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Elizondo Rodríguez N, La Rosa-Salas V, Leite ACAB, Domingo-Osle M, Nascimento LC, García-Vivar C. "Opportunistic Care": A Focus Group Study of Nurses' Perspective on Caring for Long-term Cancer Survivors and Their Families. Cancer Nurs 2024:00002820-990000000-00230. [PMID: 38498794 DOI: 10.1097/ncc.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The global population of long-term cancer survivors is increasing, thanks to advances in treatments and care. Healthcare systems are working to address the unique needs of these individuals. However, there remains a knowledge gap concerning nurses' view on cancer survivorship care. OBJECTIVE To identify nurses' perspective of care for long-term cancer survivors and their families. METHODS This qualitative descriptive study used 5 focus groups comprising 33 nurses from primary healthcare and specialized oncology care. Data analysis was conducted through thematic analysis, and the study received ethical approval. RESULTS Long-term cancer survivors and their families often remained unrecognized as a distinct group within the healthcare system. Consequently, nurses provide what can be termed as "opportunistic care" during nurse-survivor encounters, addressing health needs beyond the purpose of the initial healthcare visit. This absence of a systematic or structured approach for this patient group has prompted nurses to seek the establishment of a comprehensive framework through survivorship care plans, thus ensuring a continuum of care for this specific population. CONCLUSION The lack of a structured approach to caring for long-term cancer survivors and their families, often invisible as a distinct population group, results in nurses providing care on an opportunistic basis. IMPLICATIONS FOR PRACTICE It is crucial to develop and implement survivorship care plans tailored to this population's needs. Simultaneously, it is important to advance research in this area and establish an educational framework for nurses, enabling them to effectively address the care of long-term cancer survivors and their families.
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Affiliation(s)
- Nerea Elizondo Rodríguez
- Author Affiliations: Universidad de Navarra (Mrs Elizondo-Rodríguez and Drs Domingo-Osle and La Rosa-Salas); Universidad Pública de Navarra, Departamento de Ciencias de la Salud (Drs García-Vivar and Leite); and Instituto de Investigación Sanitaria de Navarra (IdiSNA) (Mrs Elizondo-Rodríguez and Drs Domingo-Osle, García-Vivar, La Rosa-Salas, and Leite), Pamplona, Spain; and Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (Dr Nascimento)
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Marcu I, Melnyk M, Nekkanti S, Nagel C. Pelvic floor dysfunction survivorship needs and referrals in the gynecologic oncology population: a narrative review. Int J Gynecol Cancer 2024; 34:144-149. [PMID: 37935522 DOI: 10.1136/ijgc-2023-004810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
The population of survivors of gynecologic malignancies continues to grow. The population of gynecologic oncology survivors has a high prevalence of pelvic floor disorders. Gynecologic oncology patients identify several survivorship needs, including a need for more focused pelvic floor disorder sequelae care. The increasing focus on patient needs following cancer treatment has led to the development of survivorship care plans and other strategies for addressing post-treatment transitions and sequelae. Common themes in patient survivorship care are patient needs for flexible and integrated care, and it is unclear if survivorship care plans in their current state improve patient outcomes. Patient referrals, specifically to urogynecologists, may help address the gaps in survivorship care of pelvic floor dysfunction.The objective of this review is to discuss the burden of pelvic floor disorders in the gynecologic population and to contextualize these needs within broader survivorship needs. The review will then discuss current strategies of survivorship care, including a discussion of whether these methods meet survivorship pelvic floor disorder needs. This review addresses several gaps in the literature by contextualizing pelvic floor disorder needs within other survivorship needs and providing a critical discussion of current survivorship care strategies with a focus on pelvic floor disorders.
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Affiliation(s)
- Ioana Marcu
- Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Megan Melnyk
- School of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Silpa Nekkanti
- Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christa Nagel
- Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Peerenboom R, Ackroyd SA, Chang C, Diaz Moore E, Jenkins Vogel T, Lippitt MH, Rodriguez G, Kirschner Concept development CV. Surviving and thriving: what do survivors of gynecologic cancer want? Gynecol Oncol Rep 2022; 41:101011. [PMID: 35663850 PMCID: PMC9160655 DOI: 10.1016/j.gore.2022.101011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 11/26/2022] Open
Abstract
Gynecologic cancer survivors’ top concern was fear of cancer recurrence. Nutrition and weight loss were the most desired survivorship program components. Survivorship concerns/preferences varied by clinical and demographic factors.
The purpose of this study was to characterize survivorship concerns and survivorship program preferences among gynecologic cancer survivors. Women treated for gynecologic malignancy at our cancer center were surveyed from 1/2019 to 10/2020 on concerns and preferences using a 5-point Likert scale. Descriptive analysis and multivariable logistic regression were performed to describe survivors’ concerns/preferences. The most frequent survivorship concerns were fear of cancer recurrence (49.6%), desire to lose weight (40.0%), and long-term side effects (30.7%). The highest ranked survivorship program components included assistance with nutrition (36.5%), weight loss (30.4%), and stress reduction (29.0%). Older patients (≥64 y) were less likely to report concern with losing weight (OR 0.26, p < 0.05), sex life (OR 0.18, p < 0.01), and strain in family relationships (OR 0.27, p < 0.05) compared with younger patients. Compared with ovarian/fallopian tube/primary peritoneal cancer survivors, endometrial cancer survivors were less likely to desire nutritional education (OR 0.06, p < 0.01). Participants with advanced cancer were less likely to desire assistance with weight loss than those with early stage cancer (OR 0.23, p < 0.05). A significant portion of gynecologic cancer survivors reported a fear of cancer recurrence. Assistance with nutrition and weight loss were the most desired survivorship program components. Variation in patient preferences and differences among clinical subgroups highlight the need for tailored survivorship care.
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Snyder C, Choi Y, Smith KC, Wilson RF, Yuan CT, Nathan PC, Zhang A, Robinson KA. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6525236. [PMID: 35603840 PMCID: PMC8946685 DOI: 10.1093/jncics/pkac012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/12/2022] Open
Abstract
Appropriate models of survivorship care for the growing number of adult survivors of childhood cancer are unclear. We conducted a realist review to describe how models of care that include primary care and relevant resources (eg, tools, training) could be effective for adult survivors of childhood cancer. We first developed an initial program theory based on qualitative literature (studies, commentaries, opinion pieces) and stakeholder consultations. We then reviewed quantitative evidence and consulted stakeholders to refine the program theory and develop and refine context-mechanism-outcome hypotheses regarding how models of care that include primary care could be effective for adult survivors of childhood cancer. Effectiveness for both resources and models is defined by survivors living longer and feeling better through high-value care. Intermediate measures of effectiveness evaluate the extent to which survivors and providers understand the survivor’s history, risks, symptoms and problems, health-care needs, and available resources. Thus, the models of care and resources are intended to provide information to survivors and/or primary care providers to enable them to obtain/deliver appropriate care. The variables from our program theory found most consistently in the literature include oncology vs primary care specialty, survivor and provider knowledge, provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects. In turn, these variables were prominent in our context-mechanism-outcome hypotheses. The findings from this realist review can inform future research to improve childhood cancer survivorship care and outcomes.
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Affiliation(s)
- Claire Snyder
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Correspondence to: Claire Snyder, PhD, Professor of Medicine, Oncology, and Health Policy and Management, Johns Hopkins Schools of Medicine and Public Health, 624 N. Broadway, 6th Floor, Baltimore, MD 21205, USA (e-mail: )
| | - Youngjee Choi
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine C Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Renee F Wilson
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christina T Yuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Departments of Pediatrics and Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen A Robinson
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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O’Hea EL, Creamer S, Flahive JM, Keating BA, Crocker CR, Williamson SR, Edmiston KL, Harralson T, Boudreaux ED. Survivorship care planning, quality of life, and confidence to transition to survivorship: A randomized controlled trial with women ending treatment for breast cancer. J Psychosoc Oncol 2022; 40:574-594. [PMID: 34151734 PMCID: PMC9157313 DOI: 10.1080/07347332.2021.1936336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The Polaris Oncology Survivorship Transition (POST) system is a computer-based program that integrates information from the electronic health record, oncology team, and the patient to produce a personalized Survivorship Care Plan. The purpose of this study was to compare the POST to treatment as usual on confidence, quality of life, and interest in mental health referrals in women ending treatment for breast cancer. SAMPLE Two hundred women (100 POST, 100 treatment as usual) ending treatment for breast cancer were enrolled in a randomized controlled trial. DESIGN Women randomized to the POST condition received a personalized care plan during a baseline/intervention appointment. At enrollment and baseline/intervention, a number of outcomes were examined in this study, including confidence to enter survivorship measured by the Confidence in Survivorship Index (CSI) and Quality of Life (QOL). One, three, and six month follow up assessments were also conducted. FINDINGS Treatment groups did not differ in terms of QOL scores at any time points. Mean CSI scores were statistically different between POST and treatment as usual at baseline for the total CSI score and both subscales, but only for confidence in knowledge about prevention and treatment at the 1-month follow-up. All significant differences were in favor of the POST intervention as mean CSI scores were higher for participants who received the POST intervention as opposed to treatment as usual. These findings disappeared at the 3 and 6 month follow up assessments. Finally, patients who received the POST intervention were twice as likely to request mental health/social services referrals compared to women who received treatment as usual. IMPLICATIONS Oncologists may use the POST to build personalized care plans for women ending treatment for cancer, which may enhance patients' confidence in the short term as well as encourage use of mental health resources.
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Affiliation(s)
- Erin L. O’Hea
- Stonehill College and University of Massachusetts Medical School, 320 Washington Street, Easton, MA, USA 02357
| | - Samantha Creamer
- University of Massachusetts Medical School, Department of Psychiatry
| | - Julie M. Flahive
- University of Massachusetts Medical School, Department of Population and Quantitative Health Science
| | - Beth A. Keating
- University of Massachusetts Medical School, Department of Hematology/Oncology
| | | | | | | | | | - Edwin D. Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School
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Mikles SP, Griffin AC, Chung AE. Health information technology to support cancer survivorship care planning: A systematic review. J Am Med Inform Assoc 2021; 28:2277-2286. [PMID: 34333588 PMCID: PMC8449616 DOI: 10.1093/jamia/ocab134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/13/2021] [Accepted: 06/23/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The study sought to conduct a systematic review to explore the functions utilized by electronic cancer survivorship care planning interventions and assess their effects on patient and provider outcomes. MATERIALS AND METHODS Based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, studies published from January 2000 to January 2020 were identified in PubMed, CINAHL, EMBASE, PsychINFO, Scopus, Web of Science, and the ACM Digital Library . The search combined terms for cancer, survivorship, care planning, and health information technology (HIT). Eligible studies evaluated the effects of a HIT intervention on usability, knowledge, process, or health-related outcomes. A total of 578 abstracts were reviewed, resulting in 60 manuscripts describing 40 studies. Thematic analyses were used to define meta-themes of system functions, and Fisher's exact tests were used to examine associations between functions and outcomes. RESULTS Patients were the target end users for 18 interventions, while 12 targeted providers and 10 targeted both groups. Interventions used patient-reported outcomes collection (60%), automated content generation (58%), electronic sharing (40%), persistent engagement (28%), and communication features (20%). Overall, interventions decreased the time to create survivorship care plans (SCPs) and supported care planning knowledge and abilities, but results were mixed for effects on healthcare utilization, SCP sharing, and provoking anxiety. Persistent engagement features were associated with improvements in health or quality-of-life outcomes (17 studies, P = .003). CONCLUSIONS Features that engaged users persistently over time were associated with better health and quality-of-life outcomes. Most systems have not capitalized on the potential of HIT to share SCPs across a care team and support care coordination.
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Affiliation(s)
- Sean P Mikles
- Lineberger Comprehensive Cancer Outcomes Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley C Griffin
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Arlene E Chung
- Lineberger Comprehensive Cancer Outcomes Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Program on Health and Clinical Informatics, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Snyder C, Choi Y, Blackford AL, DeSanto J, Mayonado N, Rall S, White S, Bowie J, Cowall DE, Johnston F, Joyner RL, Mischtschuk J, Peairs KS, Thorner E, Tran PT, Wolff AC, Smith KC. Simplifying Survivorship Care Planning: A Randomized Controlled Trial Comparing 3 Care Plan Delivery Approaches. J Natl Cancer Inst 2021; 114:139-148. [PMID: 34302474 DOI: 10.1093/jnci/djab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Survivorship care plans seek to improve the transition to survivorship, but the required resources present implementation barriers. This randomized controlled trial aimed to identify the simplest, most effective approach for survivorship care planning. METHODS Stage 1-3 breast, colorectal, and prostate cancer patients aged 21+ completing treatment were recruited from an urban-academic and rural-community cancer center. Participants were randomized, stratified by recruitment site and cancer type, 1:1:1 to (a)mailed plan, (b)plan delivered during one-time transition visit, or (c)plan delivered during transition visit plus 6-month follow-up visit. Health service use data were collected from participants and medical records for 18 months. The primary outcome, receipt of all plan-recommended care, was compared across intervention arms using logistic regression adjusting for cancer type and recruitment site with p < 0.05 considered statistically significant. RESULTS Of 378 participants randomized, 159 (42.1%) were breast, 142 (37.6%) prostate, 77 (20.4%) colorectal cancer survivors; 207 (54.8%) from the academic site, 171 (45.2%) from the community site; 316 analyzable for the primary outcome. There was no difference across arms in the proportion of participants receiving all plan-recommended care: 45.2% mail, 50.5% one-visit, 42.7% two-visit (2-sided P = 0.60). Adherence by cancer type for mail, one-visit, and two-visit, respectively, was 52.2%, 53.3%, 40.0% for breast cancer; 48.6%, 64.1%, 57.1% for prostate cancer; and 23.8%, 19.0%, 26.1% for colorectal cancer. There were no statistically significant interactions by recruitment site or cancer type. CONCLUSIONS This study did not find differences in receipt of recommended follow-up care by plan delivery approach. Feasibility and other factors may determine the best approach for survivorship care planning.
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Affiliation(s)
- Claire Snyder
- Johns Hopkins University School of Medicine.,Johns Hopkins Bloomberg School of Public Health.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | | | | | | | - Susan Rall
- TidalHealth Richard A. Henson Research Institute
| | | | | | | | - Fabian Johnston
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | | | - Kimberly S Peairs
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | - Phuoc T Tran
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - Antonio C Wolff
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - Katherine C Smith
- Johns Hopkins Bloomberg School of Public Health.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
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Elizondo Rodriguez N, Ambrosio L, La Rosa-Salas V, Domingo-Osle M, Garcia-Vivar C. Role of the nurse in the design, delivery, monitoring and coordination of cancer survivorship care plans: An integrative review. J Adv Nurs 2021; 78:48-62. [PMID: 34235775 DOI: 10.1111/jan.14962] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
AIM Survivorship care plans (SCPs) are recommended as a tool for the care of cancer survivors. SCPs have been implemented with a multidisciplinary approach; however, the specific role of nurses in the SCP is unknown. Our aim is to determine the role of nurses and their degree of participation in cancer SCPs. DESIGN Integrative review of the literature with systematic methodology. DATA SOURCES PubMed, CINAHL, PsycINFO, Web of Science, Cochrane and Cancerlit databases were reviewed. Articles published up to March 2021 were included. REVIEW METHOD Of the 2,638 publications identified, 22 studies met our inclusion criteria. Quality of included studies was assessed using Joanna Briggs Institute quality assessment tools. RESULTS The studies showed that nurses play a key role and participate in different phases of the SCP, including design, delivery, monitoring and coordination among different levels of care, with varying degrees of involvement and responsibility; design and delivery of the SCP are the phases with the highest nurse participation (18 out of 22 studies). The majority of SCPs are implemented in specialized, hospital-based care and focus on short-term cancer survivors, who are actively undergoing oncological treatments. CONCLUSION This review shows that nurses actively participate in the design, implementation and coordination of SCPs. However, SCPs focus on the acute survival and treatment phases, and there is a gap in their use in long-term cancer survivorship. This gap may be one reason the needs of long-term cancer survivors are not covered. IMPACT This review contributes to the current body of knowledge by addressing the role of nurses in cancer SCPs. We recommend the involvement of an advanced practice nurse as SCP coordinator to improve communication between cancer specialists and primary care providers and to promote continued care throughout the different phases of cancer survivorship, including long-term survival.
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Affiliation(s)
| | - Leire Ambrosio
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Marta Domingo-Osle
- Registered Nurse at University of Navarra Clinic and Lecturer at the Practical Teaching Unit, Faculty of Nursing, University of Navarra, Pamplona, Spain
| | - Cristina Garcia-Vivar
- Department of Health Sciences, Public University of Navarre, IdiSNA, Pamplona, Spain
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Scheepers ERM, de Rooij BH, Pijnenborg JMA, van Huis-Tanja LH, Ezendam NPM, Hamaker ME. Perceived social support in patients with endometrial or ovarian cancer: A secondary analysis from the ROGY care study. Gynecol Oncol 2021; 160:811-816. [PMID: 33454131 DOI: 10.1016/j.ygyno.2020.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/21/2020] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Social support may reduce the amount of psychological distress and increase quality of life. This study assessed whether socio-demographic, personality, and clinical characteristics predict the level of perceived social support in patients with endometrial or ovarian cancer. METHODS Patients with endometrial or ovarian cancer who participated in the ROGY Care study and completed the Multidimensional Scale of Perceived Social Support(MSPSS) 12 months after inclusion were eligible for this study (n=238). Logistic regression analysis was conducted to determine the predictive value of socio-demographic characteristics, personality and clinical characteristics after initial treatment on the perceived level of social support after 12 months. RESULTS Of the 238 patients (mean age 64.8 ± 9.4 years), 139 patients had endometrial cancer (58%) and 99 patients had ovarian cancer (42%). One year after inclusion, the level of perceived social support was high in 79% of all patients (n=189). Patients experiencing low level of perceived social support (n=49) less often had a partner (69% versus 83% in patients with high level of perceived social support; p=0.029), had a higher education level (24% versus 15% respectively; p=0.013) and a distressed (type D) personality was more common (40% versus 16% respectively; p<0.001). In multivariable analysis, a type D personality, characterized by negative affect and social inhibition, was the only independent predictor of a low level of perceived social support (OR 2.96; 95% CI 1.37-6.37; p=0.006). CONCLUSIONS In patients with endometrial or ovarian cancer, the level of perceived social support is mainly associated with a distressed (type D) personality. Those patients can be at risk of experiencing less social support. Future research is needed to assess whether they might benefit from additional support during cancer diagnosis and treatment.
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Affiliation(s)
- E R M Scheepers
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands.
| | - B H de Rooij
- Netherlands Comprehensive Cancer Organisation (IKNL), the Netherlands
| | - J M A Pijnenborg
- Department of Gynaecology, Radboud university medical center Nijmegen, the Netherlands
| | - L H van Huis-Tanja
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | - N P M Ezendam
- Netherlands Comprehensive Cancer Organisation (IKNL) and Tilburg University, the Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, the Netherlands
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Hua A, Sesto ME, Zhang X, Wassenaar TR, Tevaarwerk AJ. Impact of Survivorship Care Plans and Planning on Breast, Colon, and Prostate Cancer Survivors in a Community Oncology Practice. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:249-255. [PMID: 30610655 PMCID: PMC6609493 DOI: 10.1007/s13187-018-1457-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With a growing number of cancer survivors, survivorship care plans (SCPs) are recommended to communicate information about late effects of treatment and follow-up care. Community oncology practices follow 85% of adult cancer survivors but report more difficulty in providing SCPs compared to academic centers. Our objective was to evaluate the impact of delivering SCPs in a community oncology practice by examining awareness of SCP receipt as well as how provision affects survivors' perception of care quality and of their condition. Survivors who accepted a SCP as standard of care were recruited from a community oncology practice in the Midwest and completed surveys prior to SCP provision (baseline) and 4 weeks later (follow-up). Within-survivor changes in knowledge of SCP receipt, satisfaction and perceived care coordination were assessed. Thirty cancer survivors (breast, colon, and prostate) completed the baseline survey, while 24 completed the follow-up survey (80% response rate). Participants reported receiving SCPs and treatment summaries more frequently at follow-up after receiving a SCP. At follow-up, there was a significant increase in survivor activation and involvement in care along with satisfaction of knowledge of care. Communication about and during SCP provision may need to be clearer: 34% of survivors could not correctly identify SCP receipt in this study. This may place these survivors at a disadvantage, if this leads to less awareness of important information regarding follow-up surveillance and management. Of those aware of SCP receipt, SCP provision had positive impacts in this small, short-term study.
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Affiliation(s)
- Alexandra Hua
- University of Wisconsin, School of Medicine & Public Health, Madison, USA
| | - Mary E Sesto
- University of Wisconsin, School of Medicine & Public Health, Madison, USA
- Carbone Cancer Center, Madison, WI, USA
| | | | | | - Amye J Tevaarwerk
- University of Wisconsin, School of Medicine & Public Health, Madison, USA.
- Carbone Cancer Center, Madison, WI, USA.
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11
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van Walree IC, Hamaker ME, de Rooij BH, Boll D, van Huis-Tanja LH, Emmelot-Vonk MH, Ezendam NPM. Do age and comorbidity impair recovery during two years after treatment for endometrial cancer? J Geriatr Oncol 2020; 11:1078-1086. [PMID: 32169547 DOI: 10.1016/j.jgo.2020.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/17/2019] [Accepted: 02/26/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND A better understanding of the impact of age and comorbidity on health-related quality of life (HRQoL) may improve treatment decision-making in patients with endometrial cancer. We investigated whether either age or comorbidity is more strongly associated with changes in HRQoL over time. METHODS Endometrial cancer patients (n = 296) were invited to complete questionnaires after initial treatment and after 6, 12 and 24 months follow-up. Patients were divided into subgroups according to age (<60, 60-75 and ≥75 years) and according to comorbidity (0, 1, 2 or ≥3). HRQoL was measured with the five EORTC QLQ-C30 functioning scales. Linear mixed models were performed for the different subgroups to assess changes in HRQoL over time. HRQoL was also compared to longitudinal outcomes from an age- and gender-matched normative population. RESULTS The first questionnaire was returned by 221 patients (75%) of whom six were excluded due to progressive disease. Changes in HRQoL were mainly associated with cumulative comorbidity burden and not with age. Patients with comorbidity reported deterioration of physical and role functioning between 12 and 24 months. Compared to the normative population, patients initially scored higher on physical and role functioning, but at 24 months outcomes were no longer different. CONCLUSION Cumulative comorbidity burden was more strongly associated with deterioration of HRQoL than patient's age. Therefore, patients with endometrial cancer and multiple comorbid conditions require careful follow-up of HRQoL after treatment.
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Affiliation(s)
- Inez C van Walree
- Department of Internal Medicine, Diakonessenhuis Utrecht, the Netherlands.
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, the Netherlands
| | - Belle H de Rooij
- Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Dorry Boll
- Department of Obstetrics and Gynecology, Catharina Hospital Eindhoven, the Netherlands
| | | | | | - Nicole P M Ezendam
- Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
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Impact of treatment summaries for cancer survivors: a systematic review. J Cancer Surviv 2020; 14:405-416. [PMID: 32030627 DOI: 10.1007/s11764-020-00859-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE As a treatment summary (TS) documents information for follow-up care, it is believed to be an important communication tool for the patient, their GP, and other health professionals. The aim of this systematic review (SR) was to evaluate the impact of receiving a TS for cancer survivors when compared to receiving standard care and to identify knowledge gaps to inform future research. METHODS A systematic search of electronic databases and grey literature was undertaken from August 2018 to October 2018. Studies were included if participants (cancer survivors) were over 18 years of age and had received a TS, and if outcomes for TS could be separated from other survivorship interventions. The McMaster Critical Appraisal Tool was used to evaluate the methodological quality of the included studies. A narrative synthesis of the study outcomes was then conducted. RESULTS Seven studies (one prospective cohort and six cross-sectional studies) met the inclusion criteria. The impact of TS was assessed using widely varied outcomes in these studies. Overall, receipt of a TS was related to greater patient understanding and perception of the quality of care provided. However, caution is required when interpreting these results due to methodological limitations. CONCLUSIONS This systematic review found that TS may have a positive impact on patient understandings about and perceptions of cancer care. However, more robust research including perspectives of cancer survivors is required. IMPLICATIONS FOR CANCER SURVIVORS TS could play an important role for cancer survivors especially in terms of knowledge of cancer care.
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13
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McDowell BD, Klemp J, Blaes A, Cohee AA, Trentham-Dietz A, Kamaraju S, Otte JL, Mott SL, Chrischilles EA. The association between cancer care coordination and quality of life is stronger for breast cancer patients with lower health literacy: A Greater Plains Collaborative study. Support Care Cancer 2020; 28:887-895. [PMID: 31168710 PMCID: PMC6893112 DOI: 10.1007/s00520-019-04894-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/22/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Health literacy (HL) and cancer care coordination (CCC) were examined for their relationship to quality of life (QOL) among breast cancer survivors. CCC was hypothesized to have a stronger relationship to QOL for women with lower HL. METHODS Women (N = 1138) who had completed treatment for Stage 0-III, ductal carcinoma breast cancer between January 2013 and May 2014 at one of eight large medical centers responded to a mailed questionnaire. Responses to questions about survivorship care planning and presence of professional care coordinator were combined to form an index of CCC. An index of HL was also derived. QOL was measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B) scales. RESULTS 74.3% (N = 845) of patients reported having a health professional coordinate their care during treatment and 78.8% (N = 897) reported receiving survivorship care planning. CCC was classified as none, partial, or high for 7.1%, 32.7%, and 60.2% of the patients, respectively. Except for emotional well-being, the interaction between HL and CCC was significant for all QOL domains (p < .05); the effect of CCC on FACT-B scores was largest for people with lower HL. For the 39.8% of patients with less than high CCC, 111 (27.3%) had a level of HL associated with clinically meaningful lower QOL. CONCLUSIONS The association between CCC and later QOL is strongest for people who have lower HL. Prioritizing care coordination for patients with lower health literacy may be an effective strategy in a setting of limited resources.
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Affiliation(s)
- Bradley D McDowell
- 5240 MERF, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA.
| | - Jennifer Klemp
- Department of Medicine, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, KS, USA
| | - Anne Blaes
- Division of Hematology, Oncology and Transplantation, 420 Delaware St SE, MMC 480, Minneapolis, MN, 55455, USA
| | - Andrea A Cohee
- Community and Health Systems, Nursing W433, Indiana University, Indianapolis, IN, 47405, USA
| | - Amy Trentham-Dietz
- Carbone Cancer Center and Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St., WARF Room 307, Madison, WI, 53726, USA
| | - Sailaja Kamaraju
- Division of Hematology, Oncology and Transplantation, Medical College of Wisconsin, Watertown Plank Road, 4th Fl Cancer Center, Milwaukee, WI, 53226, USA
| | - Julie L Otte
- Science of Nursing Care, Nursing W401, Indiana University, Indianapolis, IN, 46220, USA
| | - Sarah L Mott
- N319 CPHB, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
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14
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Hill RE, Wakefield CE, Cohn RJ, Fardell JE, Brierley ME, Kothe E, Jacobsen PB, Hetherington K, Mercieca‐Bebber R. Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes. Oncologist 2020; 25:e351-e372. [PMID: 32043786 PMCID: PMC7011634 DOI: 10.1634/theoncologist.2019-0184] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision. METHODS We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome. RESULTS Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects. CONCLUSION SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies. IMPLICATIONS FOR PRACTICE Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.
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Affiliation(s)
- Rebecca E. Hill
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Claire E. Wakefield
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Richard J. Cohn
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Joanna E. Fardell
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Mary‐Ellen E. Brierley
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Emily Kothe
- School of Psychology, Deakin UniversityGeelongAustralia
| | | | - Kate Hetherington
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Rebecca Mercieca‐Bebber
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of SydneyCamperdownAustralia
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15
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Høeg BL, Bidstrup PE, Karlsen RV, Friberg AS, Albieri V, Dalton SO, Saltbæk L, Andersen KK, Horsboel TA, Johansen C. Follow-up strategies following completion of primary cancer treatment in adult cancer survivors. Cochrane Database Syst Rev 2019; 2019:CD012425. [PMID: 31750936 PMCID: PMC6870787 DOI: 10.1002/14651858.cd012425.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most cancer survivors receive follow-up care after completion of treatment with the primary aim of detecting recurrence. Traditional follow-up consisting of fixed visits to a cancer specialist for examinations and tests are expensive and may be burdensome for the patient. Follow-up strategies involving non-specialist care providers, different intensity of procedures, or addition of survivorship care packages have been developed and tested, however their effectiveness remains unclear. OBJECTIVES The objective of this review is to compare the effect of different follow-up strategies in adult cancer survivors, following completion of primary cancer treatment, on the primary outcomes of overall survival and time to detection of recurrence. Secondary outcomes are health-related quality of life, anxiety (including fear of recurrence), depression and cost. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases and two trials registries on 11 December 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We included all randomised trials comparing different follow-up strategies for adult cancer survivors following completion of curatively-intended primary cancer treatment, which included at least one of the outcomes listed above. We compared the effectiveness of: 1) non-specialist-led follow-up (i.e. general practitioner (GP)-led, nurse-led, patient-initiated or shared care) versus specialist-led follow-up; 2) less intensive versus more intensive follow-up (based on clinical visits, examinations and diagnostic procedures) and 3) follow-up integrating additional care components relevant for detection of recurrence (e.g. patient symptom education or monitoring, or survivorship care plans) versus usual care. DATA COLLECTION AND ANALYSIS We used the standard methodological guidelines by Cochrane and Cochrane Effective Practice and Organisation of Care (EPOC). We assessed the certainty of the evidence using the GRADE approach. For each comparison, we present synthesised findings for overall survival and time to detection of recurrence as hazard ratios (HR) and for health-related quality of life, anxiety and depression as mean differences (MD), with 95% confidence intervals (CI). When meta-analysis was not possible, we reported the results from individual studies. For survival and recurrence, we used meta-regression analysis where possible to investigate whether the effects varied with regards to cancer site, publication year and study quality. MAIN RESULTS We included 53 trials involving 20,832 participants across 12 cancer sites and 15 countries, mainly in Europe, North America and Australia. All the studies were carried out in either a hospital or general practice setting. Seventeen studies compared non-specialist-led follow-up with specialist-led follow-up, 24 studies compared intensity of follow-up and 12 studies compared patient symptom education or monitoring, or survivorship care plans with usual care. Risk of bias was generally low or unclear in most of the studies, with a higher risk of bias in the smaller trials. Non-specialist-led follow-up compared with specialist-led follow-up It is uncertain how this strategy affects overall survival (HR 1.21, 95% CI 0.68 to 2.15; 2 studies; 603 participants), time to detection of recurrence (4 studies, 1691 participants) or cost (8 studies, 1756 participants) because the certainty of the evidence is very low. Non-specialist- versus specialist-led follow up may make little or no difference to health-related quality of life at 12 months (MD 1.06, 95% CI -1.83 to 3.95; 4 studies; 605 participants; low-certainty evidence); and probably makes little or no difference to anxiety at 12 months (MD -0.03, 95% CI -0.73 to 0.67; 5 studies; 1266 participants; moderate-certainty evidence). We are more certain that it has little or no effect on depression at 12 months (MD 0.03, 95% CI -0.35 to 0.42; 5 studies; 1266 participants; high-certainty evidence). Less intensive follow-up compared with more intensive follow-up Less intensive versus more intensive follow-up may make little or no difference to overall survival (HR 1.05, 95% CI 0.96 to 1.14; 13 studies; 10,726 participants; low-certainty evidence) and probably increases time to detection of recurrence (HR 0.85, 95% CI 0.79 to 0.92; 12 studies; 11,276 participants; moderate-certainty evidence). Meta-regression analysis showed little or no difference in the intervention effects by cancer site, publication year or study quality. It is uncertain whether this strategy has an effect on health-related quality of life (3 studies, 2742 participants), anxiety (1 study, 180 participants) or cost (6 studies, 1412 participants) because the certainty of evidence is very low. None of the studies reported on depression. Follow-up strategies integrating additional patient symptom education or monitoring, or survivorship care plans compared with usual care: None of the studies reported on overall survival or time to detection of recurrence. It is uncertain whether this strategy makes a difference to health-related quality of life (12 studies, 2846 participants), anxiety (1 study, 470 participants), depression (8 studies, 2351 participants) or cost (1 studies, 408 participants), as the certainty of evidence is very low. AUTHORS' CONCLUSIONS Evidence regarding the effectiveness of the different follow-up strategies varies substantially. Less intensive follow-up may make little or no difference to overall survival but probably delays detection of recurrence. However, as we did not analyse the two outcomes together, we cannot make direct conclusions about the effect of interventions on survival after detection of recurrence. The effects of non-specialist-led follow-up on survival and detection of recurrence, and how intensity of follow-up affects health-related quality of life, anxiety and depression, are uncertain. There was little evidence for the effects of follow-up integrating additional patient symptom education/monitoring and survivorship care plans.
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Affiliation(s)
- Beverley L Høeg
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Pernille E Bidstrup
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Randi V Karlsen
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Anne Sofie Friberg
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Rigshospitalet, Copenhagen University HospitalDepartment of OncologyCopenhagenDenmark
| | - Vanna Albieri
- Danish Cancer Society Research CenterStatistics and Pharmaco‐Epidemiology UnitStrandboulevarden 49CopenhagenDenmark
| | - Susanne O Dalton
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Zealand University HospitalDepartment of OncologyNæstvedDenmark
| | - Lena Saltbæk
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Zealand University HospitalDepartment of OncologyNæstvedDenmark
| | - Klaus Kaae Andersen
- Danish Cancer Society Research CenterStatistics and Pharmaco‐Epidemiology UnitStrandboulevarden 49CopenhagenDenmark
| | - Trine Allerslev Horsboel
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Christoffer Johansen
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Rigshospitalet, Copenhagen University HospitalDepartment of OncologyCopenhagenDenmark
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16
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Kadan-Lottick NS, Ross WL, Mitchell HR, Rotatori J, Gross CP, Ma X. Randomized Trial of the Impact of Empowering Childhood Cancer Survivors With Survivorship Care Plans. J Natl Cancer Inst 2019; 110:1352-1359. [PMID: 29771337 DOI: 10.1093/jnci/djy057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/06/2018] [Indexed: 12/24/2022] Open
Abstract
Background A survivorship care plan (SCP), that is, individualized treatment summary and schedule of off-therapy surveillance, will be mandated by January 2019. It is unclear whether SCPs improve adherence to recommended follow-up care in the community. In this trial, we evaluated the impact of randomly assigning childhood cancer survivors to 1) SCPs to be taken to their primary care physician (PCP) to implement or 2) survivorship clinic (SC) on health care quality measures. Methods Eligibility included cancer diagnosis younger than age 18 years (2000-2012), cancer free, one or more years off therapy, and no prior survivorship clinic attendance. At 12 months, the random assignment groups were compared (SCP+PCP vs SC) by intent-to-treat analysis with two-sided statistical tests in terms of patient adherence to guideline-recommended surveillance tests (eg, echocardiogram) and number of newly identified late complications of therapy. Results From 2011 to 2013, 96 participants (46.9% female, mean age = 15.9 ± 6.1 years) were randomly assigned. Adherence to 14 evaluated guideline-recommended surveillance tests ranged from 0% to 46.9% in the SCP+PCP group (n = 47) and from 50.0% to 86.4% in the SC group (n = 47). Adherence to 10 tests was statistically significantly different between the groups (all P < .05). One mild new late complication was identified in the SCP+PCP group compared with 21 late complications, ranging from mild to severe, identified in 11 patients in the SC group (2.1% vs 23.4% of patients, respectively, P = .003). Conclusions Our randomized trial suggests that empowering childhood cancer survivors with SCPs to be implemented by their PCPs is not sufficient to meet consensus follow-up recommendations.
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Affiliation(s)
- Nina S Kadan-Lottick
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Wilhelmenia L Ross
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT
| | - Hannah-Rose Mitchell
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT.,Department of Psychology, University of Miami, Coral Gables, FL
| | - Jaime Rotatori
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT
| | - Cary P Gross
- Department of General Internal Medicine, Yale School of Medicine, New Haven, CT.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale School of Medicine, New Haven, CT.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
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17
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Kargo AS, Coulter A, Jensen PT, Steffensen KD. Proactive use of PROMs in ovarian cancer survivors: a systematic review. J Ovarian Res 2019; 12:63. [PMID: 31307510 PMCID: PMC6631969 DOI: 10.1186/s13048-019-0538-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 07/04/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The use of patient reported outcome measures (PROMs) has increased during the past decade, and the focus on how to use them has resulted in a more proactive application. Studies have shown that proactive use of PROMs during treatment improves patient-clinician communication, leads to better symptom management and may prolong survival among advanced cancer patients. Ovarian cancer is a serious disease in which the majority of patients experience recurrence during the follow-up period and suffer from a number of severe symptoms from underlying disease. This systematic review was conducted to assess the evidence on the proactive use of PROMs as a dialogue tool during follow-up of ovarian cancer patients. RESULTS The following databases were searched for relevant literature; PubMed, EMBASE, CINAHL, and the Cochrane Library. The search was conducted in April 2019 without any filters or limits. A total of 643 publications were identified, and 48 studies were found to be potentially eligible. Of the 48 papers, none met the final inclusion criterion of using PROMs proactively as a dialogue tool for ovarian cancer patients during follow-up. CONCLUSION Studies have shown that PROMs can identify otherwise undetected symptoms. Using PROMs proactively during the consultation has been shown to improve symptom management for patients with some other types of cancer. However, we found no studies that had examined the proactive use of PROMs during follow-up of ovarian cancer patients. Future studies should evaluate if the proactive use of PROMs could facilitate a more individualized and more effective follow-up program tailored to the ovarian cancer patient's needs and preferences.
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Affiliation(s)
- Anette Stolberg Kargo
- Department of Clinical Oncology, Sygehus Lillebalt, Vejle Sygehus, Beriderbakken 4, DK-7100 Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, 5000 Odense, Denmark
- Center for Shared Decision Making, Sygehus Lillebalt, Vejle Sygehus, Beriderbakken 4, 7100 Vejle, Denmark
| | - Angela Coulter
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, 5000 Odense, Denmark
- Center for Shared Decision Making, Sygehus Lillebalt, Vejle Sygehus, Beriderbakken 4, 7100 Vejle, Denmark
| | - Pernille Tine Jensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000 Odense, Denmark
| | - Karina Dahl Steffensen
- Department of Clinical Oncology, Sygehus Lillebalt, Vejle Sygehus, Beriderbakken 4, DK-7100 Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, 5000 Odense, Denmark
- Center for Shared Decision Making, Sygehus Lillebalt, Vejle Sygehus, Beriderbakken 4, 7100 Vejle, Denmark
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18
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Birken SA, Raskin S, Zhang Y, Lane G, Zizzi A, Pratt-Chapman M. Survivorship Care Plan Implementation in US Cancer Programs: a National Survey of Cancer Care Providers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:614-622. [PMID: 29948925 PMCID: PMC6294719 DOI: 10.1007/s13187-018-1374-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Survivorship care plans (SCPs)-documents intended to improve care for cancer survivors who have completed active treatment-are required, yet implementation is poor. We sought to understand SCP implementation in cancer programs in the USA with the objective of identifying opportunities for improvement. We recruited cancer care providers in the USA via several cancer care networks to participate in a survey regarding SCP implementation. We used descriptive statistics to analyze the data. Three hundred ninety-five providers from diverse cancer programs in 47 states and Washington, DC responded to the survey. The timing of SCP implementation varied across and within cancer programs, with approximately 40% of respondents reporting developing SCPs more than 3 months after primary treatment or adjuvant therapy completion. Nurse navigators were responsible for 48-58% of each stage of SCP implementation. Processes that could have been automated often occurred in-person or via phone and vice versa. Respondents reported spending more than 2 h per SCP to complete all stages of implementation, of which less than a third was reimbursed by third-party payers. We identified several opportunities for improving SCP implementation, including broadening the base of responsibility, optimizing modes of communication, decreasing the time required and increasing the funding available, and limiting variation in SCP implementation across and within cancer programs. Future work should assess the influence of approaches to SCP implementation on desired outcomes.
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Affiliation(s)
- Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | - Yuqing Zhang
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
| | - Gema Lane
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
| | - Alexandra Zizzi
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
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19
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Abstract
PURPOSE OF REVIEW The transition from primary cancer treatment to posttreatment follow-up care is seen as critical to the long-term health of survivors. However, relatively little attention has been paid to understanding this pivotal period. This review will offer a brief outline of the significant work surrounding this pivotal time published in the past year. RECENT FINDINGS The growing number of cancer survivors has stimulated an emphasis on finding new models of care, whereby responsibility for survivorship follow-up is transitioned to primary care providers. A variety of models and tools have emerged for follow-up care. Survivorship care plans are heralded as a key component of survivorship care and a vehicle for supporting transition. Uptake of survivorship care plans and implementation of evidence-based models of survivorship care has been slow, hindered by a range of barriers. SUMMARY Evaluation is needed regarding survivorship models in terms of feasibility, survivor friendliness, cost effectiveness, and achievement of sustainable outcomes. How, and when, to introduce plans for transition to the patient and determine transition readiness are important considerations but need to be informed by evidence. Additional study is needed to identify best practice for the introduction and application of survivorship care plans.
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20
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Caring for Survivors of Gynecologic Cancer: Assessment and Management of Long-term and Late Effects. Semin Oncol Nurs 2019; 35:192-201. [DOI: 10.1016/j.soncn.2019.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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21
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Tevaarwerk AJ, Hocking WG, Buhr KA, Gribble M, Seaborne LA, Wisinski KB, Burkard ME, Yen T, Wiegmann DA, Sesto ME. A randomized trial of immediate versus delayed survivorship care plan receipt on patient satisfaction and knowledge of diagnosis and treatment. Cancer 2019; 125:1000-1007. [PMID: 30690714 DOI: 10.1002/cncr.31875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/07/2018] [Accepted: 10/08/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivorship care plans (SCPs) and care-planning sessions have been recommended for over a decade, yet evidence for their benefit remains mixed. In a randomized trial, changes in survivor knowledge and satisfaction before and after the receipt of an SCP were assessed. METHODS Patients with breast cancer who had completed curative-intent treatment were randomized to immediate versus delayed receipt of an individualized SCP. All participants completed the modified Wisconsin Survey of Cancer Diagnosis and Management in Breast Cancer and the Preparing for Life As a New Survivor survey to assess individual knowledge about cancer diagnosis, treatment, side effects, and follow-up as well as satisfaction with communication and care coordination. Surveys were completed at baseline, at 4 weeks (before delayed receipt), and again at 12 weeks (after all participants had received SCPs); the primary outcome was change in knowledge at 4 weeks. RESULTS In total, 127 eligible women were randomized. An improvement in individual knowledge was observed between baseline and week 12 for both arms combined (+1.6; 95% confidence interval, 0.9-2.3; P < .001). There was no statistically significant difference in the change in knowledge from baseline through week 4 between the arms. No significant change occurred for satisfaction scores over time. CONCLUSIONS This randomized trial of immediate versus delayed SCP receipt demonstrated a small improvement (4%) in survivor knowledge. However, this improvement did not appear to be related to SCP provision. The authors hypothesized that the improvement was because of repeated administration of the knowledge survey. If improved survivor knowledge is a goal, then strategies beyond the 1-time provision and review of an SCP should be explored.
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Affiliation(s)
- Amye J Tevaarwerk
- Division of Hematology/Oncology, Department of Medicine, The University of Wisconsin-Madison, Madison, Wisconsin.,The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin
| | | | - Kevin A Buhr
- Department of Biostatistics and Medical Informatics, The University of Wisconsin-Madison, Madison, Wisconsin
| | - Mindy Gribble
- Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Lori A Seaborne
- Department of Surgery, The University of Wisconsin-Madison, Madison, Wisconsin
| | - Kari B Wisinski
- The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin.,The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Mark E Burkard
- Division of Hematology/Oncology, Department of Medicine, The University of Wisconsin-Madison, Madison, Wisconsin.,The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin
| | - Thomas Yen
- The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Douglas A Wiegmann
- The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Mary E Sesto
- The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin.,Department of Medicine, The University of Wisconsin-Madison, Madison, Wisconsin
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22
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de Rooij BH, Ezendam NPM, Vos MC, Pijnenborg JMA, Boll D, Kruitwagen RFPM, van de Poll-Franse LV. Patients' information coping styles influence the benefit of a survivorship care plan in the ROGY Care Trial: New insights for tailored delivery. Cancer 2018; 125:788-797. [PMID: 30500067 PMCID: PMC6587821 DOI: 10.1002/cncr.31844] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/14/2018] [Accepted: 09/27/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND In efforts to improve the implementation of survivorship care plans (SCPs), the authors assessed whether the impact of SCPs on patient-reported outcomes differed between patients with an information-seeking coping style (monitoring) versus those with an information-avoiding coping style (blunting). METHODS In the Registration System Oncological Gynecology (ROGY) Care Trial, 12 hospitals in the Netherlands were randomized to deliver SCP care or usual care. All patients with newly diagnosed endometrial and ovarian cancer in the SCP care arm received an SCP that was generated automatically by their oncology provider through the web-based ROGY registration system. Outcomes (satisfaction with information provision and care, illness perceptions, and health care use) were measured directly after initial treatment and after 6, 12, and 24 months. Information coping style was measured at 12 months after initial treatment. RESULTS Among patients who had a monitoring coping style (N = 123), those in the SCP care arm reported higher satisfaction with information provision (mean score: 73.9 vs 63.9, respectively; P = .04) and care (mean score: 74.5 vs 69.2, respectively; P = .03) compared with those in the usual care arm. Among patients who had a blunting coping style (N = 102), those in the SCP care arm reported a higher impact of the disease on life (mean score: 5.0 vs 4.5, respectively; P = .02) and a higher emotional impact of the disease (mean score: 5.4 vs 4.2, respectively; P = .01) compared with those in the usual care arm. CONCLUSIONS SCPs may be beneficial for patients who desire information about their disease, whereas SCPs may be less beneficial for patients who avoid medical information, suggesting a need for tailored SCP delivery to improve survivorship care.
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Affiliation(s)
- Belle H de Rooij
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Nicole P M Ezendam
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - M Caroline Vos
- Gynecologic Cancer Center South, Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk, the Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dorry Boll
- Department of Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Roy F P M Kruitwagen
- Department of Gynecology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lonneke V van de Poll-Franse
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.,Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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23
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Tevaarwerk AJ, Sesto ME. Continued Challenges to the Adoption and Implementation of Survivorship Care Plans. J Oncol Pract 2018; 14:573-576. [PMID: 30192692 PMCID: PMC6184078 DOI: 10.1200/jop.18.00378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amye J. Tevaarwerk
- University of Wisconsin; and University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Mary E. Sesto
- University of Wisconsin; and University of Wisconsin Carbone Cancer Center, Madison, WI
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24
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de Rooij BH, Thomas TH, Post KE, Flanagan J, Ezendam NPM, Peppercorn J, Dizon DS. Survivorship care planning in gynecologic oncology-perspectives from patients, caregivers, and health care providers. J Cancer Surviv 2018; 12:762-774. [PMID: 30209681 PMCID: PMC6244937 DOI: 10.1007/s11764-018-0713-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/28/2018] [Indexed: 11/24/2022]
Abstract
Purpose This qualitative study sought to describe the challenges following treatment and the preferences regarding survivorship care among patients treated for gynecological cancer, their caregivers, and health care providers. Methods Between July and August 2017, in-depth semi-structured interviews regarding survivorship were conducted at a large academic hospital in the USA among patients who recently completed treatment (< 12 months) for a gynecological cancer (ovarian, endometrial, cervical, and vulvar) and their primary caregivers. A focus group was conducted among health care providers (oncologists, nurses, and fellows). Main themes were identified using descriptive content analysis. Results A total of 30 individuals participated in this study (13 patients, 9 caregivers, 8 health care providers). Almost all participants reported a desire for more information on how to address survivorship needs, specifically as they related to side effects, follow-up schedule, and psychological assistance. Despite this uniformly identified need for more information, preferences for survivorship care planning differed across cancer types and individuals, with respect to content, timing, and mode of delivery. Health care providers expressed challenges in communicating with patients about survivorship, a desire to shift post-treatment conversations to the goal of improving quality of life as opposed to focusing on disease recurrence, and an unmet need for disease specific and individualized survivorship care planning. Conclusions Patients, caregivers, and health care providers each expressed a need for gynecologic cancer-tailored survivorship care resources. Implications for Cancer Survivors The variation of disease types and patient and caregiver needs may require multi-faceted, individualized survivorship care planning. Electronic supplementary material The online version of this article (10.1007/s11764-018-0713-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Belle H de Rooij
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA. .,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands. .,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
| | | | - Kathryn E Post
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.,Boston College William F. Connell School of Nursing, Boston, MA, USA
| | - Jane Flanagan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.,Boston College William F. Connell School of Nursing, Boston, MA, USA
| | - Nicole P M Ezendam
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jeffrey Peppercorn
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Don S Dizon
- Lifespan Cancer Institute/Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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25
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Tevaarwerk AJ, Klemp JR, van Londen GJ, Hesse BW, Sesto ME. Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors. Cancer 2018; 124:4292-4300. [PMID: 30277575 DOI: 10.1002/cncr.31546] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/13/2018] [Accepted: 03/19/2018] [Indexed: 01/22/2023]
Abstract
The American cancer survivor population is ever-growing, with necessary follow-up primarily accomplished in a high-touch fashion-adding to unsustainability and fragmentation of care. Given the complexities of the health care system processes needed to support survivorship, engineering approaches may best address performance deficits and facilitate the provision of patient-centered care. Such collaboration between health care and engineering is recommended for redesigning health care delivery systems. By using Systems Engineering Initiative for Patient Safety (SEIPS), a systems engineering model widely used to improve health care quality and delivery, the authors examine the work system to identify the barriers and facilitators to necessary care in the presence of a survivorship care plan and visit. Recommendations for future improvement include ensuring that care-planning processes are dynamic, clearly assigned, resilient, and integrated with electronic health record systems.
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Affiliation(s)
- Amye J Tevaarwerk
- Department of Medicine, University of Wisconsin, Madison and Carbone Cancer Center, Madison, Wisconsin
| | - Jennifer R Klemp
- Department of Medicine, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, Kansas
| | - Gijsberta J van Londen
- University of Pittsburgh Cancer Institute and School/Department of Medicine, Pittsburgh, Pennsylvania
| | - Bradford W Hesse
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Mary E Sesto
- Department of Medicine, University of Wisconsin, Madison and Carbone Cancer Center, Madison, Wisconsin
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26
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de Rooij BH, Thong MS, van Roij J, Bonhof CS, Husson O, Ezendam NPM. Optimistic, realistic, and pessimistic illness perceptions; quality of life; and survival among 2457 cancer survivors: the population-based PROFILES registry. Cancer 2018; 124:3609-3617. [DOI: 10.1002/cncr.31634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Belle H. de Rooij
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology; Tilburg University; Tilburg the Netherlands
- The Netherlands Comprehensive Cancer Organisation; Utrecht the Netherlands
| | - Melissa S.Y. Thong
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam, Amsterdam Public Health Research Institute; Amsterdam the Netherlands
| | - Janneke van Roij
- The Netherlands Comprehensive Cancer Organisation; Utrecht the Netherlands
| | - Cynthia S. Bonhof
- The Netherlands Comprehensive Cancer Organisation; Utrecht the Netherlands
| | - Olga Husson
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust; London United Kingdom
| | - Nicole P. M. Ezendam
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology; Tilburg University; Tilburg the Netherlands
- The Netherlands Comprehensive Cancer Organisation; Utrecht the Netherlands
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27
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Birken SA, Clary AS, Bernstein S, Bolton J, Tardif-Douglin M, Mayer DK, Deal AM, Jacobs SR. Strategies for Successful Survivorship Care Plan Implementation: Results From a Qualitative Study. J Oncol Pract 2018; 14:e462-e483. [PMID: 30004824 PMCID: PMC6804914 DOI: 10.1200/jop.17.00054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Care for US cancer survivors is often fragmented, contributing to poor health outcomes. Care and outcomes may improve when survivors and follow-up care providers receive survivorship care plans (SCPs), written documents containing information regarding cancer diagnosis, treatment, surveillance plans, and health promotion. However, implementing SCPs is challenging. As such, we sought to identify strategies for successfully implementing SCPs. METHODS We measured SCP implementation using performance data from cancer programs participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative, an oncologist-led quality assessment and improvement program. We used semistructured interviews with cancer program employees (eg, physicians) to identify strategies for successfully implementing SCPs by comparing approaches in cancer programs that, according to Quality Oncology Practice Initiative performance indicators, developed and delivered SCPs to a relatively small proportion of eligible survivors and their follow-up care providers (ie, low performers; n = 6 participants in five programs) with approaches among programs with better performance (ie, moderate performers; n = 15 participants in nine programs). RESULTS Ten of 14 cancer programs developed SCPs for ≥ 50% of eligible survivors; two of 14 delivered SCPs to any survivors; and eight of 14 delivered SCPs to ≥ 25% of follow-up care providers. We found that moderate performers proactively addressed SCP requirements, leveraged requirements to improve survivorship care, set internal targets, automated implementation, had active leaders and champions, and tasked appropriate employees with SCP implementation. CONCLUSION SCP implementation remains challenging. We identified strategies for successfully implementing SCPs. Future research should examine how cancer programs have achieved these strategies; findings could contribute to an understanding of the changes needed to implement comprehensive survivorship care.
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Affiliation(s)
- Sarah A. Birken
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Alecia S. Clary
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Shampa Bernstein
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Jamiyla Bolton
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Miriam Tardif-Douglin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Deborah K. Mayer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Allison M. Deal
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Sara R. Jacobs
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
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28
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Donovan HS, Campbell GB. Persistent chemotherapy-induced peripheral neuropathy: Are dose reductions and drug modifications our only options? Gynecol Oncol 2018; 149:433-434. [DOI: 10.1016/j.ygyno.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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29
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Rietveld MJA, Husson O, Vos MCC, van de Poll-Franse LV, Ottevanger PBN, Ezendam NPM. Association between information provision and supportive care needs among ovarian cancer survivors: A cross-sectional study from the PROFILES registry. Psychooncology 2018; 27:1922-1929. [PMID: 29683231 DOI: 10.1002/pon.4742] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association between satisfaction with perceived information provision during diagnosis and treatment and supportive care needs in ovarian cancer survivors. METHODS In 2012, women (n = 348) diagnosed with ovarian cancer, as registered between 2000 and 2010 in the Netherlands Cancer Registry, received a questionnaire including questions on the perceived level of, and satisfaction with, information received (EORTC QLQ-INFO25) and supportive care needs (Cancer Survivors' Unmet Needs Measure). RESULTS Of 348 women, 191 (55%) responded. Of all participants, 35% were not satisfied (n = 65) with the perceived amount of information received. Participants who were satisfied with the amount of information reported significantly higher levels of perceived information on disease, medical tests, treatment, and other services. Patients not satisfied with information provision had a higher total number of needs and a higher number of unmet needs than women satisfied with information provision. Multivariable linear regression analysis showed that satisfaction with information provision was negatively associated with the total number of unmet needs (β = -0.20, P = .03) after adjustment for potential confounding clinical and sociodemographic factors. CONCLUSION Ovarian cancer survivors satisfied with the information provision during treatment reported fewer unmet needs during survivorship. Optimization of information provision for ovarian cancer patients during initial diagnosis and treatment may contribute to a decrease in unmet needs during survivorship.
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Affiliation(s)
- Mark J A Rietveld
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - M C Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Lonneke V van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands.,Department of Medical Psychology, Tilburg University, Tilburg, Netherlands.,Division of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - P B Nelleke Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicole P M Ezendam
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands.,Department of Medical Psychology, Tilburg University, Tilburg, Netherlands
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30
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Thomas TH, Nauth-Shelley K, Thompson MA, Attai DJ, Katz MS, Graham D, Sparacio D, Lizaso C, Utengen A, Dizon DS. The Needs of Women Treated for Ovarian Cancer: Results From a #gyncsm Twitter Chat. J Patient Cent Res Rev 2018; 5:149-157. [PMID: 31413999 DOI: 10.17294/2330-0698.1592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Ovarian cancer is the most fatal of all gynecologic cancers, with a high relapse rate regardless of stage. Women treated for ovarian cancer, therefore, likely have supportive care needs that extend well beyond the time frame of first-line therapy. Unfortunately, there is minimal data describing these needs. The purpose of this qualitative study is to understand the supportive care needs of women with ovarian care at the end of treatment. Methods To better understand the issues faced by women with ovarian cancer, we conducted a public Twitter chat in collaboration with gynecologic cancer social media (#gyncsm). Both quantitative and qualitative analyses were performed. Results The chat occurred over a 1-hour time frame on Twitter and resulted in more than 300 unique and original tweets from 43 participants during the chat and an additional 60 unique participants following the chat. Survivors and physicians represented 32% and 11% of participants, respectively; caregivers, advocates, and other clinicians represented the remaining participants. Participants noted deep interest in receiving support during survivorship and dissatisfaction with currently available resources. Sentiment analysis showed that participants viewed the support from social media in a positive light and also revealed negative sentiment around the lack of support from health care providers at the end of treatment. Conclusions Themes derived from the Twitter chat revealed the unique experiences of individuals with ovarian cancer after treatment, including a heightened sense of vulnerability. Understanding these themes represents an opportunity for clinicians to better understand and address the needs of this patient community.
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Affiliation(s)
| | | | | | | | | | - David Graham
- Levine Cancer Institute-Mallard Creek, Charlotte, NC
| | | | | | | | - Don S Dizon
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI
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31
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Ezendam NPM, de Rooij BH, Kruitwagen RFPM, Creutzberg CL, van Loon I, Boll D, Vos MC, van de Poll-Franse LV. ENdometrial cancer SURvivors' follow-up carE (ENSURE): Less is more? Evaluating patient satisfaction and cost-effectiveness of a reduced follow-up schedule: study protocol of a randomized controlled trial. Trials 2018; 19:227. [PMID: 29661218 PMCID: PMC5902894 DOI: 10.1186/s13063-018-2611-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/27/2018] [Indexed: 11/12/2022] Open
Abstract
Background It has often been hypothesized that the frequency of follow-up visits for patients with early-stage endometrial cancer could be decreased. However, studies evaluating effects of a reduced follow-up schedule among this patient group are lacking. The aim of this study is to assess patient satisfaction and cost-effectiveness of a less frequent follow-up schedule compared to the schedule according to the Dutch guideline. Methods In this multicenter randomized controlled trial, patients diagnosed in the Netherlands with stage 1A and 1B low-risk endometrial cancer, for whom adjuvant radiotherapy is not indicated (n = 282), are randomized. Patients allocated to the intervention group receive four follow-up visits during three years. Patients allocated to the control group receive 10–13 follow-up visits during five years, according to the Dutch guideline. Patients are asked to fill out a questionnaire at baseline and after 6, 12, 36, and 60 months. Primary outcomes include patient satisfaction with follow-up care and cost-effectiveness. Secondary outcomes include healthcare use, adherence to schedule, health-related quality of life, fear of recurrence, anxiety and depression, information provision, recurrence, and survival. Linear regression analyses will be used to assess differences in patient satisfaction with follow-up care between intervention and control group. Discussion We anticipate that patients in the intervention arm have a similar satisfaction with follow-up care and overall outcomes, but lower healthcare use and costs than patients in the control arm. No differences are expected in quality-adjusted life-years and satisfaction, but the reduced schedule is expected to be cost-saving when implemented in the Netherlands. Trial registration ClinicalTrials.gov, NCT02413606. Registered on 10 April 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2611-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole P M Ezendam
- The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands. .,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
| | - Belle H de Rooij
- The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Gynecology and GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carien L Creutzberg
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ingrid van Loon
- Department of Obstetrics and Gynaecology, Amphia hospital, Breda, The Netherlands
| | - Dorry Boll
- Department of Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk, The Netherlands
| | - Lonneke V van de Poll-Franse
- The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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32
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Bonhof CS, Mols F, Vos MC, Pijnenborg JMA, Boll D, Vreugdenhil G, Ezendam NPM, van de Poll-Franse LV. Course of chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer patients: A longitudinal study. Gynecol Oncol 2018; 149:455-463. [PMID: 29605500 DOI: 10.1016/j.ygyno.2018.03.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/07/2018] [Accepted: 03/15/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Chemotherapy-induced peripheral neuropathy (CIPN) presents itself as sensory peripheral neuropathy (SPN) or motor peripheral neuropathy (MPN). Our aim was to examine the course of SPN and MPN, and their impact on health-related quality of life (HRQoL) among ovarian cancer patients. METHODS All newly diagnosed ovarian cancer patients from twelve hospitals in the South of the Netherlands were eligible for participation. Patients (N=174) completed questions on CIPN (EORTC QLQ-OV28) and HRQoL (EORTC QLQ-C30) after initial treatment and at 6, 12, and 24months (response rates were 70%, 71%, 58%, and 43% respectively). RESULTS Generalized linear mixed models showed that among chemotherapy-treated patients (N=98), SPN levels were stable over time. For MPN, symptoms significantly improved at 12months. At 2years, 13% still reported high SPN. Also, 11% still reported high MPN. Regarding HRQoL, patients with high SPN reported a worse physical, role, emotional, social, and cognitive functioning compared to those with low SPN. Moreover, those who changed from low to high SPN over time worsened on physical functioning. For MPN, a worse global quality of life and a worse functioning was reported among patients with high MPN. Also, those who changed from low to high MPN over time worsened on global quality of life and on physical, role, social, and cognitive functioning. CONCLUSIONS Among chemotherapy-treated ovarian cancer patients, SPN levels were stable over time. In contrast, MPN symptoms significantly improved at 12months. These symptoms seriously impacted HRQoL. Future studies should examine the impact of different treatment decisions and alterations on CIPN, so recommendations can be made to reduce CIPN (prevalence).
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Affiliation(s)
- Cynthia S Bonhof
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - Floortje Mols
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorry Boll
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven and Veldhoven, The Netherlands; Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Nicole P M Ezendam
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Lonneke V van de Poll-Franse
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Birken SA, Urquhart R, Munoz-Plaza C, Zizzi AR, Haines E, Stover A, Mayer DK, Hahn EE. Survivorship care plans: are randomized controlled trials assessing outcomes that are relevant to stakeholders? J Cancer Surviv 2018; 12:495-508. [PMID: 29572602 DOI: 10.1007/s11764-018-0688-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/09/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to compare outcomes assessed in extant randomized controlled trials (RCTs) to outcomes that stakeholders expect from survivorship care plans (SCPs). To facilitate the transition from active treatment to follow-up care for the 15.5 million US cancer survivors, many organizations require SCP use. However, results of several RCTs of SCPs' effectiveness have been null, possibly because they have evaluated outcomes on which SCPs should be expected to have limited influence. Stakeholders (e.g., survivors, oncologists) may expect outcomes that differ from RCTs' outcomes. METHODS We identified RCTs' outcomes using a PubMed literature review. We identified outcomes that stakeholders expect from SCPs using semistructured interviews with stakeholders in three healthcare systems in the USA and Canada. Finally, we mapped RCTs' outcomes onto stakeholder-identified outcomes. RESULTS RCT outcomes did not fully address outcomes that stakeholders expected from SCPs, and RCTs assessed outcomes that stakeholders did not expect from SCPs. RCTs often assessed outcomes only from survivors' perspectives. CONCLUSIONS RCTs of SCPs' effectiveness have not assessed outcomes that stakeholders expect. To better understand SCPs' effectiveness, future RCTs should assess outcomes of SCP use that are relevant from the perspective of multiple stakeholders. IMPLICATIONS FOR CANCER SURVIVORS SCPs' effectiveness may be optimized when used with an eye toward outcomes that stakeholders expect from SCPs. For survivors, this means using SCPs as a map to guide them with respect to what kind of follow-up care they should seek, when they should seek it, and from whom they should seek it.
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Affiliation(s)
- Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg Hall, 135 Dauer Dr., Chapel Hill, NC, 27599, USA.
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Corrine Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA, USA
| | - Alexandra R Zizzi
- Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg Hall, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Emily Haines
- Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg Hall, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Angela Stover
- Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg Hall, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Deborah K Mayer
- School of Nursing, Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, NC, USA
| | - Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA, USA
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Survivorship care plans have a negative impact on long-term quality of life and anxiety through more threatening illness perceptions in gynecological cancer patients: the ROGY care trial. Qual Life Res 2018; 27:1533-1544. [PMID: 29511906 PMCID: PMC5951872 DOI: 10.1007/s11136-018-1825-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 11/29/2022]
Abstract
Purpose Prior results from the registration system oncological gynecology (ROGY) care trial showed that survivorship care plans (SCPs) increased threatening illness perceptions in gynecological cancer survivors, but it remained unclear whether this would result in poorer physical and psychosocial outcomes. The aim of the current study is to assess the direct and indirect effects of SCPs on health-related quality of life (HRQoL) and anxiety and depression, through illness perceptions. Methods Twelve hospitals in the South of the Netherlands were randomized to providing ‘SCP care’ or ‘usual care.’ Newly diagnosed endometrial and ovarian cancer patients completed questionnaires after initial treatment (endometrial, 221 [75%]; ovarian, 174 [71%]) and after 6, 12, and 24 months. SCPs were automatically generated after initial treatment by the oncology providers through the web-based ROGY. Illness perceptions were measured after initial treatment and HRQoL and anxiety and depression after 6, 12, and 24 months. Results Structural equation models showed that endometrial cancer patients who experienced more symptoms or concern due to the SCP reported worse social functioning (β = − 0.82; p = 0.01) and more fatigue, insomnia, pain, and anxiety (β = 0.58–0.86, p < 0.05) within 12 months after treatment. Ovarian cancer patients who had lower trust that the treatment would cure their disease due to the SCP reported worse emotional functioning 6 months after treatment (β = 0.27, p = 0.02). Conclusions Current results show that SCPs may have negative effects on HRQoL and anxiety in patients who experience more threatening illness perceptions due to the SCP. We should be aware of the potential negative consequences of SCPs. Trial Registration clinicaltrials.gov Identifier: NCT01185626.
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Recurrent Cancer Is Associated With Dissatisfaction With Care—A Longitudinal Analysis Among Ovarian and Endometrial Cancer Patients. Int J Gynecol Cancer 2018; 28:614-622. [DOI: 10.1097/igc.0000000000001204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe primary aim of this study was to assess the longitudinal impact of a recurrence of gynecological cancer on satisfaction with information provision and care. The secondary aim was to assess the impact of a recurrence on illness perceptions, anxiety, and depression and health-related quality of life.MethodsThis study is a longitudinal analysis from the ROGY Care trial, conducted between 2011 and 2014, including patients with endometrial (n = 215) and ovarian (n = 149) cancer. Patients were invited to complete questionnaires directly after initial treatment and after 6, 12, and 24 months. Satisfaction with information provision and care, illness perceptions, anxiety, and depression were compared before and after the recurrence. Linear mixed-model analyses were conducted to assess the differences in outcomes of patients with a recurrence compared with patients without a recurrence.ResultsDuring 2-year follow-up, 25 patients with endometrial cancer (12%) and 64 patients with ovarian cancer (43%) had recurrent disease, of whom 9 endometrial and 26 ovarian cancer patients completed at least 1 questionnaire after their recurrence was determined. Patients reported lower satisfaction with care after the diagnosis of a recurrence (doctor interpersonal skills, exchange of information between caregivers, and general satisfaction with care) compared with patients without recurrence. In addition, patients reported lower health-related quality of life, more anxiety and depression, and more threatening illness perceptions after diagnosis of a recurrence.ConclusionsAfter diagnosis of recurrent disease, endometrial and ovarian cancer patients were less satisfied with care compared with patients without a recurrence. Our findings suggest that patients with recurrent cancer are in need of care that is better tailored to their needs.
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