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Rossen S, Sandager MT, Hofland DT, Nielsen CV, Maribo T. Are all cancer survivors included when using electronically administered patient reported outcomes in primary healthcare cancer rehabilitation? A cross-sectional study. J Patient Rep Outcomes 2024; 8:67. [PMID: 38976222 PMCID: PMC11231107 DOI: 10.1186/s41687-024-00753-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 06/26/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Patient reported outcomes (PROs) are being used frequently in clinical practice. PROs often serve several purposes, such as increasing patient involvement, assessing health status, and monitoring and improving the quality-of-care at an aggregated level. However, the lack of representative PRO-data may have implications for all these purposes. This study aims to assess the association of non-administration of (not sending an electronic invite to PRO) and non-response to (not responding to PRO) electronically administered PROs with social inequality in a primary healthcare cancer rehabilitation setting. Furthermore, it examines whether the workflows surrounding PRO have an impact on non-administration and non-response. METHODS This is a cross sectional study using routinely collected data from electronic health records and registers including cancer survivors (CSs) over 18 years booked for an initial consultation in a primary healthcare cancer rehabilitation setting using PROs for systematic health status assessment. During the study period two different PRO platforms were used, each associated with different workflows. Non-administration and non-response rates were calculated for sociodemographic characteristics for each PRO platform. Crude and adjusted odds ratios were calculated using univariate and multivariate logistic regression. RESULTS In total, 1868 (platform 1) and 1446 (platform 2) CSCSs were booked for an initial consultation. Of these, 233 (12.5%) (platform 1) and 283 (19.6%) (platform 2) were not sent a PRO (non-administration). Among those who received a PRO, 157 (9.6%) on platform 1 and 140 (12.0%) on platform 2 did not respond (non-response). Non-administration of and non-response to PROs were significantly associated with lower socioeconomic status. Moreover, the workflows surrounding PROs seem to have an impact on non-inclusion in and non-response to PROs. CONCLUSIONS Non-administration of and non-response to PROs in clinical practice is associated with determinants of social inequality. Clinical workflows and the PRO platforms used may potentially worsen this inequality. It is important to consider these implications when using PROs at both the individual and aggregated levels. A key aspect of implementing PROs in clinical practice is the ongoing focus on representativeness, including a focus on monitoring PRO administration and response.
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Affiliation(s)
- Sine Rossen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, Copenhagen N, DK-2200, Denmark.
| | - Mette Thønnings Sandager
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, Copenhagen N, DK-2200, Denmark
| | - Dorte Thoning Hofland
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, Copenhagen N, DK-2200, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Social Medicine and Rehabilitation, Region Hospital Goedstrup, Herning, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Larsen LL, Hoffmann Merrild C. Good cancer follow-up for socially disadvantaged patients in general practice? Perspectives from patients and general practitioners. Scand J Prim Health Care 2024; 42:316-326. [PMID: 38376126 PMCID: PMC11003317 DOI: 10.1080/02813432.2024.2317843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients.
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Erlik M, Timm H, Larsen ATS, Quist M. Reasons for non-participation in cancer rehabilitation: a scoping literature review. Support Care Cancer 2024; 32:346. [PMID: 38743121 PMCID: PMC11093823 DOI: 10.1007/s00520-024-08553-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Rehabilitation plays an important role in addressing the many challenges of living with cancer, but a large proportion of people with cancer do not participate in available cancer rehabilitation. Hence, reasons for non-participation in cancer rehabilitation need to be explored. OBJECTIVE The present study undertakes a scoping review of research examining reasons for non-participation in cancer rehabilitation among people with cancer. DESIGN A systematic search was conducted in PubMed, Scopus and CINAHL for articles published until July 2023. Included studies were hand searched for relevant references and citations. ELIGIBILITY CRITERIA Method: Studies with qualitative, quantitative or mixed-method design. POPULATION Studies targeting adults (> 18) living with cancer, not participating in rehabilitation. Program type: The review included all studies defining program as rehabilitation but excluded clinical trials. OUTCOME Studies examining reasons for non-participation in available rehabilitation. DATA EXTRACTION The extracted data included author(s)/year of publication, aim, population, information, rehabilitation type and main reasons for non-participation. RESULTS A total of nine studies were included (n = 3 quantitative, n = 2 qualitative, n = 4 mixed methods). Reasons for non-participation included physical, psychosocial and practical aspects. The main reason across studies was 'no need for public support' related to receiving sufficient support from family and friends. All studies focused on individual reasons, and structural conditions were rarely present. CONCLUSION Research within this field is sparse. Future research should explore how individual reasons for non-participation relate to structural conditions, especially among people in socially disadvantaged positions living with cancer.
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Affiliation(s)
- Mikala Erlik
- UCSF-Centre for Health Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
- Department of Public Health, University of Copenhagen, Copenhagen N, Denmark.
| | - Helle Timm
- UCSF-Centre for Health Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Faculty of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands
| | | | - Morten Quist
- UCSF-Centre for Health Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen N, Denmark
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Watts T, Courtier N, Fry S, Gale N, Gillen E, McCutchan G, Patil M, Rees T, Roche D, Wheelwright S, Hopkinson J. Access, acceptance and adherence to cancer prehabilitation: a mixed-methods systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01605-3. [PMID: 38709465 DOI: 10.1007/s11764-024-01605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The purpose of this systematic review is to better understand access to, acceptance of and adherence to cancer prehabilitation. METHODS MEDLINE, CINAHL, PsychINFO, Embase, Physiotherapy Evidence Database, ProQuest Medical Library, Cochrane Library, Web of Science and grey literature were systematically searched for quantitative, qualitative and mixed-methods studies published in English between January 2017 and June 2023. Screening, data extraction and critical appraisal were conducted by two reviewers independently using Covidence™ systematic review software. Data were analysed and synthesised thematically to address the question 'What do we know about access, acceptance and adherence to cancer prehabilitation, particularly among socially deprived and minority ethnic groups?' The protocol is published on PROSPERO CRD42023403776 RESULTS: Searches identified 11,715 records, and 56 studies of variable methodological quality were included: 32 quantitative, 15 qualitative and nine mixed-methods. Analysis identified facilitators and barriers at individual and structural levels, and with interpersonal connections important for prehabilitation access, acceptance and adherence. No study reported analysis of facilitators and barriers to prehabilitation specific to people from ethnic minority communities. One study described health literacy as a barrier to access for people from socioeconomically deprived communities. CONCLUSIONS There is limited empirical research of barriers and facilitators to inform improvement in equity of access to cancer prehabilitation. IMPLICATIONS FOR CANCER SURVIVORS To enhance the inclusivity of cancer prehabilitation, adjustments may be needed to accommodate individual characteristics and attention given to structural factors, such as staff training. Interpersonal connections are proposed as a fundamental ingredient for successful prehabilitation.
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Hjorth CF, Schmidt JA, Farkas DK, Cronin-Fenton D. Social characteristics and social benefit use among premenopausal breast cancer survivors in Denmark: a population-based cohort study. J Cancer Surviv 2024:10.1007/s11764-024-01598-z. [PMID: 38647591 DOI: 10.1007/s11764-024-01598-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE In 2020, one million women aged < 55 years were diagnosed with breast cancer globally. The impact of breast cancer and its treatments on these women's ability to work and need for social benefits may differ by social characteristics. We evaluated social benefit use following breast cancer by education and cohabitation. METHODS We conducted a nationwide population-based cohort study, including women aged 18-55 years diagnosed with stage I-III breast cancer in Denmark during 2002-2011. Statistics Denmark provided information on cohabitation, education, and social benefit use from 1 year pre-diagnosis to 10 years post-diagnosis. We calculated weekly proportions of self-support, unemployment, disability pension, flexi jobs, and sick leave according to education and cohabitation. RESULTS Of 5345 women, 81.8% were self-supporting, 4.5% received disability pensions, 1.6% had flexi jobs, 3.6% were on sick leave, and 5.5% were unemployed 1 year pre-diagnosis. Ten years post-diagnosis, the proportions were 69.0%, 13.0%, 10.5%, 3.4%, and 2.0% of 3663 survivors. Disability pensions and flexi jobs increased from 12.1 to 26.4% and 2.8 to 13.5% in women with short education, from 4.1 to 12.8% and 1.8 to 12.2% in women with medium education, and from 0.8 to 6.0% and 0.9 to 6.9% in longer educated. Disability pensions increased more in women living alone (7.8 to 19.9%), than in cohabiting women (3.6 to 11.3%). CONCLUSIONS Use of social benefits reflecting lost ability to work was highest in less educated women and in women living alone. IMPLICATIONS FOR CANCER SURVIVORS Awareness of these groups is crucial when tailoring efforts to support work participation in cancer survivors.
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Affiliation(s)
- Cathrine F Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Julie A Schmidt
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Dóra K Farkas
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
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Sandager MT, Rossen S, Hofland DT, Nielsen CV, Maribo T. Health-related quality of life, needs, and concerns among cancer survivors referred to rehabilitation in primary healthcare setting. Acta Oncol 2024; 63:76-82. [PMID: 38482717 PMCID: PMC11332470 DOI: 10.2340/1651-226x.2024.19636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/29/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND AND PURPOSE There is a growing need for rehabilitation services beyond hospitals. This study aims to describe challenges faced by cancer survivors (CSs) referred for rehabilitation in primary healthcare, employing standardized scales measuring health-related quality of life (HRQOL) and open-ended questions. Furthermore, the study explores the applicability of patient-reported outcomes (PROs) in comprehensively understanding challenges encountered by CSs. MATERIAL AND METHODS This cross-sectional study involves CSs referred for cancer rehabilitation in a primary healthcare setting, including those participating in PROs as a part of routine practice. HRQOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The International Classification of Functioning, Disability and Health (ICF) framed the analysis of responses to open-ended questions 'what concerns you the most?' and 'what matters to you?' Results: FACT-G showed the lowest scores for functional well-being (14.4) and emotional well-being (16.6), with higher scores for physical well-being (18.9) and social/family well-being (21.1). Responses to open-ended questions unveiled worries about everyday life and how cancer will impact family well-being presently and in the future. Furthermore, CSs reported a need to maintain normality and proactively address the challenges posed by the disease. INTERPRETATION CSs referred for rehabilitation in primary healthcare experience comprehensive challenges necessitating a holistic rehabilitation approach. This includes interventions supporting CSs in dealing with uncertainty, regaining a sense of control, and addressing family well-being concerns. When using PROs for need assessment, the combination of validated HRQOL scales and open-ended questions is crucial for an in-depth understanding of CSs' challenges.
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Affiliation(s)
- Mette T Sandager
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Copenhagen, Denmark
| | - Sine Rossen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Copenhagen, Denmark.
| | - Dorte T Hofland
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Copenhagen, Denmark
| | - Claus V Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM Central Denmark Region, Aarhus, Denmark; Social Medicine and Rehabilitation, Region Hospital Goedstrup, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM Central Denmark Region, Aarhus, Denmark
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Navntoft S, Andreasen J, Petersen KS, Rossau HK, Jørgensen L. Barriers and facilitators to cancer rehabilitation for patients with head and neck or lung cancer-a scoping review mapping structural and healthcare professionals' perspectives. Disabil Rehabil 2023:1-13. [PMID: 37961874 DOI: 10.1080/09638288.2023.2280073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer. MATERIALS AND METHODS Two systematic searches were conducted in five databases mapping peer-reviewed research literature. RESULTS In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation. CONCLUSION From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation.
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Affiliation(s)
- Sophie Navntoft
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Jane Andreasen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
- Aalborg Centre of Health and Rehabilitation, Aalborg Municipality, Aalborg, Denmark
| | - Kirsten Schultz Petersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Henriette Knold Rossau
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Jørgensen
- Clinic for Surgery and Cancer Treatment & Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Møller JJK, la Cour K, Pilegaard MS, Dalton SO, Bidstrup P, Möller S, Jarlbaek L. The use and timing of rehabilitation and palliative care to cancer patients, and the influence of social vulnerability - a population-based study. BMJ Support Palliat Care 2023:spcare-2023-004487. [PMID: 37816594 DOI: 10.1136/spcare-2023-004487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES To identify and investigate different cohorts of cancer patients' use of physical rehabilitation and specialised palliative care (SPC) services, focusing on patients with incurable cancer and the impact of social vulnerability. METHODS The sample originated from patients diagnosed during 2013-2018 and alive 1 January 2015. Use of physical rehabilitation and/or SPC units were identified from contacts registered in population-based administrative databases. Competing-risks regression models were applied to investigate disparities with regard to social vulnerability, disease duration, gender and age. RESULTS A total of 101 268 patients with cancer were included and 60 125 survived longer than 3 years after their diagnosis. Among the 41 143 patients, who died from cancer, 66%, survived less than 1 year, 23% survived from 1 to 2 years and 11% survived from 2 to 3 years. Contacts regarding physical rehabilitation services appeared in the entire cancer trajectory, whereas contacts regarding SPC showed a steep increase as time drew closer to death. The largest disparity was related to disease duration. Socially vulnerable patients had less contact with SPC, while a larger proportion of the socially vulnerable cancer survivors used rehabilitation, compared with the non-vulnerable patients. CONCLUSIONS This study provides a previously unseen detailed overview of the use of physical rehabilitation and/or SPC among patients with incurable cancer. The services appeared to overlap at a group level in the cancer trajectory, emphasising the importance of awareness with regard to coordination and combination of the services. Disparities between socially vulnerable or non-vulnerable patients were identified.
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Affiliation(s)
- Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- DEFACTUM, Central Region Denmark, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Pernille Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sören Möller
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Chan VHY, Heller DR, Berger ER, Capozza S, Greenup RA, Sanft TB. Ancillary Treatment Referrals and Visits After Breast Cancer Surgery in a Sociodemographically Diverse Population. Ann Surg Oncol 2023; 30:5637-5648. [PMID: 37266804 DOI: 10.1245/s10434-023-13431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Ancillary therapies with rehabilitative, palliative, and survivorship specialists mitigate adverse effects of breast cancer surgery. Existing data suggest that patients from disadvantaged backgrounds may be less likely to receive these services. This study aimed to assess variations in ancillary provider referrals and patient visits at a high-volume urban cancer center. METHODS Electronic health records of breast cancer surgical patients at the Yale-New Haven Health System between 2010 and 2017 were reviewed. The primary end points were postoperative referral to ancillary service providers and patient use of ancillary services (defined as attending ≥ 1 consultation). Associations between end points and demographic/disease variables were identified in uni- and multivariable logistic regression analyses. RESULTS The study identified 5496 patients: 2288 patients (41.6%) referred to ancillary services and 1572 patients (28.6%) who attended one or more consultations. Referrals were highest among the patients with Hispanic (57.5%) or black (54.9%) ancestry, no health insurance (57.6%), lowest percentage of high school degrees for the zip code area (50.5%), and poorest median income bracket (50.7%). Associations remained significant in the multivariable analysis (p < 0.05). Minority race remained associated with referrals in analyses of each ancillary service individually. Visits to ancillary specialists were greatest among the patients with private insurance (70.7%), highest percentage of high school degrees (72.8%), highest median household income (72.2%), and Hispanic ethnicity (73.5%). Highest median household income (odds ratio [OR] 1.45; p = 0.02) and Hispanic ethnicity (OR, 1.50; p = 0.05) remained associated in the multivariable analysis. CONCLUSIONS In a well-resourced health system serving a demographically diverse population, traditional markers of poor health care access were associated with referral for ancillary treatment after breast cancer surgery but not with utilization of ancillary treatment. Health care access remains a critical barrier to adjunctive therapies that target postoperative morbidity and elevate quality of life.
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Affiliation(s)
- Vernice H Y Chan
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Danielle R Heller
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Elizabeth R Berger
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Scott Capozza
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Rachel A Greenup
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tara B Sanft
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA.
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Gupta S, Li Q, Nathan PC, D'Agostino N, Baxter NN, Fox C, Chalifour K, Coburn N, Sutradhar R. Prevalence, severity, and predictors of symptom burden among adolescents and young adults with cancer. Cancer Med 2023. [DOI: 10.1002/cam4.5837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023] Open
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Borre M, Fassov J, Juul T, Laurberg S, Christensen P, Bräuner AB, Thorlacius Ussing O, Lauritzen MB, Drewes AM, Faaborg PM, Krogh K. Diet and bowel symptoms among colon cancer survivors. Acta Oncol 2022; 61:1192-1199. [DOI: 10.1080/0284186x.2022.2101901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mette Borre
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Janne Fassov
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Therese Juul
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Annette Boesen Bräuner
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Surgery, Regional Hospital Viborg, Viborg, Denmark
| | - Ole Thorlacius Ussing
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Bødker Lauritzen
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Surgery, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Asbjørn Mohr Drewes
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Pia Møller Faaborg
- Department of Surgery, Danish Colorectal Cancer Center South, Vejle, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
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12
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Møller JJK, la Cour K, Pilegaard MS, Möller S, Jarlbaek L. Identification of socially vulnerable cancer patients - development of a register-based index (rSVI). Support Care Cancer 2022; 30:5277-5287. [PMID: 35275294 DOI: 10.1007/s00520-022-06937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Social vulnerability is a complex construct which is beyond relying on single measures. If socially vulnerable patients should be identified, we need a composite measure capturing the patient's overall circumstances. This study presents the development of a social vulnerability index (rSVI) for cancer patients based on administrative data from population-based registers. METHODS All patients, who died from cancer within 5 years after the cancer diagnosis during 2013-2018 (n = 44,187), were identified and divided in four subcohorts according to survival; index cohort surviving 3-5 years (n = 3044 surviving 3-5 years), cohort 1 (n = 27,170 surviving < 1 year), cohort 2 (n = 9450 surviving 1-2 years), and cohort 3 (n = 4523 surviving 2-3 years). Variables from ten registries on health and social issues were linked to each individual patient. Variables of interest were weighted to construct the rSVI using the index-cohort. rSVI was subsequently tested on the three other cohorts for validation. RESULTS The rSVI included weighted values for marital status, ethnicity, education, income, unemployment, psychiatric comorbidity, and somatic comorbidity. The validity of the rSVI was supported by the expected trend in proportions of vulnerable patients when applied on the other cohorts. Single social measures appeared insufficient in identification of vulnerable patients when compared with the rSVI. CONCLUSION The rSVI provides a tool for identification of socially vulnerable cancer patients using administrative data. The index requires further validation in other patient groups and is tested against other measures of vulnerability. Future perspectives are to use the rSVI as predictor of advanced cancer patients' use of healthcare services.
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Affiliation(s)
- Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Danish Research Centre for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark.
| | - Karen la Cour
- Danish Research Centre for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark
- Research Unit for User Perspectives and Community-based Interventions, the Research group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit for User Perspectives and Community-based Interventions, the Research group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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13
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Nissen N, Rossau HK, Pilegaard MS, la Cour K. Cancer rehabilitation and palliative care for socially vulnerable patients in Denmark: an exploration of practices and conceptualisations. Palliat Care Soc Pract 2022; 16:26323524221097982. [PMID: 35800415 PMCID: PMC9253993 DOI: 10.1177/26323524221097982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Despite a tax-funded, needs-based organisation of the Danish health system,
social inequality in cancer rehabilitation and palliative care (PC) has been
noted repeatedly. Little is known about how best to improve access and
participation in cancer rehabilitation and PC for socio-economically
disadvantaged and socially vulnerable patients. Aim: To gather, synthesise and describe practice-orientated development studies
presented in Danish-language publications and examine the underpinning
conceptualisations of social inequality and vulnerability; explore related
views of stakeholders working in the field. Methods: The study comprised a narrative review of Danish-language literature on
practice-orientated development studies which address social inequality and
vulnerability in cancer rehabilitation and PC and an online stakeholder
consultation workshop with Danish professionals and academics working in the
field. Results: Two themes characterise the included publications (n = 8):
types of interventions; conceptualisations of social inequality and
vulnerability; three themes were identified in the workshop data: focus and
type of interventions; organisation of cancer care; and vulnerability of the
healthcare system. The publications and the workshop participants
(n = 12) favoured approaches which provide additional
individualised resources throughout the cancer trajectory for this patient
group. The terms social inequality and social vulnerability are largely used
interchangeably, and associated with low income and no or little education
yet qualified with multiple descriptors, which reflect the diverse
socio-economic situations professionals encounter in cancer patients and
their psychosocial needs. Conclusion: Addressing social inequality and vulnerability in cancer rehabilitation and
PC in Denmark entails practical and conceptual challenges. Of importance is
individualised support and the integration of rehabilitation and PC into
standardised care pathways. To conceive of social vulnerability as a
layered, dynamic, relational and contextual concept reflects current
practice in identifying the diversity of cancer patients who may benefit
from additional support in accessing and participating in rehabilitation and
PC.
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Affiliation(s)
- Nina Nissen
- Independent Researcher, Berlin, Germany
- Affiliation during the study: REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Henriette Knold Rossau
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Affiliation during the study: REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Marc Sampedro Pilegaard
- User Perspectives and Community-Based Interventions, Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- User Perspectives and Community-Based Interventions, Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Affiliation during the study: REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
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14
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Cho S, Chung SH, Kang M, Jo A, Sim SH, Kim YJ, Yang EJ. Underutilisation of Physical Rehabilitation Therapy by Cancer Patients in Korea: a Population-based Study of 958,928 Korean Cancer Patients. J Korean Med Sci 2021; 36:e304. [PMID: 34845872 PMCID: PMC8629717 DOI: 10.3346/jkms.2021.36.e304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Advanced cancers are associated with more severe symptoms and greater impairment. Although most patients with metastatic cancer would benefit from rehabilitation, few patients receive appropriate rehabilitation therapy. We explored the use of rehabilitation therapy by cancer patients. Our data represented the entire population of Korea. The analyses were performed according to cancer type and stage. METHODS We extracted rehabilitation utilization data of patients newly diagnosed with cancer in the period of 2011-2015 from the Korea Central Cancer Registry, which is linked to the claims database of the National Health Insurance Service (n = 958,928). RESULTS The utilisation rate increased during the study period, from 6.0% (11,504) of 192,835 newly diagnosed patients in 2011 to 6.8% (12,455) of 183,084 newly diagnosed patients in 2015. Patients with central nervous system (28.4%) and bone (27.8%) cancer were most likely to undergo physical rehabilitation. The rehabilitation rate was higher in patients with metastatic than localised or regional cancer (8.7% vs. 5.3% vs. 5.5%). CONCLUSION This claims-based study revealed that rehabilitation therapy for cancer patients is underutilised in Korea. Although patients with metastasis underwent more intensive rehabilitation than patients with early stage cancer, those without brain and bone tumours (the treatment of which is covered by insurance) were less likely to use rehabilitation services. Further efforts to improve the use of rehabilitation would improve the outcomes of cancer patients.
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Affiliation(s)
- Songhee Cho
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seung Hyun Chung
- Department of Physical Medicine and Rehabilitation, National Cancer Center, Goyang, Korea
| | - Minjoo Kang
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Aejeong Jo
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sung Hoon Sim
- Division of Hematology-Oncology, Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Joo Yang
- Department of Physical Medicine and Rehabilitation, Seoul National University Bundang Hospital, Seongnam, Korea.
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15
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Hjorth CF, Damkier P, Ejlertsen B, Lash T, Sørensen HT, Cronin-Fenton D. Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark. BMC Med 2021; 19:235. [PMID: 34587961 PMCID: PMC8482675 DOI: 10.1186/s12916-021-02108-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To investigate how socioeconomic position (SEP) influences the effectiveness of cancer-directed treatment in premenopausal breast cancer patients in terms of breast cancer recurrence and mortality. METHODS We conducted a cohort study nested in the ProBeCaRe (Predictors of Breast Cancer Recurrence) cohort (n = 5959). We identified all premenopausal women aged 18-55 years diagnosed with non-metastatic breast cancer and prescribed docetaxel-based chemotherapy in Denmark during 2007-2011. Population-based administrative registries provided data on SEP: marital status (married including registered partnership or single including divorced or widowed), cohabitation (cohabiting or living alone), education (low, intermediate, or high), income (low, medium, or high), and employment status (employed, unemployed, or health-related absenteeism). For each SEP measure, we computed incidence rates, cumulative incidence proportions (CIPs), and used Poisson regression to compute incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of recurrence and death. We stratified on estrogen receptor (ER) status/tamoxifen to evaluate interaction. RESULTS Our study cohort included 2616 women; 286 (CIP 13%) experienced recurrence and 223 (CIP 11%) died during follow-up (median 6.6 and 7.2 years, respectively). Single women had both increased 5-year risks of recurrence (IRR 1.45, 95% CI 1.11-1.89) and mortality (IRR 1.83, 95% CI 1.32-2.52). Furthermore, we observed increased 5-year mortality in women with low education (IRR 1.49, 95% CI 0.95-2.33), low income (IRR 1.37, 95% CI 0.83-2.28), unemployment (IRR 1.61, 95% CI 0.83-3.13), or health-related work absenteeism (IRR 1.80, 95% CI 1.14-2.82), but smaller or no increased risk of recurrence. These findings were especially evident among women with ER+ tumors prescribed tamoxifen. Overall analyses (follow-up max. 10 years) provided similar results. CONCLUSIONS Low SEP in premenopausal women with non-metastatic breast cancer was associated with increased mortality, but not always recurrence. This suggests underdetection of recurrences in certain groups. Poor prognosis in women with low SEP, especially single women, may partly be explained by tamoxifen adherence.
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Affiliation(s)
- Cathrine Fonnesbech Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, J.B. Winsløvs vej 4, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, Winsløwparken 19, University of Southern Denmark, 5000, Odense, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Oncology, University of Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Timothy Lash
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
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16
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Sampedro Pilegaard M, Knold Rossau H, Lejsgaard E, Kjer Møller JJ, Jarlbaek L, Dalton SO, la Cour K. Rehabilitation and palliative care for socioeconomically disadvantaged patients with advanced cancer: a scoping review. Acta Oncol 2021; 60:112-123. [PMID: 33021852 DOI: 10.1080/0284186x.2020.1827156] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Rehabilitation and palliative care may play an important role in addressing the problems and needs perceived by socioeconomically disadvantaged patients with advanced cancer. However, no study has synthesized existing research on rehabilitation and palliative care for socioeconomically disadvantaged patients with advanced cancer. The study aimed to map existing research of rehabilitation and palliative care for patients with advanced cancer who are socioeconomically disadvantaged. MATERIAL AND METHODS A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A systematic literature search was performed in CINAHL, PubMed and EMBASE. Two reviewers independently assessed abstracts and full-text articles for eligibility and performed data extraction. Both qualitative and quantitative studies published between 2010 and 2019 were included if they addressed rehabilitation or palliative care for socioeconomically disadvantaged (adults ≥18 years) patients with advanced cancer. Socioeconomic disadvantage is defined by socioeconomic position (income, educational level and occupational status). RESULTS In total, 11 studies were included in this scoping review (138,152 patients and 45 healthcare providers) of which 10 were quantitative studies and 1 was a qualitative study. All included studies investigated the use of and preferences for palliative care, and none focused on rehabilitation. Two studies explored health professionals' perspectives on the delivery of palliative care. CONCLUSION Existing research within this research field is sparse. Future research should focus more on how best to reach and support socioeconomically disadvantaged people with advanced cancer in community-based rehabilitation and palliative care.
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Affiliation(s)
- Marc Sampedro Pilegaard
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
- Department of Public Health, Research Unit of General Practice, The Research Initiative of Activity Studies and Occupational Therapy, University of Southern Denmark, Odense, Denmark
| | - Henriette Knold Rossau
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Esben Lejsgaard
- Department of Sociology and Social Work, Aalborg University, Denmark, Aalborg, Denmark
| | - Jens-Jakob Kjer Møller
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship & Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department for Clinical Oncology & Palliative Care, Danish Research Center for Equality in Cancer (COMPAS), Zealand University Hospital, Næstved, Denmark
| | - Karen la Cour
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
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17
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IJsbrandy C, Ottevanger PB, Gerritsen WR, van Harten WH, Hermens RPMG. Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study. J Cancer Surviv 2020; 15:163-177. [PMID: 32986232 PMCID: PMC7822788 DOI: 10.1007/s11764-020-00921-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center. METHODS We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2). RESULTS Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47-2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31-2.45), referral to PCRPs (OR 1.81, 95% CI 1.18-2.78), participation in PCRPs (OR 2.04, 95% CI 1.43-2.91), and PAU (OR 1.69, 95% CI 1.25-2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators. CONCLUSIONS The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care. IMPLICATIONS FOR CANCER SURVIVORS Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.
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Affiliation(s)
- Charlotte IJsbrandy
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands. .,Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. .,Department of Radiation Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, MB-HTSR, University of Twente, Enschede, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
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18
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Dalton SO, Johansen C. European cancer rehabilitation and survivorship, 2018: one of a kind. Acta Oncol 2019; 58:519-521. [PMID: 31035842 DOI: 10.1080/0284186x.2019.1606937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Cancer Society Research Center, Unit of Survivorship Research, Copenhagen, Denmark
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