey (HINTS). Factors associated with seeking health information were examined using multinomial logistic regression. Data from HINTS 4, cycles 1–4 (2011–2014) and HINTS 5, cycles 1–2 (2017–2018) were combined and used for all analyses. HINTS-FDA, cycles 1–2 (2015–2017) were excluded from this study because the question about a cancer history was not asked.

Results

Over half of cancer survivors (52.7%) and those without a cancer history (60.9%) obtained their health information through the media. Among cancer survivors, factors associated with health information seeking either through the media or interpersonal communication relative to not seeking information were age, gender, level of education, income, marital status and having a regular healthcare provider. Male survivors were 39% less likely to seek health information from the media (aOR: 0.61; 95% CI: 0.38–0.99) while those with a regular health provider had significantly higher odds of seeking health information via interpersonal communication (aOR: 1.92; 95% CI: 1.09–3.38). In addition, widowed cancer survivors had lower odds of seeking health information from either interpersonal communication (aOR: 0.28; 95% CI: 0.13–0.60) or the media (aOR: 0.30; 95% CI: 0.13–0.69). In the study population without a cancer history, compared to non-Hispanic whites, non-Hispanic blacks, Hispanics and non-Hispanic other categories were significantly less likely to seek health information from the media rather than not seek health information.

Conclusion

Socioeconomic status, marital status, gender and age are important correlates of choice of health information source among cancer survivors in the US. These factors may be useful in guiding interventions aimed at various groups of cancer surviving populations to ensure that they improve their health seeking behaviors.

The use of survivorship care plans by female racial and ethnic minority breast cancer survivors: a systematic review

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.

Implementation of Survivorship Care Plans in Patients With Glioblastoma

Background: The outcomes and survival of patients diagnosed with glioblastoma are improving due to advancements in therapy and better symptom management. Focusing on survivorship is an important initiative for these patients. A quality improvement project performed by an advanced practitioner in adults with glioblastoma evaluated the efficacy and utility of survivorship care plans (SCP). Providing patients and their families with SCPs gives them important information about their cancer, treatment, and follow-up management and care. Methods: Survivors of a glioblastoma who were receiving an oral alkylating agent and/or bevacizumab, as well as those who had completed these therapies within the past year were included. Patients had received surgery and radiation. The National Comprehensive Cancer Network (NCCN) Distress Thermometer and a pre- and postintervention survey evaluated knowledge, distress, and rate of follow-up care. Results: Over 2 months, 18 eligible participants received the SCP with a long-term care coaching appointment with an advanced practitioner. Knowledge pertaining to long-term effects of therapy and chemotherapy regimen improved. Ratings of overall distress and patient-reported primary care follow-up remained the same. Conclusion: Providing patients with glioblastoma with an SCP and an educational visit can improve knowledge pertaining to their chemotherapy regimens and long-term effects of therapy. This can result in more effective long-term management and care.

Sustained degradation of quality of life in a subgroup of lymphoma survivors: a two-year prospective survey

Background

Previous studies have suggested that lymphoma survivors commonly display altered Health-Related Quality of Life (HRQoL). Because these were predominantly cross-sectional studies, the dynamic of events as well as the factors which influence HRQoL remain to be determined.

Methods

We conducted a prospective study on a cohort of 204 Hodgkin and non-Hodgkin lymphoma survivors who remained disease-free 2 years after undergoing chemotherapy (referred to the M0-M12-M24 periods).

Results

We found that although Physical and Mental Component Scores (PCS and MCS) of HRQoL significantly improved from M0 to M24 in the vast majority of patients (favorable group), approximately 20% of patients displayed severe alterations in HRQoL (global SF-36 scores < 50) extending over the 2-year period (unfavorable group). Low M24 PCSs were associated with Post-Traumatic Stress Disorder (PTSD), depression, cardiovascular events and neuropathy. In contrast social determinants, comorbidity and infections, as well as several other parameters related to the disease or to the treatment itself were not associated with low M24 PCSs. Low M24 MCSs were associated with a low educational level, aggressive histology, infections, cardiovascular events and PTSS. However, the most predictive risk factor for low SF-36 scores at M24 was a low SF-36 score at M12. The unfavorable group also displayed a low incidence of return to work.

Conclusions

Although the HRQoL of lymphoma survivors generally improved over time, persistent and severe HRQoL alterations still affected approximately one fifth of patients, resulting in important social consequences. This specific group, which presents with identifiable risk factors, may benefit from early, targeted psycho-social support.

Cancer patients' interest in participating in cancer rehabilitation

Introduction: Rehabilitation for cancer patients aims at preventing and reducing the physical, mental, social and existential consequences of a cancer disease and its treatment. The aim of this study is to describe the patients' self-perceived interest in participating in cancer rehabilitation (CR).Material and methods: A total of 1179 cancer patients, diagnosed with 28 different cancer diagnoses, from November 2015 to October 2016, were identified via the national cancer quality registers. A questionnaire was developed for the purpose of this study, the Cancer Rehabilitation Interest. The questionnaire comprises 16 different rehabilitation activities. This study describes what activities the patients are interested to participate in.Results: The response rate was 62% and the final sample comprised 728 patients. The rehabilitation activities wanted by the cancer patients were Psychoeducational support group together with others with the same cancer diagnosis, Open lectures on cancer, Individual weight training with a physiotherapist and Personal support from a social worker. Most interested in cancer rehabilitation were women, younger patients, university educated patients and those who had received their diagnosis ≥12 months prior. Patients with a mandatory educational level had the lowest interest in all suggested activities compared with those having medium or high education.Conclusions: The interest of cancer rehabilitation of all approached patients in this study were 21%. Most interested were women, young patients, university educated and those who received their diagnosis ≥12 months earlier. About 30% of the participating cancer patients reported an interest of information and supportive groups, physical training and support from a hospital social worker. Patients with low level of education reported a low interest in CR. There are limitations in rehabilitation accessibility and that might affect a person's motivation to participate in this study.

Breast cancer patients' experiences of adherence and persistence to oral endocrine therapy: A qualitative evidence synthesis

PURPOSE

Adjuvant endocrine therapy (AET) significantly reduces the risk of breast cancer recurrence and mortality in women with hormone receptor (HR+) breast cancer. Despite the documented survival benefits with AET, non-adherence and non-persistence remains a significant problem. This systematic review of qualitative research aimed to synthesise breast cancer patients' experiences of adherence and persistence to oral endocrine therapy.

METHODS

The ENTREQ guidelines were followed. A systematic search strategy was performed across eleven electronic databases (Embase, Cinahl, Pubmed, Psychinfo, Proquest, Lenus, Scopus, Web of Science, Rian.ie, EThOS e-theses online, DART Europe). Thomas and Harden's three-stage approach to thematic analysis was undertaken on the findings of all included studies. Confidence in the findings were reviewed using GRADE-CERQual.

RESULTS

Twenty-four qualitative studies were included in the synthesis. Three analytic themes were identified (We don't have an option; the side effects are worse than the disease; help us with information and support). Adherence was often driven by women feeling they had no option and a fear of cancer recurrence. Persistence was helped with support and information. Non-adherence and non-persistence were associated with debilitating side effects, inadequate information and lack of support.

CONCLUSIONS

Adherence and persistence to AET was often suboptimal among breast cancer patients. Women commonly felt isolated and neglected as a result of insufficient information and support from healthcare professionals. If women are to persist with AET, primary care providers should be aware of the facilitators and barriers to adherence, and they should be knowledgeable in symptom management strategies.

A scoping review of consumer needs for cancer information

OBJECTIVE

This study was a scoping review of research on cancer-related health information seeking and needs of patients, survivor, non-patients, and caregivers.

METHODS

This study used the COSI model to search for articles published from 2007 to 2017.

RESULTS

In total, 117 articles with titles and abstracts including the following terms were selected: cancer, health, information, seeking. Non-patients obtained information from the Internet, doctors, and media, whereas patients obtained information from doctors, the Internet, and media. Information needs were the highest for treatment, prognosis, and psychosocial support. Patients had the highest need for information on prognosis and treatment, whereas non-patients had the highest need for general cancer information, prevention, and cancer examination. Caregivers sought information about treatment, psychosocial support, and prevention.

CONCLUSION

This study revealed an increase in the number of research articles identifying cancer patients' information needs. Cancer patients rely on health professionals for information; thus, relevant materials are needed. Furthermore, not only medical but also psychosocial support information is needed.

PRACTICE IMPLICATIONS

There is a need for cancer information from health professionals, and thus for patient-centered training materials. Furthermore, a survey system to evaluate consumers' cancer information needs should be developed.

Challenges and perceived unmet needs of Chinese migrants affected by cancer: Focus group findings

OBJECTIVES

Chinese migrant cancer survivors and carers face multiple barriers to accessing quality cancer information and support. This study aimed to explore the challenges and unmet needs experienced by the Australian Chinese community affected by cancer, and understand the contexts that hindered optimal care for this community.

METHODS

Adult cancer survivors and carers, whose native language is Mandarin or Cantonese, were recruited through community cancer support organizations. Bilingual researchers conducted focus groups with participants in either Mandarin or Cantonese. Focus groups were audio-recorded, transcribed, translated into English and thematically analyzed using qualitative methods.

FINDINGS

62 Chinese-speaking participants (34 cancer survivors and 28 carers) participated in one of the eight focus groups conducted. The three main themes were (1) unmet information and support needs (trust, wellness, and rights); (2) barriers compounding unmet needs (language, health literacy, culture); and (3) participants' recommendations regarding cancer information and support provision. Seven subthemes of unmet needs were also identified: Trust (e.g., communication barriers, health system barriers, comparison regarding the care received), wellness (e.g., cultural differences produce conflict on views about wellness, need for psychological, community, and spiritual support), and rights (e.g., low awareness of financial and legal assistance, other factors increasing or reducing vulnerability).

CONCLUSIONS

This study highlights the needs and provides new insights into the impact of language, culture and health literacy barriers on the unmet information and support needs of the Chinese community affected by cancer. The key findings will inform the development of culturally targeted information and support resources for this community.

[Cancer: Communicating the diagnosis and prognosis]

The diagnoses and prognoses that medical professionals have to communicate in cases of cancer come with special problems. Of all fatal diseases, cancer possibly causes most psychological impact on the patient. Although, by nature, medical professionals are aware of this negative impact and take care to be as prudent and human as possible, recent studies have shown that the "psychological factors of the patient" are of direct relevance to the medical factors in cancer, over and above their importance on quality of life during the course of the disease. This direct relevance needs replies that go beyond purely medical knowledge, as well as a specific training as to their application. Interdisciplinary medical-psychological cooperation is probably required. Studies indicate that compliance with both requisites may bring an improvement to clinical results. In Europe, although less than in the United States of America, the necessary inclusion has been the recognition of psychological training in academic pre- and postgraduate training in communicating these cases.

The Role of Survivorship Care for Patients with Glioma

OBJECTIVES

To discuss the role of survivorship care and survivorship care plans, including a recently developed neuro-oncology-specific plan care (https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx) for adult patients diagnosed with primary glial neoplasms and the necessary educational needs of oncology nurses.

DATA SOURCES

Published peer-reviewed literature and resources from cancer and neuro-oncology professional organizations and patient advocacy organizations.

CONCLUSION

The current Commission on Cancer mandates adult cancer patients treated with curative intent each receive an individualized survivorship care plan. Patients with glioma are likely to benefit from receiving survivorship care, including survivorship care plans aimed at addressing the complex and evolving needs of this unique patient population throughout their illness trajectory.

IMPLICATIONS FOR NURSING PRACTICE

Nurse professionals are critical to the development and implementation of cancer survivorship care. This growing leadership role presents oncology nurses with specific and new educational needs regarding survivorship care.

Short-term efficacy of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: a randomized controlled trial

BACKGROUND

Physical activity (PA) is beneficial in improving negative physical and psychological effects of cancer and cancer treatment, but adherence to PA guidelines is low. Computer-tailored PA interventions can reach large populations with little resources. They match with patients' preference for home-based, unsupervised PA programs and are thus promising for the growing population of cancer survivors. The current study assessed the efficacy of a computer-tailored PA intervention in (four subgroups of) prostate and colorectal cancer survivors.

METHODS

Prostate and colorectal cancer patients and survivors were randomized to the OncoActive intervention group (N = 249), or a usual-care waiting-list control group (N = 229). OncoActive participants received a pedometer and computer-tailored PA advice, both Web-based via an interactive website and with printed materials. Minutes moderate-to-vigorous PA (MVPA) and days ≥30 min PA were assessed with an accelerometer (ActiGraph) at baseline and 6 months. Further, questionnaires were used to assess self-reported PA, fatigue, distress, and quality of life at baseline, 3 and 6 months. Differences between both groups were assessed using linear regression analyses (complete cases and intention-to-treat). In addition, efficacy in relation to age, gender, education, type of cancer, and time since treatment was examined.

RESULTS

Three months after baseline OncoActive participants significantly increased their self-reported PA (PA days: d = 0.46; MVPA: d = 0.23). Physical functioning (d = 0.23) and fatigue (d = - 0.21) also improved significantly after three months. Six months after baseline, self-reported PA (PA days: d = 0.51; MVPA: d = 0.37) and ActiGraph MVPA (d = 0.27) increased significantly, and ActiGraph days (d = 0.16) increased borderline significantly (p = .05; d = 0.16). Furthermore, OncoActive participants reported significantly improvements in physical functioning (d = 0.14), fatigue (d = - 0.23) and depression (d = - 0.32). Similar results were found for intention-to-treat analyses. Higher increases in PA were found for colorectal cancer participants at 3 months, and for medium and highly educated participants' PA at 6 months. Health outcomes at 6 months were more prominent in colorectal cancer participants and in women.

CONCLUSIONS

The OncoActive intervention was effective at increasing PA in prostate and colorectal cancer patients and survivors. Health-related effects were especially apparent in colorectal cancer participants. The intervention provides opportunities to accelerate cancer recovery. Long-term follow-up should examine further sustainability of these effects.

TRIAL REGISTRATION

The study was registered in the Dutch Trial Register ( NTR4296 ) on October 17 2018.

Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis

BACKGROUND

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the US. CRC survivors may have complex healthcare needs requiring care from both specialists and primary care. Our objective was to understand how CRC survivors perceive their survivorship care, especially management of their cardiovascular-related chronic diseases.

METHODS

We identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia. In 2016, we conducted telephone-based, semi-structured interviews to assess survivors' experiences with cancer survivorship and changes in health priorities. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed, and coded.

RESULTS

The 25 participants were, on average, 64 years old and approximately 4 years post-CRC diagnosis at the time of interview; most were white (60%), male (92%), and diagnosed with colon cancer (64%) as opposed to rectal cancer. CRC survivors reported: (1) a shift in focus from surviving cancer to reducing cardiovascular disease risk (e.g., by managing weight); (2) challenges with taking medications for CVD-related conditions; (3) new recognition of the importance of engaging with primary care providers.

CONCLUSIONS

Experiences with cancer shapes how survivors view their health. Management of cardiovascular-related chronic disease is important to veteran CRC survivors. There is a need to deliver cardiovascular disease risk reduction programs tailored for CRC survivors.

Integrating survivorship care planning in radiation oncology workflow

Various groups, including the American College of Surgeons' Commission on Cancer and the National Accreditation Program for Breast Centers, are mandating the provision of a survivorship care plan (SCP) to cancer survivors who have completed curative-intent treatment as a requirement for oncology practice accreditation. This article reviews the development of survivorship care, including survivorship care in radiation oncology. Challenges of developing treatment summaries and SCPs and implementing their delivery are explored. Details of the article include how the University of Wisconsin Health radiation oncology department integrated a survivorship visit into the existing radiation oncology workflow. Oncology practices may benefit from the model described here to meet accreditation requirements for SCP delivery to cancer survivors.

Do Perceived Needs Affect Willingness to Use Traditional Chinese Medicine for Survivorship Care Among Chinese Cancer Survivors? A Cross-Sectional Survey

Purpose We aimed to quantify Chinese cancer survivors' perceived needs for survivorship care and to evaluate whether these needs could impact their willingness to use traditional Chinese medicine (TCM). Methods We conducted a cross-sectional survey with members of the Beijing Anti-Cancer Association in China. We measured perceived needs with the seven-item Brief Chinese Cancer Survivorship Needs Scale that assesses psychological, functional, nutritional, social, body image, pain, and symptom needs. The outcome variable was willingness to use TCM for survivorship care. We performed multivariable logistic regression analyses to evaluate whether perceived needs are associated with willingness. Results A total of 600 patients were invited, with a response rate of 81%. The mean (standard deviation) score of the perceived needs scale (0 to 10) was 4.4 (2.2), with the majority of participants endorsing nutritional (72%), symptom (65%), and psychological (54%) needs. Among survivors, 387 (80%; 95% CI, 76% to 83%) were willing to use TCM for survivorship care. In multivariable analysis, a higher perceived needs score (adjusted odds ratio [OR], 1.33; 95% CI, 1.14 to 1.56; P < .001) was associated with greater willingness to use TCM. Specifically, nutritional (OR, 3.17; 95% CI, 1.79 to 5.62; P < .001) and symptom needs (OR, 3.15; 95% CI, 1.79 to 5.55; P < .001) had the strongest relationship. Conclusion A higher level of perceived needs, especially in the areas of nutrition and symptoms, was associated with greater willingness to use TCM for survivorship care.

A Web-Based and Print-Based Computer-Tailored Physical Activity Intervention for Prostate and Colorectal Cancer Survivors: A Comparison of User Characteristics and Intervention Use

Background

Physical activity (PA) is beneficial in improving negative physical and psychological effects of cancer. The rapidly increasing number of cancer survivors, resulting from aging and improved cancer care, emphasizes the importance to develop and provide low cost, easy accessible PA programs. Such programs could be provided through the Internet, but that could result in the exclusion of cancer survivors not familiar with the Internet. Therefore, we developed a computer-tailored PA intervention for prostate and colorectal cancer survivors in which both Web-based and print materials are provided, and participants can choose their own preferred delivery mode.

Objective

The aim of this study was to assess participants’ characteristics related to delivery mode and use of intervention materials.

Methods

We studied characteristics of participants using Web-based and printed intervention materials in a randomized controlled trial (RCT). Prostate and colorectal cancer survivors recruited from hospitals were randomized to OncoActive (computer-tailored PA intervention) or a usual-care control group. OncoActive participants received both Web-based and printed materials. Participants were classified into initial print- or Web-based participants based on their preferred mode of completion of the first questionnaire, which was needed for the computer-tailored PA advice. Intervention material use during the remainder of the intervention was compared for initial print- or Web-based participants. Additionally, participants were classified into those using only print materials and those using Web-based materials. Differences in participant characteristics and intervention material use were studied through analysis of variance (ANOVAs), chi-square tests, and logistic regressions.

Results

The majority of the participants in the intervention group were classified as initial Web-based participants (170/249, 68.3%), and 84.9% (191/249) used Web-based intervention materials. Dropout was low (15/249, 6.0%) and differed between initial Web-based (4/170, 2.4%) and print-based (11/79, 14%) participants. Participants were less likely to start Web-based with higher age (odds ratio [OR]=0.93), longer time since last treatment (OR=0.87), and higher fatigue (OR=0.96), and more likely with higher education (OR=4.08) and having completed treatments (OR=5.58). Those who were older (OR=0.93) and post treatment for a longer time (OR=0.86) were less likely to use Web-based intervention materials. Initial print-based participants predominantly used print-based materials, whereas initial Web-based participants used both print- and Web-based materials.

Conclusions

To our knowledge, this is one of the first studies that assessed participant characteristics related to delivery mode in an intervention in which participants had a free choice of delivery modes. Use of print-based materials among the initial Web-based participants was substantial, indicating the importance of print-based materials. According to our findings, it may be important to offer Web- and print-based materials alongside each other. Providing Web-based materials only may exclude older, less educated, more fatigued, or currently treated participants; these groups are especially more vulnerable and could benefit most from PA interventions.

Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive

Background

Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems. Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands

Methods

The OncoActive intervention was developed through systematic adaptation of a proven effective, evidence-based, computer-tailored PA intervention for adults over fifty, called Active Plus. The Intervention Mapping (IM) protocol was used to guide the systematic adaptation. A literature study and interviews with prostate and colorectal CPS and health care professionals revealed that both general and cancer-specific PA determinants are important and should be addressed. Change objectives, theoretical methods and applications and the actual program content were adapted to address the specific needs, beliefs and cancer-related issues of prostate and colorectal CPS. Intervention participants received tailored PA advice three times, on internet and with printed materials, and a pedometer to set goals to improve PA. Pre- and pilot tests showed that the intervention was highly appreciated (target group) and regarded safe and feasible (healthcare professionals). The effectiveness of the intervention is being evaluated in a randomized controlled trial (RCT) (n = 428), consisting of an intervention group and a usual care waiting-list control group, with follow-up measurements at three, six and twelve months. Participants are recruited from seventeen hospitals and with posters, flyers and calls in several media.

Discussion

Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored.

Trial registration

The study is registered in the Dutch Trial Register (NTR4296) on November 23rd 2013 and can be accessed at http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4296.

Disparities in Cancer Survivorship Indicators in the Deep South Based on BRFSS Data: Recommendations for Survivorship Care Plans

OBJECTIVES

The purpose of this investigation was to describe cancer survivorship based on the Behavioral Risk Factor Surveillance System (BRFSS) cancer survivorship modules in Alabama, Georgia, and Mississippi, conducted in 2012 and 2014, and to investigate disparities across the US Deep South region.

METHODS

The optional BRFSS cancer survivorship module was introduced in 2009. Data from Alabama (2012), Georgia (2012), and Mississippi (2014) were assessed. Demographic factors were analyzed through weighted regression for risk of receiving cancer treatment summary information and follow-up care.

RESULTS

Excluding nonmelanoma skin cancer cases, a total of 1105 adults in the Alabama 2012 survey, 571 adults in the Georgia 2012 survey, and 442 adults in the 2014 Mississippi survey reported ever having cancer and were available for analysis. Among Alabamians, those with a higher level of education (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.1-1.7) and higher income (OR 1.3, 95% CI 1.1-1.6) were more likely to receive a written summary of their cancer treatments. Adults older than age 65 were only half as likely to receive a written summary of cancer treatments compared with adults 65 years or younger (OR 0.5, 95% CI 0.3-0.8). We found no significant differences in receipt of treatment summary by race or sex. Among those who reported receiving instructions from a doctor for follow-up care, these survivors tended to have a higher level of education, higher income, and were younger (younger than 65 years). Receipt of written or printed follow-up care was positively associated with higher income (OR 1.4, 95% CI 1.1-1.8) and inversely associated with age older than 65 years (OR 0.9, 95% CI 0.1-0.6) in Georgia.

CONCLUSIONS

Addressing the gap identified between survivorship care plan development by the health team and the delivery of it to survivors is important given the evidence of disparities in the receipt of survivorship care plans across survivor age and socioeconomic status in the Deep South.