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Atlas SJ, Haas JS, Perez GK, Park ER, Peppercorn JM. Engaging Patients, Oncologists, and Primary Care Clinicians in the Care of Cancer Survivors: A Coordinated Care Model With System-Level Technology to Move the Outcomes Needle. JCO Oncol Pract 2024:OP2300818. [PMID: 39088767 DOI: 10.1200/op.23.00818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 08/03/2024] Open
Affiliation(s)
- Steven J Atlas
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jennifer S Haas
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Giselle K Perez
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Elyse R Park
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Hayes BD, Young HG, Atrchian S, Vis-Dunbar M, Stork MJ, Pandher S, Samper S, McCorquodale S, Loader A, Voss C. Primary care provider-led cancer survivorship care in the first 5 years following initial cancer treatment: a scoping review of the barriers and solutions to implementation. J Cancer Surviv 2024; 18:352-365. [PMID: 36376712 DOI: 10.1007/s11764-022-01268-y] [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: 06/02/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To synthesize the barriers to primary care provider (PCP)-led cancer survivorship care (≤ 5 years after initial cancer treatment) experienced by healthcare systems around the world, and to explore potential solutions that would succeed within a developed country. METHODS A scoping review of peer-reviewed articles and grey literature was conducted. Four electronic databases (Medline, Embase, Web of Science Core Collection, and Google Scholar) were searched for articles prior to April 2021. RESULTS Ninety-seven articles published across the globe (USA, Canada, Australia, European Union, and UK) met the review inclusion/exclusion criteria. The four most frequently discussed barriers to PCP-led survivorship care in healthcare systems were as follows: (1) insufficient communication between PCPs and cancer specialists, (2) limited PCP knowledge, (3) time restrictions for PCPs to provide comprehensive survivorship care, and (4) a lack of resources (e.g., survivorship care guidelines). Potential solutions to combat these barriers were as follows: (1) improving interdisciplinary communication, (2) bolstering PCP education, and (3) providing survivorship resources. CONCLUSIONS This scoping review identified and summarized key barriers and solutions to the provision of PCP-led cancer survivorship care. Importantly, the findings from this review provide insight and direction to guide optimization of cancer care practice within BC's healthcare system. IMPLICATIONS FOR CANCER SURVIVORS Optimizing the PCP-led survivorship care model will be a valuable contribution to the field of cancer survivorship care and will hopefully lead to more widespread use of this model, ultimately lessening the growing demand for cancer-specific care by cancer specialists.
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Affiliation(s)
- Brian D Hayes
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Hannah G Young
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Siavash Atrchian
- BC Cancer, Kelowna, Canada
- Department of Surgery, Division of Radiation Oncology and Developmental Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Matthew J Stork
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Satvir Pandher
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sofia Samper
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Sarah McCorquodale
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | | | - Christine Voss
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada.
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada.
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Halpern M, Mollica MA, Han PK, Tonorezos ES. Myths and Presumptions About Cancer Survivorship. J Clin Oncol 2024; 42:134-139. [PMID: 37972343 PMCID: PMC10824378 DOI: 10.1200/jco.23.00631] [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: 03/22/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
Identifying cancer survivorship myths and presumptions perpetuated in survivorship circles.
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Affiliation(s)
- Michael Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Michelle A. Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Paul K.J. Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Emily S. Tonorezos
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
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Garcia MA, Schlecht NF, Rokitka DA, Attwood KM, Rodriguez EM. Examining the Barriers and Opportunities for Human Papillomavirus Vaccine Delivery in Cancer Care Settings: A Mixed-Methods Study. Cancer Prev Res (Phila) 2023; 16:581-589. [PMID: 37258419 PMCID: PMC10810245 DOI: 10.1158/1940-6207.capr-23-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023]
Abstract
Although pediatric, adolescent, and young adult (PAYA) cancer survivors are at increased risks for secondary cancers, their HPV vaccine uptake rates are poor. Therefore, we conducted a mixed-methods study to identify the barriers and opportunities for HPV vaccine delivery among PAYA cancer care providers. We distributed a semistructured questionnaire to a professional organization comprised of PAYA oncology and hematology healthcare providers between April and July 2022. Questionnaire measures included demographic and practice characteristics, HPV vaccine knowledge, willingness, barriers, opportunities, and roles for HPV vaccine delivery. Descriptive characteristics were generated for quantitative data, and content analysis was used to identify themes. A total of 49 providers responded to our survey. A majority were female (68%) and non-Hispanic white (74%). Approximately 76% were oncology or hematology physicians, and most worked in a cancer center or children's hospital (86%). Over half (63%) had been practicing for >15 years, and a majority saw patients ages 11 to 17. Although less than half reported discussing HPV vaccination with their patients, 69% were willing to become involved in HPV vaccine delivery. The most frequently reported barriers identified in our content analysis were related to system-level factors. Furthermore, providers identified opportunities within cancer prevention education, transitions in care, and at the system-level. Although barriers to HPV vaccination persist in cancer care, most providers perceived there to be opportunities to become involved in HPV vaccine delivery. Identifying strategies for PAYA oncology and hematology healthcare providers to adopt a stronger role in HPV vaccination remains a significant opportunity for future implementation research. PREVENTION RELEVANCE This mixed-methods study is the first to investigate and assess barriers and opportunities for HPV vaccine delivery among PAYA cancer healthcare providers. Our findings can serve as an important framework for future implementation research targeted towards HPV vaccine delivery in cancer clinical settings. See related Spotlight, p. 545.
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Affiliation(s)
- Melany A. Garcia
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
| | - Nicolas F. Schlecht
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
| | - Denise A. Rokitka
- Department of Pediatrics; Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Kristopher M. Attwood
- Roswell Park Comprehensive Cancer Center, Biostatistics and Bioinformatics, Buffalo, NY, United States of America
| | - Elisa M. Rodriguez
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Control, Buffalo, NY, United States of America
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Attai DJ, Katz MS, Streja E, Hsiung JT, Marroquin MV, Zavaleta BA, Nekhlyudov L. Patient preferences and comfort for cancer survivorship models of care: results of an online survey. J Cancer Surviv 2023; 17:1327-1337. [PMID: 35113306 DOI: 10.1007/s11764-022-01177-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/21/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Workforce shortages will impact oncologists' ability to provide both active and survivorship care. While primary care provider (PCP) or survivorship clinic transition has been emphasized, there is little evidence regarding patient comfort. METHODS We developed an online survey in partnership with patient advocates to assess survivors' comfort with PCP or survivorship clinic care and distributed the survey to online, cancer-specific patient communities from June to August 2020. Descriptive and logistic regression analyses were conducted. RESULTS A total of 975 surveys were complete. Most respondents were women (91%) and had private insurance (65%). Thirty-six cancer types were reported. Ninety-three percent had a PCP. Twenty-four percent were comfortable seeing a PCP for survivorship care. Higher odds of comfort were seen among respondents who were Black or had stage 0 cancer; female sex was associated with lower odds. Fifty-five percent were comfortable with a survivorship clinic. Higher odds of comfort were seen with lymphoma or ovarian cancer, > 15 years from diagnosis, and non-US government insurance. Lower odds were seen with melanoma, advanced stage, Medicaid insurance, and one late effect. Preference for PCP care was 87% for general health, 32% for recurrence monitoring, and 37% for late effect management. CONCLUSIONS One quarter of cancer survivors were comfortable with PCP-led survivorship care and about half with a survivorship clinic. Most preferred oncologist care for recurrence monitoring and late-effect management. IMPLICATIONS FOR CANCER SURVIVORS Patient preference and comfort should be considered when developing survivorship care models. Future efforts should focus on facilitating patient-centered transitions to non-oncologist care.
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Affiliation(s)
- Deanna J Attai
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- UCLA Health Burbank Breast Care, 191 S. Buena Vista #415, Burbank, CA, 91505, USA.
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, MA, USA
| | - Elani Streja
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jui-Ting Hsiung
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | | | - Beverly A Zavaleta
- Department of Medicine, Valley Baptist Medical Center - Brownsville, Brownsville, TX, USA
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Dixit N, Rodriguez G, Sarkar U, Burke N, Trejo E, Devore DJ, Couey P, Nápoles AM. Identifying the Needs of Primary Care Providers Caring for Breast and Colon Cancer Survivors in the Safety-Net: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:845-853. [PMID: 35829986 PMCID: PMC10234859 DOI: 10.1007/s13187-022-02195-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 05/07/2023]
Abstract
As the number of cancer survivors continues to increase and given the shortage of oncology clinicians in safety net health care settings, primary care providers (PCPs) in these settings will increasingly provide cancer survivorship care. In order to ensure equitable care for low-income and underserved breast and colon cancer survivors, it is essential to understand the safety-net PCPs' perspective. We conducted semi-structured, in-depth qualitative interviews with 11 PCPs working in a safety-net health care system to identify their needs in caring for cancer survivors. Interviews were audio-recorded and professionally transcribed. Two coders independently coded the interviews and conducted regular meetings until we reached consensus on the results. Analysis was based in grounded theory and performed using the constant comparative method. Thematic analysis identified six themes as follows: (1) Cancer survivorship care can be integrated with the whole person and chronic disease care management that occurs in primary care; (2) PCPs' perceptions regarding patients' survivorship care needs and their confidence in meeting those needs; (3) preference for a shared care model; (4) coordination of care; (5) PCPs' need for survivorship care education and training; and (6) unique issues involved in the care of older cancer survivors. PCPs in the safety-net believe that providing comprehensive survivorship care requires coordination of care through the cancer continuum. Tools like checklists, electronic health records-based communication, and convenient electronic consultations with cancer specialists would enhance the quality of survivorship care. Respondents advocate the inclusion of survivorship care education in medical education. The continuity of care with PCPs means that they play a particularly important role in the care of older cancer survivors.
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Affiliation(s)
- Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Gladys Rodriguez
- Hematology/Oncology, Stanford School of Medicine, Palo Alto, CA, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nancy Burke
- School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, CA, USA
| | - Evelin Trejo
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Paul Couey
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Gao Y, Rosas JC, Fink H, Behrens S, Chang-Claude J, Seibold P. Longitudinal changes of health-related quality of life over 10 years in breast cancer patients treated with radiotherapy following breast-conserving surgery. Qual Life Res 2023:10.1007/s11136-023-03408-y. [PMID: 37093543 PMCID: PMC10393846 DOI: 10.1007/s11136-023-03408-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
PURPOSES The study intended to (1) assess changes of health-related quality of life (HRQoL) between early treatment-related time points and 10 years post-treatment in a cohort of breast cancer (BC) patients who received radiotherapy (RT), (2) to evaluate differences in HRQoL between long-term BC survivors and unaffected women from the same geographical region and (3) to identify determinants of long-term HRQoL in the survivor cohort. METHODS 292 BC patients were recruited prior to RT after breast-conserving surgery between 1998 and 2001 in Germany and prospectively followed up for a median of 11.4 years (range 10.3-12.8 years). HRQoL was assessed using EORTC QLQ-C30 at pre-RT (baseline), during RT, 6 weeks after RT, and at the 10-year follow-up. Changes in mean HRQoL scores over time were assessed using linear-mixed models. HRQoL in long-term survivors and controls was compared using Wilcoxon rank-sum test, stratified by age groups. Multivariable linear regression models were used to identify determinants for HRQoL in long-term BC survivors. RESULTS Compared to baseline level (mean summary score of 64.9), global health status/quality of life (GHS/QoL) declined during RT (62.4) and improved 6 weeks after RT (69.9) before decreasing to baseline level at the 10-year follow-up (66.7). Most functional domains deteriorated or remained stable at 10 years post-diagnosis compared to post-RT scores, except for role functioning which improved, while dyspnea and diarrhea significantly deteriorated between those two time points. There were no significant differences in long-term GHS/QoL between BC survivors 10 years post-RT and controls for all age groups (p > 0.05). However, deficits in specific HRQoL domains such as emotional burden, sleep problems or fatigue were found to more strongly affect survivors, in particular those younger than 65 years, compared to controls. In the determinant analysis, being overweight was associated with lower GHS/QoL and physical functioning, while living with others was found to be associated with better physical functioning, and decreased dyspnea and pain levels. Certain comorbidities such as depression had a strong association with multiple HRQoL domains, including lower GHS/QoL and functioning as well as a higher level of fatigue, pain, sleep/intestinal problems, and financial difficulties. Side effects such as lymphedema/pain and fibrosis were associated with worse physical and social functioning, respectively. CONCLUSION The long-term GHS/QoL remained comparable when compared with the control population while restrictions in certain functional and symptoms domains in long-term BC survivors persisted over 10 years, in particular among younger survivors. Targeted screening to identify cancer survivors at risk for psychosocial/other impairment accounting also for comorbidities and treatment side effects may be warranted in long-term aftercare to address unmet health needs.
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Affiliation(s)
- Yifeng Gao
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Juan C Rosas
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
| | - Hanna Fink
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany.
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Peng X, Hui-Qin L, Xia H. Whether preferences of gastric cancer patients after surgery for follow-up change over time? Analysis based on discrete choice experiment. Support Care Cancer 2023; 31:234. [PMID: 36964800 DOI: 10.1007/s00520-023-07699-2] [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: 09/10/2022] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
PURPOSES The purposes of this discrete choice experiment are as follows: (1) quantify the relevant characteristics that may affect the follow-up selection of gastric cancer patients after surgery and (2) explore the differences in follow-up preferences of gastric cancer patients at different stages and reveal the change trend of preferences over time, thereby providing references for the formulation and optimization of follow-up strategies. METHODS A survey instrument that was developed using the design principle of a discrete choice experiment investigated gastric cancer patients on the day of discharge, and at 3 months, 6 months, and 12 months after discharge. In Stata 15.0, a mixed logit model was used to explore the preferences of gastric cancer patients after surgery at different stages, the willingness to pay was calculated, and the NLCOM command was used to simulate the follow-up uptake rates of different attribute levels at different stages. RESULTS On the day of discharge, and 3 months, 6 months, and 12 months after discharge, the most important attribute levels of gastric cancer patients after surgery were "thoroughness-very thorough," "method-face-to-face," "thoroughness-very thorough," and "provider-specialist nurse," respectively, and patients were willing to pay more for these services. Patients' preference for the attribute level "very thorough" decreased over time, while their preferences for "specialist doctors" as follow-up providers remained relatively stable. Furthermore, the attribute levels with the greatest effect on receiving the baseline follow-up program varied across stages. CONCLUSION The gastric cancer patients' preferences for follow-up change over time, and the time factor should be considered when developing follow-up strategies.
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Affiliation(s)
- Xie Peng
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan province, People's Republic of China
| | - Li Hui-Qin
- Mental Health Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan province, People's Republic of China
| | - Huang Xia
- Mental Health Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan province, People's Republic of China.
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Factors influencing cancer survivors' experiences with follow-up cancer care: results from the pan-Canadian Experiences of Cancer Patients in Transition Study survey. Support Care Cancer 2022; 30:9559-9575. [PMID: 36123549 DOI: 10.1007/s00520-022-07357-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: 04/02/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care. METHODS In 2016, the Canadian Partnership Against Cancer collected survey responses from cancer survivors about their experiences with follow-up cancer care. We included respondents from this survey if they were diagnosed with non-metastatic breast, hematologic, colon, melanoma, and prostate cancer. Our primary outcome was cancer survivors' self-reported overall experience with follow-up cancer care. We used multivariable logistic regression to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care. RESULTS Of the 8402 cancer survivors included in our study, 81.8% (n = 6,875) reported a positive experience with their follow-up cancer care. The individual factors associated with positive overall experiences were more commonly those associated with self-perceptions of respondents' personal health and well-being rather than baseline sociodemographic factors, such as sex, income, or education. For example, respondents were more likely to report a positive experience if they perceived their quality of life as good (OR 1.9, 95% CI 1.0-3.5, p < 0.01) or reported not having an unmet practical concern (OR 1.3, 95% CI 1.1-1.6, p < 0.01). The structural factors most strongly associated with positive overall experiences included respondents perceiving their oncology specialist was in charge of their follow-up cancer care (OR 5.2, 95% CI 3.6-7.5, p < 0.01) and reporting the coordination of their follow-up cancer care among healthcare providers was good or very good (OR 8.4, 95% CI 6.7-10.6, p < 0.01). CONCLUSION While real-world experiences with follow-up cancer care in Canada are reported to be positive by most cancer survivors included in this study, we found differences exist based on individual and structural factors. A better understanding of the reasons for these differences is required to guide the provision of high-quality follow-up care that is adapted to the needs and resources of individuals and contexts.
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Gaillard V, Tricard T, Rebel S, Schumacher C, Saussine C, Somme G, Lang H. Primary care–based follow-up for prostate and kidney cancer survivors: a retrospective monocentric study. Support Care Cancer 2022; 30:7293-7302. [DOI: 10.1007/s00520-022-07151-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
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Malartre-Sapienza S, Buono R, Sontag P. [Post-treatment, a delicate and insufficiently structured period]. REVUE DE L'INFIRMIERE 2022; 71:24-26. [PMID: 35843637 DOI: 10.1016/j.revinf.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In France, the number of cancer survivors is expected to increase significantly in the coming years. However, there seems to be a lack of identification and management of complications after treatment. Coordination nurses and advanced practice nurses play a fundamental and complementary role to physicians in responding to this problem.
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Affiliation(s)
| | - Romain Buono
- Centre Léon-Bérard, 28 rue Laennec, 69373 Lyon cedex 08, France
| | - Pascale Sontag
- Centre Léon-Bérard, 28 rue Laennec, 69373 Lyon cedex 08, France
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12
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Li HQ, Liu SX, Xue H, Yuan H, Zhang XY. The Public's Preferences for Psychological Interventions During the COVID-19 Pandemic: A Discrete Choice Experiment. Front Psychiatry 2022; 13:805512. [PMID: 35573350 PMCID: PMC9091726 DOI: 10.3389/fpsyt.2022.805512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Aims To explore the public's preference for psychological interventions through a discrete choice experiment and to provide references for formulating psychological intervention policies and establishing psychological intervention procedures in response to public health emergencies. Methods This study is a discrete choice experiment. Attributes and levels were identified through literature reviews, in-depth interviews, focus group discussions, and expert consultations. Experimental design principles were applied to generate choice sets containing different attribute levels and develop a survey instrument. Convenience sampling was conducted nationwide, and 1,045 participants were investigated. A mixed logit model was used to evaluate the public's preferences. Results All attributes in our study were found to have a significant influence on the public's preferences for psychological interventions during the COVID-19 pandemic. The public's preferences for providers and duration were influenced by the public's levels of education and classifications. Furthermore, the most ideal scenario was found to be a one-on-one psychological intervention provided by family and friends through social network platforms, for which the frequency is twice per week, and the duration of each intervention is 0.5-1 h. Conclusions The public's preferences for psychological interventions during the COVID-19 pandemic are affected by the method, form, frequency, provider, and duration of interventions. Our findings provide references for the formulation of psychological intervention policies and the establishment of psychological intervention procedures in response to public health emergencies.
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Affiliation(s)
- Hui-qin Li
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, China
| | - Shu-xiang Liu
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, China
| | - Hui Xue
- Department of Histology and Embryology, College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Hua Yuan
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, China
| | - Xiu-ying Zhang
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, China
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Risendal B, Westfall JM, Zittleman L, Hodgson C, Garrington T, Sutter C, Jarrell L, LeBlanc W, Overholser L. Impact of Cancer Survivorship Care Training on Rural Primary Care Practice Teams: a Mixed Methods Approach. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:71-80. [PMID: 32974812 DOI: 10.1007/s13187-020-01788-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With the increasing numbers of individuals surviving a diagnosis of cancer, an aging population, and more individuals experiencing multi-morbidity, primary care providers (PCPs) are seeing more patients with a history of cancer. Effective strategies are needed to adequately prepare the primary care workforce for the phase of cancer care now widely recognized as survivorship. A survivorship education program for rural primary care practices was developed using a community engagement process and delivered at the practice level by community health liaisons. A mixed method approach was used to evaluate the program impact which included a questionnaire and interviews. Descriptive analyses and generalized linear regression were used to evaluate quantitative outcomes from the questionnaires. Immersion crystallization was used to define themes from the qualitative components. Thirty-two (32) practices participated, averaging 10.3 team members/practice. The percent of correct responses to the knowledge questionnaire increased significantly, almost doubling between baseline and post-test (25% vs 46%, p < .001). Four major themes emerged from the interviews which included positive impact of the training, putting the training into practice, intention to change care delivery, contextual influences in survivorship care. Evidence from the cancer survivorship education program evaluation supports its value to key stakeholders and the potential wider dissemination of the iSurvive Program. These data also suggest the need for additional investigation into other ways beyond education that primary care practices can be supported to ensure the needs of the growing cancer survivor population in the US are met.
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Affiliation(s)
- Betsy Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, 13001 E 17th Place, Building 500, Room 3350, Aurora, CO, 80045, USA.
| | - John M Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carol Hodgson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Timothy Garrington
- Department of Pediatric Hematology and Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christin Sutter
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lori Jarrell
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - William LeBlanc
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Linda Overholser
- Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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14
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Margariti C, Gannon K, Thompson R, Walsh J, Green J. Experiences of UK African-Caribbean prostate cancer survivors of discharge to primary care. ETHNICITY & HEALTH 2021; 26:1115-1129. [PMID: 30987446 DOI: 10.1080/13557858.2019.1606162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
Objective: Black men are three times more likely to develop prostate cancer (PCa), to do so at a younger age and to experience a more aggressive form than White men. This study aims to understand the experiences of African-Caribbean men with respect to their discharge to primary care following successful PCa treatment and the challenges associated with survivorship.Design: Eight African-Caribbean men, who had been successfully treated for PCa, were recruited through the charity BME Cancer Communities. They participated in a focus group, which took place on the premises of the charity and was audio-recorded. The recording was transcribed and the data were analysed employing thematic analysis.Results: Three overarching themes were developed: Discharge - misconceptions and uncertainties; Survivorship - challenges and ways of coping; Black men and PCa: real and potential discrimination. Participants expressed concerns regarding the lack of information and clarity about what discharge meant, the quality of follow-up care, especially the levels of specialist knowledge among GPs, and the impact of side-effects, particularly erectile dysfunction (ED). Participants linked ED with stereotypes of Black male sexuality, particularly in relation to difficulties of expressing their emotions and psychological distress. African-Caribbean men face particular challenges in dealing with the side-effects of treatment for PCa, which are linked to socially-constructed ideas of masculinity.Conclusion: There needs to be a greater focus in primary care on understanding these issues and providing individualised culturally-sensitive care. In particular, GPs should be aware of sensitivities concerning help-seeking related to culturally-mediated understandings of masculinity.
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Affiliation(s)
- C Margariti
- School of Psychology, University of East London, London, UK
| | - K Gannon
- School of Psychology, University of East London, London, UK
| | - R Thompson
- Director of Black and Minority Ethnic (BME) Cancer Communities, Nottingham, UK
| | - J Walsh
- School of Psychology, University of East London, London, UK
| | - J Green
- Clinical Lecturer in Oncological Surgery, Institute of Oncology, Queen Mary & Westfield College, London, UK
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15
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Preferences of gastric cancer survivors for follow-up care-a multicenter discrete choice experiment study. Support Care Cancer 2021; 30:1221-1229. [PMID: 34455494 DOI: 10.1007/s00520-021-06505-1] [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: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 12/24/2022]
Abstract
PURPOSES The purposes of this discrete choice experiment are as follows: (1) to investigate the preferences of gastric cancer survivors for follow-up care, and (2) to quantify the importance of follow-up care-related characteristics that may affect the gastric cancer survivors' choices of their follow-up, so as to provide references for the development of the follow-up strategy of gastric cancer survivors. METHODS Discrete choice experimental design principle was applied to develop the survey instrument. All questionnaires were filled out by the respondents and collected on site. A mixed logit model was used to estimate gastric cancer survivors' preferences. Willingness to pay estimates and simulations of follow-up uptake rates were calculated. RESULTS All six attributes are significantly important for the follow-up care of gastric cancer survivors (p < 0.05). Achieving very thorough follow-up contents was the most valued attribute level (coefficient = 1.995). Specialist doctors are the most preferred providers followed by specialist nurses, and gastric cancer survivors were willing to pay more for these attribute levels. Changes in attribute levels affected uptake rate of follow-up. When the multiple attribute levels were changed at the same time, a very thorough follow-up content was provided by the same specialist doctor (specialist nurse), and the probability of receiving follow-up increases by 95.82% (94.90%). CONCLUSIONS The characteristics of follow-up care in our study reflect the health management services' expectations of gastric cancer survivors. A dedicated specialist nurse involved in follow-up care should be developed to contribute to solve the complex and multifaceted personal needs of gastric cancer survivors.
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16
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"There Should Have Been a More Holistic Approach"-A Qualitative Study of Young Adult Cancer Survivors' Experiences of Follow-up After Cancer Treatment. Cancer Nurs 2021; 45:E299-E308. [PMID: 33481409 DOI: 10.1097/ncc.0000000000000924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young adult cancer survivors (YACSs) are in a vulnerable period of life with increased risk of severe physical and psychosocial late effects. However, limited research exists on follow-up of YACSs after cancer treatment. OBJECTIVE The aim of this study was to explore how YACSs experience follow-up from the healthcare system after finishing cancer treatment. METHODS Using a qualitative method with an interpretive descriptive design, 20 YACSs were interviewed 4 times over a period of 6 months. The transcribed interviews were analyzed using Systematic Text Condensation. RESULTS Four main themes were identified: "They should have prepared me better," "The GP (general practitioner) does not understand my challenges," "My check-ups are all about cancer relapse," and "I do not know who's in charge." CONCLUSION The findings indicate deficiency in the healthcare system's follow-up of YACSs in terms of preparation for the survival phase, interdisciplinary cooperation, and acknowledgement of late effects, as well as organization of follow-up care within the healthcare system. IMPLICATIONS FOR PRACTICE A more holistic perspective on follow-up care that addresses YACSs' multidimensional challenges is suggested, including a multidisciplinary approach where cancer nurses should play an active role.
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Sandell T, Schütze H, Miller A. A Shared Cancer Follow-Up Model of Care Between General Practitioners and Radiation Oncologists for Patients With Breast, Prostate, and Colorectal Cancer: Protocol for a Mixed Methods Implementation Study. JMIR Res Protoc 2021; 10:e21752. [PMID: 33464209 PMCID: PMC7854032 DOI: 10.2196/21752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/10/2020] [Accepted: 12/08/2020] [Indexed: 01/15/2023] Open
Abstract
Background The rising incidence of cancer and increasing numbers of cancer survivors have resulted in the need to find alternative models of care for cancer follow-up care. The acceptability for follow-up care in general practice is growing, and acceptance increases with shared-care models where oncologists continue to oversee the care. However, a major barrier to this model is the effective exchange of information in real time between oncologists and general practitioners. Improved communication technology plays an important role in the acceptability and feasibility of shared cancer follow-up care. Objective The aim of this study is to evaluate the feasibility and acceptability of a shared cancer follow-up model of care between patients, general practitioners and radiation oncologists. Methods This is a mixed methods, multisite implementation study exploring shared follow-up care for breast, colorectal, and prostate cancer patients treated with curative radiotherapy in New South Wales, Australia. This study uses web-based technology to support general practitioners in performing some aspects of routine radiotherapy follow-up care, while being overseen by a radiation oncologist in real time. The study has two phases: Phase 1 is designed to establish the level of agreement between general practitioners and radiation oncologists and Phase 2 is designed to implement shared follow-up care into practice and to evaluate this implementation. Results Recruitment of radiation oncologists, patients, and general practitioners commenced in December 2020 and will continue until February 2021. Data collection will occur during 2021, and data will be ready for analysis by the end of 2021. Conclusions Few studies have investigated the role of health technologies in supporting communication deficiencies for shared cancer follow-up care. The implementation and evaluation of models of care need to be conducted using a person-centered approach that is responsive to patients’ preferences and needs. Should the findings of the study be acceptable and feasible to radiation oncologists, general practitioners, and patients, it can be quickly implemented and expanded to other tumor groups or to medical oncology and hematology. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620001083987; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380057 International Registered Report Identifier (IRRID) PRR1-10.2196/21752
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Affiliation(s)
- Tiffany Sandell
- Wollongong Hospital, Wollongong, Australia.,University of Wollongong, Wollongong, Australia
| | - Heike Schütze
- University of Wollongong, Wollongong, Australia.,University of New South Wales, Sydney, Australia
| | - Andrew Miller
- Wollongong Hospital, Wollongong, Australia.,University of Wollongong, Wollongong, Australia
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18
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Cancer survivorship training in family medicine residency programs. J Cancer Surviv 2020; 15:748-754. [PMID: 33175993 DOI: 10.1007/s11764-020-00966-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/01/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The objective of the study was to examine current family medicine residency education in cancer survivorship and barriers to cancer survivorship education in the residency curriculum. METHODS Family medicine residency program directors (n = 628) were surveyed electronically between September 2019 and November 2019 through the Council of Academic Family Medicine Educational Research Alliance (CERA) annual program directory survey. Respondents (n = 250) answered questions regarding eventual cancer survivorship curriculum in their residency program, including interest and barriers to implementation. Program characteristics were assessed using univariate and multivariate analyses. RESULTS Only 9.2% of family medicine residency program directors reported having a cancer survivorship curriculum. Sixty-nine percent of program directors reported they would implement a cancer survivorship curriculum if one was available. The most significant barrier to implementation of a cancer survivorship curriculum was insufficient time (39.6%) followed by lack of faculty expertise (26.9%). Respondents that reported lack of faculty expertise as a barrier to implementation of cancer survivorship training were more likely be report that they would be willing to implement a cancer survivorship curriculum (p < 0.01). CONCLUSIONS Despite the majority of primary care physicians providing care to cancer survivors, few family medicine residency programs have formal training in cancer survivorship care. There is interest in expanding family medicine residency training in cancer survivorship care among program directors. IMPLICATIONS FOR CANCER SURVIVORS Gaining insight into the current educational curriculum and barriers to cancer survivorship training will lead to opportunities to improve residency training, and ultimately provide better care to cancer survivors in primary care settings.
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19
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Halpern MT, Cohen J, Lines LM, Mollica MA, Kent EE. Associations between shared care and patient experiences among older cancer survivors. J Cancer Surviv 2020; 15:333-343. [PMID: 32948992 DOI: 10.1007/s11764-020-00934-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Cancer survivors have unique medical care needs. "Shared care," delivered by both oncologists and primary care providers (PCPs), may better address these needs. Little information is available on differences in outcomes among survivors receiving shared care versus oncologist-led or PCP-led care. This study compared experiences of care for survivors receiving shared care, oncologist-led, PCP-led, or other care patterns. METHODS We used SEER-CAHPS data, including NCI's SEER registry data, Medicare claims, and Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses. Medicare Fee-for-Service beneficiaries age ≥ 65 years in SEER-CAHPS with breast, cervical, colorectal, lung, renal, or prostate cancers or hematologic malignancies who responded to a Medicare CAHPS survey ≥ 18 months post-diagnosis were included. CAHPS measures included ratings of overall care, personal doctor, specialist physician, health plan, prescription drug plan, and five composite scores. Survivorship care patterns were identified using proportions of oncologist, PCP, and other physician encounters. Multivariable regressions examined associations between care patterns and CAHPS outcomes. RESULTS Among 10,132 survivors, 15% received shared care, 10% oncologist-led, 33% PCP-led, and 42% other. Compared with shared care, we found no significant differences in experiences of care except for getting needed drugs (lower scores for PCP-led and other care patterns). Sensitivity analyses using different patterns of care definitions similarly showed no associations between survivorship care pattern and experience of care. CONCLUSIONS Within the limitations of the study dataset, survivors age 65+ receiving shared care reported similar experiences of care to those receiving oncologist-led, PCP-led, and other patterns of care. IMPLICATIONS FOR CANCER SURVIVORS Shared care may not provide survivor-perceived benefits compared with other care patterns.
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Affiliation(s)
- Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, 20850, USA.
| | - Julia Cohen
- RTI International, Research Triangle Park, Durham, NC, 27709, USA
| | - Lisa M Lines
- RTI International, Research Triangle Park, Durham, NC, 27709, USA.,University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Michelle A Mollica
- Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, 20850, USA
| | - Erin E Kent
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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20
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DeGuzman PB, Bernacchi V, Cupp CA, Dunn B, Ghamandi BJF, Hinton ID, Jameson MJ, Lewandowski DL, Sheffield C. Beyond broadband: digital inclusion as a driver of inequities in access to rural cancer care. J Cancer Surviv 2020; 14:643-652. [DOI: 10.1007/s11764-020-00874-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/04/2020] [Indexed: 12/24/2022]
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21
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Flores T, Glaser KM, McDaniel D, Rokitka D, Amato KA, Reid ME. Building a comprehensive cancer survivorship program. Ecancermedicalscience 2020; 13:992. [PMID: 32010216 PMCID: PMC6974369 DOI: 10.3332/ecancer.2019.992] [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: 07/23/2019] [Indexed: 11/26/2022] Open
Abstract
There is a significant increase in the number of people surviving cancer as a result of improved detection and better treatments. In the United States (US) alone, these numbers are estimated to reach 20 million by 2026 [Miller et al (2016) CA Cancer J Clin 66(4) 271–289)]; [Bluethmann et al (2016) Cancer Epidemiol Biomarkers Prev 25(7) 1029–1036]. Living through cancer treatment represents a life-changing event, often including residual and long-term emotional, physical, psychological and spiritual sequelae. Survivorship programming must encompass the clinical management of medical issues, local support services for patients and their caregivers, protocols for communicating with community primary care providers (PCPs) and education for all clinicians in the survivorship continuum on the issues impacting survivors. This article will discuss a range of issues that should be addressed when developing a comprehensive, multi-disciplinary cancer survivorship care.
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Affiliation(s)
- Tessa Flores
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Kathryn M Glaser
- Department of Cancer Prevention and Populations Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Douglas McDaniel
- Department of Cancer Prevention and Populations Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.,Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Denise Rokitka
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Katharine A Amato
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.,Department of Family Medicine, Primary Care Research Institute, University at Buffalo, Buffalo, NY 14260, USA
| | - Mary E Reid
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
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22
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Keats MR, Shea K, Parker L, Stewart SA, Flanders A, Bernstein M. After Childhood Cancer: a Qualitative Study of Family Physician, Parent/Guardian, and Survivor Information Needs and Perspectives on Long-Term Follow-up and Survivorship Care Plans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:638-646. [PMID: 29552704 DOI: 10.1007/s13187-018-1349-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite support for the provision of a survivorship care plan (SCP) to every cancer survivor, there is a lack of understanding of the needs and preferences of key stakeholders. We examined perspectives of a novel personalized SCP for childhood cancer survivors (CCS), their family, and family physicians (FP). We conducted semi-structured telephone interviews with a purposefully selected sample of CCS, parents/guardians, and FPs. Data included responses to stakeholder cancer care information needs, concerns with or gaps in communication, the perceived role of the FP in the long-term management of CCS care, utility of the SCP, preferred format, and suggestions for improvement. A deductive content analysis was conducted. Twenty-four participants including 8 CCS, 10 parents/guardians, and 6 FPs completed an interview. Four main and several sub-categories emerged. Core categories were coded as (1) informative reference, (2) coordination of follow-up, (3) barriers to follow-up care, and (4) suggestions for improvement and future implementation. The majority of participants preferred an electronic- or web-based format. Overall, the SCP was seen as an informative and concise resource. The SCP was thought to be a valuable tool to foster communication and empower CCSs to become more fully engaged in their own cancer-related health care. FPs viewed the SCP as a useful resource to facilitate and guide the long-term management of the CCS. In addition to the treatment summary, a comprehensive follow-up timeline, personalized lifestyle information, and details on how to access additional psychosocial support were highlighted as important components.
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Affiliation(s)
- Melanie R Keats
- School of Health and Human Performance, Dalhousie University, PO Box 15000, 6230 South Street, Halifax, NS, B3H 4R2, Canada.
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
| | - Kelsey Shea
- School of Health and Human Performance, Dalhousie University, PO Box 15000, 6230 South Street, Halifax, NS, B3H 4R2, Canada
| | - Louise Parker
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Samuel A Stewart
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Mark Bernstein
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
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McDonough AL, Rabin J, Horick N, Lei Y, Chinn G, Campbell EG, Park ER, Peppercorn J. Practice, Preferences, and Practical Tips From Primary Care Physicians to Improve the Care of Cancer Survivors. J Oncol Pract 2019; 15:e600-e606. [PMID: 31150311 DOI: 10.1200/jop.18.00740] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is a need to improve the coordination of care and communication between primary care physicians (PCPs) and oncology after completion of initial cancer treatment. We sought to evaluate PCP experiences and perspectives in cancer survivorship and to identify practical opportunities to improve care within an integrated health care system with a shared electronic health record (EHR). METHODS We conducted a self-administered, anonymous, electronic survey of PCPs in practices affiliated with an academic medical center to evaluate practices, the sense of preparedness, and preferences in the delivery of survivorship care and communication with oncology. RESULTS One hundred seventeen of 225 PCPs responded (response rate, 52%). A majority were engaged in survivorship care, with 94% reporting managing psychological sequelae of cancer, 84% managing chronic physical complications, 71% screening for cancer recurrence, and 60% screening for late complications. However, few PCPs felt prepared to manage these issues: 65% felt unprepared to screen for late complications, and 36% felt unprepared to screen for recurrence. Common barriers to survivorship care were uncertainty about delegation of responsibility (73%) and a lack of training (72%). PCPs expressed strong interest in survivorship care plans, preferring active tracking of ongoing care needs and delegation of care responsibility in the EHR active problem list over traditional summary documents. CONCLUSION Most PCPs are engaged in cancer survivorship care but report barriers to optimal care delivery. Opportunities to improve care could include targeted education to increase preparedness to deliver survivorship care, and optimization of communication among providers, including active survivorship care plans in the EHR.
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Affiliation(s)
| | | | - Nora Horick
- 1 Massachusetts General Hospital, Boston, MA
| | - Yvonne Lei
- 1 Massachusetts General Hospital, Boston, MA
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24
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Chaput G, Med CP, Sussman J. Integrating primary care providers through the seasons of survivorship. ACTA ACUST UNITED AC 2019; 26:48-54. [PMID: 30853798 DOI: 10.3747/co.26.4687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traditionally, the role of primary care providers (pcps) across the cancer care trajectory has focused on prevention and early detection. In combination with screening initiatives, new and evolving treatment approaches have contributed to significant improvements in survival in a number of cancer types. For Canadian cancer survivors, the 5-year survival rate is now better than it was a decade ago, and the survivor population is expected to reach 2 million by 2031. Notwithstanding those improvements, many cancer survivors experience late and long-term effects, and comorbid conditions have been noted to be increasing in prevalence for this vulnerable population. In view of those observations, and considering the anticipated shortage of oncology providers, increasing reliance is being placed on the primary care workforce for the provision of survivorship care. Despite the willingness of pcps to engage in that role, further substantial efforts to elucidate the landscape of high-quality, sustainable, and comprehensive survivorship care delivery within primary care are required. The present article offers an overview of the integration of pcps into survivorship care provision. More specifically, it outlines known barriers and potential solutions in five categories: ■ Survivorship care coordination■ Knowledge of survivorship■ pcp-led clinical environments■ Models of survivorship care■ Health policy and organizational advocacy.
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Affiliation(s)
- G Chaput
- Department of Family Medicine, McGill University, Montreal, QC.,Department of Oncology, Division of Radiation Oncology, Supportive Cancer Care Research Unit, Hamilton, ON
| | - Cac Pall Med
- Department of Family Medicine, McGill University, Montreal, QC
| | - J Sussman
- Department of Oncology, Division of Radiation Oncology, Supportive Cancer Care Research Unit, Hamilton, ON
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25
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Fidjeland HL, Brekke M, Stokstad T, Vistad I. Gynecological cancer patients' attitudes toward follow-up care after cancer treatment: Do preferences reflect patients' experience? A cross-sectional questionnaire study. Acta Obstet Gynecol Scand 2018; 97:1325-1331. [PMID: 29893058 DOI: 10.1111/aogs.13396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Due to an increasing number of cancer patients, new follow-up models are being debated, among them follow-up by general practitioners. Before changing surveillance, it is important to explore patients' views. The purpose of this study was to compare attitudes toward follow-up care among patients treated for gynecological cancer who had not yet started a follow-up regimen, with those who had been attending a hospital-based follow-up regimen for more than one year. MATERIAL AND METHODS We conducted a cross-sectional survey among gynecological cancer patients recruited from three Norwegian hospitals in 2013-2015: Sørlandet Hospital Kristiansand, Sørlandet Hospital Arendal and St. Olavs Hospital, Trondheim. RESULTS In all, 239 patients agreed to participate, 100 who had not yet started follow-up and 139 who had been attending more than one year of follow-up. Patients reported that they preferred to be followed up by a gynecologist rather than by their GP, whom they viewed as less competent for this purpose. However, patients who had not yet started follow-up were more willing to be followed up by a GP. Overall, patients rated detection of recurrence as the most important aspect of follow-up visits. CONCLUSIONS The gynecological cancer patients in our study preferred a hospital-based follow-up model. However, patients who had not yet started follow-up were more willing to be followed up by a GP. If follow-up is to be provided by GPs for selected patients, it is important that these patients are informed early of the value and limitations of follow-up visits, to ensure that they feel safe.
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Affiliation(s)
- Heidi L Fidjeland
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Obstetrics and Gynecology, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Mette Brekke
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trine Stokstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Gynecology, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology, Sørlandet Hospital Kristiansand, Kristiansand, Norway
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Schmidt ME, Wiskemann J, Steindorf K. Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis. Qual Life Res 2018; 27:2077-2086. [PMID: 29740782 DOI: 10.1007/s11136-018-1866-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE After cancer treatment, it is desirable to maintain or regain a high quality of life (QoL) and the ability to accomplish everyday tasks well. Therefore, we substantiated the scarce knowledge regarding long-term QoL after breast cancer, burdensome problems, and unmet needs for more support. METHODS Disease-free breast cancer survivors (n = 190) who had participated in two randomized controlled exercise trials during primary treatment were followed up to 5 years post-diagnosis. QoL-related functions and symptoms (EORTC QLQ-C30/-BR23), health problems, and support needs were assessed. EORTC-QLQ scores were compared with age-matched normative values from the general population in Germany. RESULTS QoL-related functions and symptoms in patients during cancer treatment were worse compared to healthy references, but largely improved over time. Yet, cognitive function and sleep were still significantly impaired at 5-year follow-up. Other common long-term problems included sexual issues (45% of survivors), hot flashes (38%), pain (34%), fatigue (24%), and polyneuropathy (21%). Regression analyses indicated fatigue having the strongest impact on global QoL. Support needs were expressed mainly for menopausal disorders (43%), physical performance (39%), sleep problems (38%), arthralgia (37%), cognitive problems (36%), weight problems (32%), and fatigue (31%). CONCLUSIONS While QoL in disease-free breast cancer survivors 5 years post-diagnosis was largely comparable to the general population on average, still many survivors suffered from adverse effects. There appears to be a need for ongoing screening and support regarding fatigue, sleep problems, cognitive problems, arthralgia/pain, menopausal/sexual symptoms, physical performance, and weight problems during and several years following breast cancer therapy.
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Affiliation(s)
- Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) and University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
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27
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Ke Y, Ng T, Chan A. Survivorship care models for breast cancer, colorectal cancer, and adolescent and young adult (AYA) cancer survivors: a systematic review. Support Care Cancer 2018; 26:2125-2141. [PMID: 29696424 DOI: 10.1007/s00520-018-4197-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/09/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Well-elucidated survivorship care models are pertinent in the long-term management of cancer survivors. This review aims to update existing literature and evaluate the key components of such models with a focus on breast, colorectal, and adolescent and young adult (AYA) cancer survivors. METHODS The PubMed electronic database were searched comprehensively for relevant publications in English through February 2017. Additional manual searches were conducted for reference lists and official guidelines published by oncology societies. Included studies addressed the correct cancer type, elaborated on each model's structure and provided patient-related outcome data to support its model's effectiveness if applicable. RESULTS Among the 25 included studies, six articles described survivorship models applicable to all cancer types, and the remaining focused on breast cancer (n = 10), colorectal cancer (n = 3), and AYA cancer survivors (n = 6). Shared-care model was largely described for all cancer types whereas multidisciplinary model predominated for AYA cancer survivors. Upon evaluation, these models described the essential components of survivorship care fairly well except for the care coordination component. Also, the definition of time points of care was vague and noncomprehensive. CONCLUSION The reviewed survivorship model studies were comprehensive but were limited by a lack of existing rigorous evaluation efforts to assess their effectiveness. This review further provided valuable recommendations for future methodological evaluation of such models. This review has highlighted care coordination as an area for improvement and emphasized the importance of obtaining data on the effectiveness of these survivorship models to ensure satisfactory quality of life and health outcomes.
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Affiliation(s)
- Yu Ke
- Department of Pharmacy, National University of Singapore, Blk S4A level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Terence Ng
- Department of Pharmacy, National University of Singapore, Blk S4A level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Blk S4A level 3, 18 Science Drive 4, Singapore, 117543, Singapore. .,Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. .,Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore, 169857, Singapore.
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28
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Ho J, McWilliams A, Emery J, Saunders C, Reid C, Robinson S, Brims F. Integrated care for resected early stage lung cancer: innovations and exploring patient needs. BMJ Open Respir Res 2017; 4:e000175. [PMID: 28883923 PMCID: PMC5531302 DOI: 10.1136/bmjresp-2016-000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 05/03/2017] [Indexed: 11/18/2022] Open
Abstract
There is no consensus as to the duration and nature of follow-up following surgical resection with curative intent of lung cancer. The integration of cancer follow-up into primary care is likely to be a key future area for quality and cost-effective cancer care. Evidence from other solid cancer types demonstrates that such follow-up has no adverse outcomes, similar health-related quality of life, high patient satisfaction rates at a lower cost to the healthcare system. Core elements for successful models of shared cancer care are required: clear roles and responsibilities, timely effective communication, guidance on follow-up protocols and common treatments and rapid routes to (re)access specialist care. There is thus a need for improved communication between hospital specialists and primary care. Unmet needs for patients with early stage lung cancer are likely to include psychological symptoms and carer stress; the importance of smoking cessation may frequently be overlooked or underappreciated in the current hospital-based follow-up system. There is therefore a need for quality randomised controlled trials of patients with resected early stage lung cancer to establish optimal protocols for primary care-based follow-up and to more adequately address patients' and carers' unmet psychosocial needs, including the crucial role of smoking cessation.
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Affiliation(s)
- Jan Ho
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Jon Emery
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Carlton, Victoria, Australia
| | - Christobel Saunders
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Department of Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Christopher Reid
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Suzanne Robinson
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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29
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O'Caoimh R, Cornally N, O'Sullivan R, Hally R, Weathers E, Lavan AH, Kearns T, Coffey A, McGlade C, Molloy DW. Advance care planning within survivorship care plans for older cancer survivors: A systematic review. Maturitas 2017; 105:52-57. [PMID: 28687135 DOI: 10.1016/j.maturitas.2017.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/17/2017] [Accepted: 06/22/2017] [Indexed: 12/24/2022]
Abstract
Advances in the medical treatment of cancer have increased the number of survivors, particularly among older adults, who now represent the majority of these. Survivorship care plans (SCPs) are documents that cancer patients receive summarising their care, usually at the end of treatment but preferably from initial diagnosis. These may increase patient satisfaction and represent an opportunity to initiate preventative strategies and address future care needs. Advance care planning (ACP), incorporating advance healthcare decision-making, including formal written directives, increases satisfaction and end-of-life care. This paper systematically reviews evaluations of ACP within SCPs among older (≥65 years) cancer survivors. No studies meeting the inclusion criteria were identified by search strategies conducted in PubMed/MEDLINE and the Cochrane databases. One paper examined cancer survivors' mainly positive views of ACP. Another discussed the use of a SCP supported by a 'distress inventory' that included an advance care directive (living will) as an issue, though no formal evaluation was reported. Although ACP is important for older adults, no study was found that evaluated its role within survivorship care planning. Despite the risk of recurrence and the potential for morbidity and mortality, especially among older cancer survivors, ACP is not yet a feature of SCPs.
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Affiliation(s)
- Rónán O'Caoimh
- Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland; Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland.
| | - Nicola Cornally
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland; School of Nursing and Midwifery, University College Cork, College Road, Cork City, Ireland
| | - Ronan O'Sullivan
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - Ruth Hally
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - Elizabeth Weathers
- Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland; School of Nursing and Midwifery, University College Cork, College Road, Cork City, Ireland
| | - Amanda H Lavan
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - Tara Kearns
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - Alice Coffey
- School of Nursing and Midwifery, University College Cork, College Road, Cork City, Ireland
| | - Ciara McGlade
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland
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30
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Jacobs LA, Shulman LN. Follow-up care of cancer survivors: challenges and solutions. Lancet Oncol 2017; 18:e19-e29. [PMID: 28049574 DOI: 10.1016/s1470-2045(16)30386-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 02/08/2023]
Abstract
Attention to survivors of adult cancers formally began more than 30 years ago with the founding of the National Coalition for Cancer Survivorship by representatives from 20 organisations who envisioned an organisation that would address survivorship issues and include friends, family, and caregivers. Since then, progress has been made in cancer care delivery, which has created challenges for and barriers to provision of optimal follow-up care to patients and survivors living with cancer as a chronic illness. Focus on post-treatment cancer care, including monitoring for long-term and late effects, and concerns regarding the effect of a cancer diagnosis and treatment on quality of life have gained momentum in the past 10 years. This impetus is largely a result of the 2005 Institute of Medicine Report From Cancer Patient to Cancer Survivor: Lost in Transition. Although the issues raised in the report were hardly novel, they gave a new and powerful voice to the cancer survivorship movement that demanded a call to action. In this Series paper, we provide an overview of the issues surrounding provision of cancer survivorship and follow-up care in the USA and discuss potential solutions to these challenges.
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Affiliation(s)
- Linda A Jacobs
- Director for Survivorship Clinical Programs, Research and Educational Initiatives, Abramson Cancer Center, Perelman Center for Advanced Medicine, Philadelphia, PA, USA.
| | - Lawrence N Shulman
- Deputy Director for Clinical Services, Abramson Cancer Center, Perelman Center for Advanced Medicine, Philadelphia, PA, USA
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31
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Mayer DK, Nasso SF, Earp JA. Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA. Lancet Oncol 2017; 18:e11-e18. [PMID: 28049573 DOI: 10.1016/s1470-2045(16)30573-3] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/01/2016] [Accepted: 08/12/2016] [Indexed: 12/21/2022]
Abstract
More people are living after a diagnosis of cancer than ever before and now account for around 5% of the US population. The specialty of cancer survivorship has been developing and growing since the mid-1980s, but the term survivor is open to debate by people living with cancer and those caring for them. Regardless of the term used, many ongoing physical, psychological, and social needs affect quality of life for people who are living with cancer and those who have survived the disease. Survivors prefer to have these needs addressed by their oncologist but also want their primary care provider to have a role. However, survivors also believe there are communication and coordination barriers between care providers. The existing method for delivering cancer care is becoming unsustainable and is not adequately configured to deliver high-quality cancer care to this growing population in the USA, especially when confronted with projected health-care shortages by 2020. In this Series paper, we define the term cancer survivor, discuss survivors' ongoing needs and preferences for care over time, and consider the implications for delivering coordinated cancer care in the USA.
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Affiliation(s)
- Deborah K Mayer
- University of North Carolina School of Nursing, University of North Carolina, Chapel Hill, NC, USA; University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | | | - Jo Anne Earp
- University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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32
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Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. J Am Board Fam Med 2017; 30:298-307. [PMID: 28484062 PMCID: PMC5870832 DOI: 10.3122/jabfm.2017.03.160359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/30/2017] [Accepted: 02/06/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The role of primary care providers (PCPs) in decision making around cancer care remains largely unknown. We evaluated how frequently men with localized prostate cancer report receiving help from their PCP about their treatment, and whether those men who do are less likely to receive definitive treatment. METHODS We mailed surveys to men newly diagnosed with localized prostate cancer between 2012 and 2014 in the greater Philadelphia region. Participants were asked whether their PCP helped decide how to treat their cancer. The outcome was receipt of definitive treatment (either radical prostatectomy or radiotherapy). RESULTS A total of 2386 men responded (adjusted response rate, 51.1%). Among these men, 38.2% reported receiving help from their PCP regarding choosing a treatment, and 79.6% received definitive treatment. In adjusted analyses, non-Hispanic black men (odds ratio, 1.76; 95% confidence interval, 1.37-2.27) were more likely than non-Hispanic white men to report receiving help from their PCP. However, men who did receive help were not more likely to forgo definitive treatment overall (P = .58) or in the subgroups of men who may be least likely to benefit from definitive treatment. CONCLUSIONS Though a substantial proportion of men reported receiving help from their PCP about prostate cancer treatment, these discussions were not associated with different treatment patterns. Further effort is needed to determine how to optimize the role of PCPs in supporting patients to make preference-sensitive cancer decisions.
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Affiliation(s)
- Archana Radhakrishnan
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP).
| | - David Grande
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Michelle Ross
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Nandita Mitra
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Justin Bekelman
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Christian Stillson
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Craig Evan Pollack
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
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33
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Gosselin TK, Beck S, Abbott DH, Grambow SC, Provenzale D, Berry P, Kahn KL, Malin JL. The Symptom Experience in Rectal Cancer Survivors. J Pain Symptom Manage 2016; 52:709-718. [PMID: 27697567 DOI: 10.1016/j.jpainsymman.2016.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 05/15/2016] [Accepted: 05/24/2016] [Indexed: 11/12/2022]
Abstract
CONTEXT As the number of rectal cancer survivors grows, it is important to understand the symptom experience after treatment. Although data show that rectal cancer survivors experience a variety of symptoms after diagnosis, little has been done to study the way these symptoms are grouped and associated. OBJECTIVES To determine symptom prevalence and intensity in rectal cancer survivors and if clusters of survivors exist, who share similar symptom-defined survivor subgroups that may vary based on antecedent variables. METHODS A secondary analysis of the Cancer Care and Outcomes Research and Surveillance database was undertaken. Cluster analysis was performed on 15-month postdiagnosis data to form post-treatment survivor subgroups, and these were examined for differences in demographic and clinical characteristics. Data were analyzed using cluster analysis, chi-square, and analysis of variance. RESULTS A total of 275 rectal cancer survivors were included who had undergone chemotherapy, radiation therapy, and surgery. Most frequently reported symptoms included feeling "worn out" (87%), feeling "tired" (85%), and "trouble sleeping" (66%). Four symptom-defined survivor subgroups (minimally symptomatic n = 40, tired and trouble sleeping n = 138, moderate symptoms n = 42, and highly symptomatic n = 55) were identified with symptom differences existing among each subgroup. Age and being married/partnered were the only two antecedents found to differ across subgroups. CONCLUSION This study documents differences in the symptom experience after treatment. The identification of survivor subgroups allows researchers to further investigate tailored, supportive care strategies to minimize ongoing symptoms in those with the greatest symptom burden.
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Affiliation(s)
- Tracy K Gosselin
- Duke University Health System, Duke Cancer Institute, Durham, North Carolina, USA.
| | - Susan Beck
- University of Utah, College of Nursing, Salt Lake City, Utah, USA
| | - David H Abbott
- Durham Veterans Affairs Epidemiologic Research and Information Center, Durham, North Carolina, USA
| | - Steven C Grambow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Dawn Provenzale
- Durham Veterans Affairs Epidemiologic Research and Information Center, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Patricia Berry
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | - Katherine L Kahn
- Division of General Internal Medicine, University of California, Los Angeles, Los Angeles, California, USA; RAND Corporation, Santa Monica, California, USA
| | - Jennifer L Malin
- Division of General Internal Medicine, University of California, Los Angeles, Los Angeles, California, USA; Anthem, Thousand Oaks, California, USA; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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