1
|
Tarver WL, Justice Z, Jonnalagadda P, Rahurkar S, Obeng-Gyasi S, Krok-Schoen JL, Petrecca A, Paskett ED. A scoping review of the evidence on survivorship care plans among minority, rural, and low-income populations. J Cancer Surviv 2024:10.1007/s11764-024-01609-z. [PMID: 38907799 DOI: 10.1007/s11764-024-01609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 04/19/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE Despite recent advances in cancer control and the number of cancer survivors increasing substantially over the past years, some cancer survivors continue to experience disparities due to barriers to recommended survivorship care. The use of survivorship care plans (SCPs) may be a way to help care for these individuals and their respective issues after they complete their primary treatment. The purpose of this scoping review is to understand the evidence on SCPs among minority, rural, and low-income populations: groups that experience disproportionately poorer cancer health outcomes. METHODS Computer-based searches were conducted in four academic databases. We included peer-reviewed studies published in the English language and conducted in the USA. We systematically extracted information from each paper meeting our inclusion criteria. RESULTS Our search identified 45 articles. The 4 major themes identified were (1) disparities in the receipt of SCPs where populations experience unmet needs; (2) benefits of SCPs, including improved care coordination and self-management of cancer; (3) needs and preferences for survivorship care; and (4) barriers and facilitators to using SCPs. CONCLUSIONS Despite the potential benefits, underserved cancer survivors experience disparities in the receipt of SCPs and continue to have unmet needs in their survivorship care. Survivorship care may benefit from a risk-stratified approach where SCPs are prioritized to survivors belonging to high-risk groups. IMPLICATIONS FOR CANCER SURVIVORS SCPs are a tool to deliver quality care for cancer survivors. While evidence is mixed on SCPs' benefits among the general population, SCPs show promise for underserved populations when it comes to proximal outcomes that contribute to disparities.
Collapse
Affiliation(s)
- Willi L Tarver
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | | | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Abigail Petrecca
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
2
|
Yan X, Newman MW, Park SY, Sander A, Choi SW, Miner J, Wu Z, Carlozzi N. Identifying Design Opportunities for Adaptive mHealth Interventions That Target General Well-Being: Interview Study With Informal Care Partners. JMIR Form Res 2023; 7:e47813. [PMID: 37874621 PMCID: PMC10630866 DOI: 10.2196/47813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions can deliver personalized behavioral support to users in daily contexts. These interventions have been increasingly adopted to support individuals who require low-cost and low-burden support. Prior research has demonstrated the feasibility and acceptability of an mHealth intervention app (CareQOL) designed for use with informal care partners. To further optimize the intervention delivery, we need to investigate how care partners, many of whom lack the time for self-care, react and act in response to different behavioral messages. OBJECTIVE The goal of this study was to understand the factors that impact care partners' decision-making and actions in response to different behavioral messages. Insights from this study will help optimize future tailored and personalized behavioral interventions. METHODS We conducted semistructured interviews with participants who had recently completed a 3-month randomized controlled feasibility trial of the CareQOL mHealth intervention app. Of the 36 participants from the treatment group of the randomized controlled trial, 23 (64%) participated in these interviews. To prepare for each interview, the team first selected representative behavioral messages (eg, targeting different health dimensions) and presented them to participants during the interview to probe their influence on participants' thoughts and actions. The time of delivery, self-reported perceptions of the day, and user ratings of a message were presented to the participants during the interviews to assist with recall. RESULTS The interview data showed that after receiving a message, participants took various actions in response to different messages. Participants performed suggested behaviors or adjusted them either immediately or in a delayed manner (eg, sometimes up to a month later). We identified 4 factors that shape the variations in user actions in response to different behavioral messages: uncertainties about the workload required to perform suggested behaviors, concerns about one's ability to routinize suggested behaviors, in-the-moment willingness and ability to plan for suggested behaviors, and overall capability to engage with the intervention. CONCLUSIONS Our study showed that care partners use mHealth behavioral messages differently regarding the immediacy of actions and the adaptation to suggested behaviors. Multiple factors influence people's perceptions and decisions regarding when and how to take actions. Future systems should consider these factors to tailor behavioral support for individuals and design system features to support the delay or adaptation of the suggested behaviors. The findings also suggest extending the assessment of user adherence by considering the variations in user actions on behavioral support (ie, performing suggested or adjusted behaviors immediately or in a delayed manner). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/32842.
Collapse
Affiliation(s)
- Xinghui Yan
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Mark W Newman
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Sun Young Park
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Penny W Stamps School of Art and Design, University of Michigan, Ann Arbor, MI, United States
| | - Angelle Sander
- H Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
3
|
Mbotwa CH, Kazaura MR, Moen K, Leshabari MT, Metta E, Mmbaga EJ. Retention in an mHealth App Aiming to Promote the Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers in Dar es Salaam, Tanzania: Prospective Cohort Study. JMIR Mhealth Uhealth 2023; 11:e46853. [PMID: 37855221 PMCID: PMC10595516 DOI: 10.2196/46853] [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: 03/21/2023] [Revised: 06/17/2023] [Accepted: 08/04/2023] [Indexed: 10/20/2023] Open
Abstract
Background Increasing access to smartphones in sub-Saharan Africa offers an opportunity to leverage mobile health (mHealth) technology to improve access to health care in underserved populations. In the domain of HIV prevention, mHealth interventions can potentially contribute to solving the challenges of suboptimal adherence to pre-exposure prophylaxis (PrEP) and low retention in PrEP services among populations most vulnerable to HIV acquisition. However, there is a gap in the knowledge about the use of such interventions in sub-Saharan Africa. Objective This study aims to evaluate the extent and predictors of retention in an mHealth app (Jichunge) that aims to promote adherence to PrEP and retention in PrEP care among female sex workers in Dar es Salaam, Tanzania. Methods A prospective cohort of female sex workers residing in Dar es Salaam were recruited, using respondent-driven sampling. All participants were provided with the Jichunge app as they started PrEP. A questionnaire was used to collect data on sociodemographics and other structural factors, while app use data for the 60-day period following the first 150 days of being in the intervention arm were extracted from the app's back end. A multivariable log-binomial model was used to determine predictors of 6-month retention in the Jichunge app. Results A total of 470 female sex workers were recruited. Nearly three-quarters of participants (206/284, 72.5%) who came to the 6-month follow-up interview no longer had the Jichunge app on their phones. The majority of these participants (193/206, 93.7%) no longer had access to the app because of issues related to their phones. Data extracted from the back end of the app showed that the use of the app declined over time, and only 13.4% (63/470) of the participants were retained (continued to use the app) after 6 months of intervention. At 6 months, women aged ≥35 years were >2 times more likely to use the app than women aged 18 to 24 years (adjusted risk ratio [aRR] 2.2, 95% CI 1.2-4.1; P=.01). Furthermore, retention in the app was higher among participants who demonstrated high PrEP awareness at baseline (aRR 1.8, 95% CI 1.1-3; P=.01) and among those who had experienced financial difficulties due to health care spending (aRR 1.9, 95% CI 1.2-3.2; P=.01). Conclusions Most female sex workers (206/284, 72.5%) who were enrolled in PrEP care in Tanzania no longer used the Jichunge app after 6 months. Retention in the app at 6 months was predicted by older age, high PrEP awareness, and financial difficulties due to health care spending. Strategies for the long-term retention of participants in mHealth apps, such as systems for reinstallations of apps, should be considered during the design phase.
Collapse
Affiliation(s)
- Christopher H Mbotwa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, United Republic of Tanzania
| | - Method R Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Melkizedeck T Leshabari
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Emmy Metta
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Elia J Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Chung T, Ahn C, Suffoletto BP. Trajectory classes of engagement with an alcohol text message intervention and predictors of intervention engagement. Addict Behav 2023; 144:107729. [PMID: 37094456 DOI: 10.1016/j.addbeh.2023.107729] [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: 11/17/2022] [Revised: 03/05/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
Digital interventions have increased our capacity to reach young adults who have hazardous alcohol use. Alcohol text message interventions have shown small effects in reducing hazardous drinking, leaving room for improvement. An important challenge to address in improving digital interventions is maintaining engagement, which reflects the "dose" of intervention received. This study aimed to identify trajectory classes of engagement with an alcohol text message intervention, and baseline predictors of the trajectory classes to determine "for whom" the digital intervention was more versus less engaging, to guide further intervention tailoring. This secondary analysis examined data from a study that compared five 12-week alcohol text message interventions designed to reduce hazardous drinking in young adults (aged 18-25; N = 1,131, 68% female) recruited from Emergency Departments in Western Pennsylvania. Engagement with the intervention was based on response (present/absent) to text message queries delivered twice per week during 2-week run-in and 12-week intervention. Repeated measures latent profile analysis identified five latent trajectory classes as having the best fit to the data: "High engagement" (55.1%), "Slow decrease, moderate engagement" (23.2%); "Mid-way decrease in engagement" (8.9%), "Steadily decreasing engagement" (8.1%); and "Fluctuating, moderate engagement" (4.6%). Females and individuals enrolled in college were overrepresented in the high engagement trajectory class, whereas individuals higher in impulsivity were more likely to be in decreasing (versus high) engagement trajectory classes. Methods to boost engagement using, for example, motivational enhancement for young adults with higher levels of impulsivity, at specific time points, such as the mid-point of the intervention, warrant consideration.
Collapse
Affiliation(s)
- Tammy Chung
- Institute for Health, Healthcare Policy and Aging Research, Rutgers University, United States.
| | - Curie Ahn
- MetroWest Medical Center, United States
| | | |
Collapse
|
5
|
Mandal S, Belli H, Cruz J, Mann D, Schoenthaler A. Analyzing user engagement within a patient-reported outcomes texting tool for diabetes management (Preprint). JMIR Diabetes 2022; 7:e41140. [DOI: 10.2196/41140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
|
6
|
Mbotwa C, Kazaura M, Moen K, Leshabari M, Metta E, Leyna G, Mmbaga EJ. Predictors of mHealth use in promoting adherence to pre-exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania. BMC Health Serv Res 2022; 22:859. [PMID: 35787285 PMCID: PMC9254514 DOI: 10.1186/s12913-022-08245-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania. Methods As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app. Results Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009). Conclusion Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed. Trial registration International Clinical Trials Registry Platform PACTR202003823226570; 04.03.2020.
Collapse
Affiliation(s)
- Christopher Mbotwa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania.
| | - Method Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Melkizedeck Leshabari
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmy Metta
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Elia J Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
7
|
Psihogios AM, Rabbi M, Ahmed A, McKelvey ER, Li Y, Laurenceau JP, Hunger SP, Fleisher L, Pai AL, Schwartz LA, Murphy SA, Barakat LP. Understanding Adolescent and Young Adult 6-Mercaptopurine Adherence and mHealth Engagement During Cancer Treatment: Protocol for Ecological Momentary Assessment. JMIR Res Protoc 2021; 10:e32789. [PMID: 34677129 PMCID: PMC8571686 DOI: 10.2196/32789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer demonstrate suboptimal oral chemotherapy adherence, increasing their risk of cancer relapse. It is unclear how everyday time-varying contextual factors (eg, mood) affect their adherence, stalling the development of personalized mobile health (mHealth) interventions. Poor engagement is also a challenge across mHealth trials; an effective adherence intervention must be engaging to promote uptake. OBJECTIVE This protocol aims to determine the temporal associations between daily contextual factors and 6-mercaptopurine (6-MP) adherence and explore the proximal impact of various engagement strategies on ecological momentary assessment survey completion. METHODS At the Children's Hospital of Philadelphia, AYAs with acute lymphoblastic leukemia or lymphoma who are prescribed prolonged maintenance chemotherapy that includes daily oral 6-MP are eligible, along with their matched caregivers. Participants will use an ecological momentary assessment app called ADAPTS (Adherence Assessments and Personalized Timely Support)-a version of an open-source app that was modified for AYAs with cancer through a user-centered process-and complete surveys in bursts over 6 months. Theory-informed engagement strategies will be microrandomized to estimate the causal effects on proximal survey completion. RESULTS With funding from the National Cancer Institute and institutional review board approval, of the proposed 30 AYA-caregiver dyads, 60% (18/30) have been enrolled; of the 18 enrolled, 15 (83%) have completed the study so far. CONCLUSIONS This protocol represents an important first step toward prescreening tailoring variables and engagement components for a just-in-time adaptive intervention designed to promote both 6-MP adherence and mHealth engagement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32789.
Collapse
Affiliation(s)
- Alexandra M Psihogios
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Mashfiqui Rabbi
- Department of Statistics, Harvard University, Boston, MA, United States
| | - Annisa Ahmed
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Elise R McKelvey
- Children's Hospital of Philadelphia, La Salle University, Philadelphia, PA, United States
| | - Yimei Li
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Stephen P Hunger
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Linda Fleisher
- Health Communications and Health Disparities, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Ahna Lh Pai
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lisa A Schwartz
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Susan A Murphy
- Department of Statistics, Harvard University, Boston, MA, United States
| | - Lamia P Barakat
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
8
|
Syrjala KL, Walsh CA, Yi JC, Leisenring WM, Rajotte EJ, Voutsinas J, Ganz PA, Jacobs LA, Palmer SC, Partridge A, Baker KS. Cancer survivorship care for young adults: a risk-stratified, multicenter randomized controlled trial to improve symptoms. J Cancer Surviv 2021; 16:1149-1164. [PMID: 34590205 DOI: 10.1007/s11764-021-01105-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Young adult (YA) cancer survivors have high rates of adverse health and psychosocial outcomes. This risk-stratified, multicenter, randomized controlled trial (RCT) compared a self-management survivorship intervention to usual care in YA survivors with symptoms of cancer-related distress, insomnia, fatigue, pain, and/or depression. METHODS Eligibility included age 18-39 at diagnosis with an invasive malignancy in the previous 1-5 years. Baseline assessment determined "high need" participants, with 2-5 elevated targeted symptoms. We randomized high need participants to intervention or usual care and offered intervention participants a survivorship clinic visit, which included mutually decided action plans for symptoms. Follow-up calls at 1 and 3 months after the clinic visit reviewed action plan progress. Outcomes compared rates of improved symptoms for intervention vs usual care at 6 months and 12 months. RESULTS N = 344 completed baseline assessment, with n = 147 (43%) categorized as high need and randomized. Of n = 73 randomized to the intervention, n = 42 (58%) did not attend their survivorship clinic visit. In intent-to-treat analyses, aggregate symptom scores did not differ between arms, though distress improved for 46% in the intervention arm at 6 months compared to 18% in usual care (p = 0.03) among those with elevated distress at baseline. CONCLUSIONS Distress improved for YAs who received self-management survivorship care. However, the study demonstrates a need for alternative strategies for providing YA survivorship care. TRIAL REGISTRATION NCT02192333 IMPLICATIONS FOR CANCER SURVIVORS: While YA survivors demonstrate some improved distress when provided survivorship care, to make care accessible and effective, they require options such as remote delivery of care.
Collapse
Affiliation(s)
- Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, D5-22098109, USA. .,University of Washington School of Medicine, Seattle, WA, USA.
| | - Casey A Walsh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, D5-22098109, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, D5-22098109, USA
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, D5-22098109, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Emily Jo Rajotte
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, D5-22098109, USA
| | - Jenna Voutsinas
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, D5-22098109, USA
| | - Patricia A Ganz
- UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Linda A Jacobs
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven C Palmer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, D5-22098109, USA.,University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|