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Wong SL, Johnston E, Rossell N, Malogolowkin M, Rios L, Gómez García W, Antillon-Klussmann F, Fu L, Fuentes-Alabi S, Quintero Delgado K, Ortiz Morales D, Rodriguez-Loza C, Apesoa-Varano EC, Friedrich P, Alvarez E. The Effect of COVID-19 on Oncology Care for Adolescents and Young Adults in Latin America. J Adolesc Young Adult Oncol 2024; 13:703-707. [PMID: 38502817 DOI: 10.1089/jayao.2023.0140] [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: 03/21/2024] Open
Abstract
Children with cancer in low- and middle-income countries were disproportionately impacted by the COVID-19 pandemic, but little is known about how adolescents and young adults (AYAs) with cancer were affected. Sixty-seven physicians and nonphysician providers were interviewed about their experiences caring for AYAs with cancer in Latin America. Quotes related to the COVID-19 pandemic were identified and grouped into themes. Barriers from the COVID-19 pandemic included limited space, restrictions on travel, reduced funding, limited staff, limited services, and changes to treatment. However, improvements to care that arose from the COVID-19 pandemic included better access to distance learning and telemedicine.
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Affiliation(s)
- Samantha L Wong
- School of Medicine, University of California Davis, Sacramento, California, USA
| | - Emily Johnston
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nuria Rossell
- Independent Medical Anthropology Researcher, San Salvador, El Salvador
| | - Marcio Malogolowkin
- Division of Pediatric Hematology and Oncology, Davis School of Medicine, University of California, Sacramento, California, USA
| | - Ligia Rios
- Department of Pediatrics, Unidad de Oncología Pediátrica y del Adolescente, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Wendy Gómez García
- Department of Oncology, Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
- National Cancer Institute, INCART, Santo Domingo, Dominican Republic
| | - Federico Antillon-Klussmann
- Department of Hematology/Oncology, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
- School of Medicine, Francisco Marroquín University, Guatemala City, Guatemala
| | - Ligia Fu
- Department of Pediatrics, Hospital Escuela, Tegucigalpa, Honduras
| | - Soad Fuentes-Alabi
- Department of Pediatric Oncology, National Program for Childhood Cancer, Ayudame a Vivir Foundation/National Children's Hospital Benjamin Bloom, San Salvador, El Salvador
| | - Karina Quintero Delgado
- Department of Pediatrics, Hospital del Niño Dr. José Renán Esquivel, Oncología, Panama City, Panama
| | | | - Carolina Rodriguez-Loza
- Department of Pediatric Oncology, National Program for Childhood Cancer, Ayudame a Vivir Foundation/National Children's Hospital Benjamin Bloom, San Salvador, El Salvador
| | | | - Paola Friedrich
- St. Jude Children's Research Hospital, Global Pediatric Medicine, Memphis, Tennessee, USA
| | - Elysia Alvarez
- Division of Pediatric Hematology and Oncology, Davis School of Medicine, University of California, Sacramento, California, USA
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Boehm L, Jalbuena T, Haskins A, Holt C, Speckhart SA. Preference of Young Adult Cancer Survivors for In-Person Versus Telemedicine Cancer Survivorship Visits. J Adolesc Young Adult Oncol 2024; 13:573-576. [PMID: 38064493 DOI: 10.1089/jayao.2023.0121] [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: 06/27/2024] Open
Abstract
Young adult (YA) cancer survivors face barriers to follow-up care, which can be exacerbated by living in a rural location. Telemedicine may mitigate these barriers, but little is known about the preferences of YA survivors for telemedicine or in-person survivorship visits. We surveyed 57 YA cancer survivors in a rural state to assess their preference for survivorship visits. Forty-six percent of respondents preferred an in-person visit while 16% preferred telemedicine. The remaining 39% reported "it depends" or were undecided. In-person visits were preferred when stratified by rural versus urban location. This work can be used to inform survivorship delivery systems.
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Affiliation(s)
- Lauren Boehm
- Department of Family Medicine, Maine Medical Center, Portland, Maine, USA
| | | | - Amy Haskins
- Department of Family Medicine, Maine Medical Center, Portland, Maine, USA
| | - Christina Holt
- Department of Family Medicine, Maine Medical Center, Portland, Maine, USA
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Jin AH, Simon PJ, Clayton A, Benedict C, Liedtke M, Muffly L, Schapira L, Smith SM. Implementation of a Pilot Clinic for Pediatric to Adult Cancer Survivorship Transitions. J Adolesc Young Adult Oncol 2023; 12:918-922. [PMID: 37615593 DOI: 10.1089/jayao.2023.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Childhood cancer survivors are recommended to have lifelong survivorship care, yet many become disengaged during pediatric to adult care transitions. We implemented a pilot clinic for adult survivors of pediatric or adolescent and young adult (AYA) leukemia transitioning to adult-focused survivorship care. The clinic featured AYA-specific care, bidirectional communication with primary care, and a quality improvement (QI) cycle. During the 1-year QI period, 27 patients were seen and 21 completed postvisit interviews. The clinic was positively received by patients and primary care providers, showed promise for improving self-management and care coordination, and highlighted the need for novel approaches to connect survivors with primary care.
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Affiliation(s)
| | - Pamela J Simon
- Lucile Salter Packard Children's Hospital at Stanford, Stanford Adolescent and Young Adult Cancer Program, Palo Alto, California, USA
| | - Alison Clayton
- Lucile Salter Packard Children's Hospital at Stanford, Stanford Adolescent and Young Adult Cancer Program, Palo Alto, California, USA
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michaela Liedtke
- Divisions of Hematology, Department of Medicine, Stanford Health Care, Stanford, California, USA
| | - Lori Muffly
- Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford Health Care, Stanford, California, USA
| | - Lidia Schapira
- Oncology, Department of Medicine, Stanford Health Care, Stanford, California, USA
- Stanford Cancer Institute, Stanford, California, USA
| | - Stephanie M Smith
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
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Boucher AA, Jewett PI, Holtan SG, Lindgren BR, Hui JY, Blaes AH. Adult Hematology/Oncology Patient Perspectives on Telemedicine Highlight Areas of Focus for Future Hybrid Care Models. Telemed J E Health 2023; 29:708-716. [PMID: 36194051 PMCID: PMC10171940 DOI: 10.1089/tmj.2022.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/24/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Telemedicine use expanded rapidly during the COVID-19 pandemic, but publications analyzing patient perspectives on telemedicine are few. We aimed to study whether patient perspectives offer insights into how best to utilize telemedicine in the future for hematology and cancer care. Methods: A modified Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) was sent to adult hematology/oncology outpatients at the University of Minnesota Masonic Cancer Clinic who had ≥1 prior phone and/or video visit between March 15, 2020, and March 31, 2021. Two focus groups were subsequently conducted with volunteers who completed the survey. We evaluated dichotomized TSUQ items using logistic regression, and focus group data were analyzed qualitatively using constant comparison analysis. Results: Of 7,848 invitations, 588 surveys were completed. Focus groups included 16 survey respondents. Most respondents found telemedicine satisfactory, easy to use, and convenient, with the majority preferring a hybrid approach going forward. Oncology patients, females, and higher income earners endorsed decreased telemedicine satisfaction. Concerns were voiced about fewer in-person interactions, communication gaps, and provider style variability. Discussion: Adult hematology/oncology patients had varied perspectives on telemedicine utilization success based on gender, income, and disease burden, suggesting that a one-size-fits-all approach, as was implemented nearly universally during the COVID-19 pandemic, is not an ideal approach for the long term. Given that telemedicine use is likely to remain in some form in most centers, our findings suggest that a nuanced and tailored approach for some patient subgroups and using feedback from patients will make implementation more effective.
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Affiliation(s)
- Alexander A. Boucher
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Patricia I. Jewett
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Shernan G. Holtan
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Bruce R. Lindgren
- Clinical and Translational Science Institute, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jane Y.C. Hui
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Anne H. Blaes
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Betts AC, Shay LA, Allicock M, Preston SM, Grimes A, Murphy CC. Impacts of the Early COVID-19 Pandemic Among a National Sample of Adolescent and Young Adult Cancer Survivors in the United States. J Adolesc Young Adult Oncol 2022. [PMID: 36173754 DOI: 10.1089/jayao.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Adolescent and young adult cancer survivors (AYAs) experience early-onset chronic conditions and disrupted psychosocial development. We report prevalence of disruptions in care delivery and social support during the early wave of the pandemic in a national sample of AYAs in the United States. Materials and Methods: We used data from the population-based National Health Interview Survey (NHIS; July-December 2020), which allows for nationally representative estimates, and included questions related to COVID-19. We identified 61 AYAs diagnosed with cancer between ages 15 and 39 years and not currently receiving cancer treatment and 244 age- and sex-matched controls. We compared the proportion of AYAs and controls reporting delayed care due to the pandemic, not getting needed care due to the pandemic, and changes in social and emotional support. Results: AYAs were predominantly non-Hispanic White (61.3%) and female (58.8%), with a median age at diagnosis of 28 years (interquartile range [IQR] 21-31 years). Fewer AYAs were employed (52.1% vs. 71.5%), and more lived in poverty (32.0% vs. 12.4%) and felt depressed daily (9.9% vs. 3.0%, all p < 0.05). The proportion of AYAs reporting delayed care (39.8% vs. 15.3%) and not getting needed care (31.7% vs. 10.4%) due to the pandemic was more than double that of controls (both p < 0.01). One in five AYAs experienced less social and emotional support compared to the prior year, although not significantly different from controls (21.6% vs. 12.4%, p = 0.10). Conclusions: The pandemic disrupted AYAs' care and exacerbated their psychosocial challenges. Providers and health systems should prioritize reconnecting AYAs to affordable and comprehensive care.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, San Antonio, Texas, USA.,Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA.,Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA.,Texas Center for Pediatric Population Health, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA
| | - Sharice M Preston
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA.,Texas Center for Pediatric Population Health, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA
| | - Allison Grimes
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Texas Health Science Center at San Antonio, Texas, USA.,Greehey Children's Cancer Research Institute, San Antonio, Texas, USA
| | - Caitlin C Murphy
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA.,Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
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