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Hart NH, Nekhlyudov L, Smith TJ, Yee J, Fitch MI, Crawford GB, Koczwara B, Ashbury FD, Lustberg MB, Mollica M, Smith AL, Jefford M, Chino F, Zon R, Agar MR, Chan RJ. Survivorship Care for People Affected by Advanced or Metastatic Cancer: MASCC-ASCO Standards and Practice Recommendations. JCO Oncol Pract 2024:OP2300716. [PMID: 38684036 DOI: 10.1200/op.23.00716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared with those with early-stage disease or those nearing the end of life. These Multinational Association for Supportive Care in Cancer (MASCC)-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer. METHODS A MASCC-ASCO expert panel was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process. RESULTS A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including eight people with lived experience) across 33 countries (33% were low- to middle-resource countries) participated in the Delphi study and achieved ≥94.8% agreement for seven standards, (1) Person-Centered Care; (2) Coordinated and Integrated Care; (3) Evidence-Based and Comprehensive Care; (4) Evaluated and Communicated Care; (5) Accessible and Equitable Care; (6) Sustainable and Resourced Care; and (7) Research and Data-Driven Care, and ≥84.2% agreement across 45 practice recommendations. CONCLUSION Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards support optimization of health outcomes and care experiences by providing guidance to stakeholders (health care professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers). Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts.Additional information is available at www.mascc.org, www.asco.org/standards and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
| | - Larissa Nekhlyudov
- Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas J Smith
- Division of General Internal Medicine and Sidney Kimmel Comprehensive Cancer Center, John Hopkins Medical Institutions, Baltimore, MD
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Cancer and Innovation Centre, Flinders Medical Centre, Adelaide, SA, Australia
| | - Fredrick D Ashbury
- VieCure, Clinical and Scientific Division, Greenwood Village, CO
- Department of Oncology, University of Calgary, Calgary, ON, Canada
| | - Maryam B Lustberg
- Department of Medicine, School of Medicine, Yale University, New Haven, CT
- Medical Oncology Division, Yale Cancer Centre, New Haven, CT
| | - Michelle Mollica
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Andrea L Smith
- The Daffodil Centre and University of Sydney: a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Zon
- Michiana Hematology-Oncology, Mishawaka, IN
- Cincinnati Cancer Advisors, Norwood, OH
| | - Meera R Agar
- IMPACCT Research Centre, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Hart NH, Nekhlyudov L, Smith TJ, Yee J, Fitch MI, Crawford GB, Koczwara B, Ashbury FD, Lustberg MB, Mollica M, Smith AL, Jefford M, Chino F, Zon R, Agar MR, Chan RJ. Survivorship care for people affected by advanced or metastatic cancer: MASCC-ASCO standards and practice recommendations. Support Care Cancer 2024; 32:313. [PMID: 38679639 PMCID: PMC11056340 DOI: 10.1007/s00520-024-08465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared to those with early-stage disease or those nearing the end-of-life. These MASCC-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer. METHODS An expert panel comprising MASCC and ASCO members was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting: (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process. RESULTS A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including 8 people with lived experience) across 33 countries (33% were low-to-middle resource countries) participated in the Delphi study and achieved ≥ 94.8% agreement for seven standards (1. Person-Centred Care; 2. Coordinated and Integrated Care; 3. Evidence-Based and Comprehensive Care; 4. Evaluated and Communicated Care; 5. Accessible and Equitable Care; 6. Sustainable and Resourced Care; 7. Research and Data-Driven Care) and ≥ 84.2% agreement across 45 practice recommendations. CONCLUSION Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards will support optimization of health outcomes and care experiences by providing guidance to stakeholders in cancer care (healthcare professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers. Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts.
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Affiliation(s)
- Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia.
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia.
| | - Larissa Nekhlyudov
- Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas J Smith
- Division of General Internal Medicine and Sidney Kimmel Comprehensive Cancer Center, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Cancer and Innovation Centre, Flinders Medical Centre, Adelaide, SA, Australia
| | - Fredrick D Ashbury
- VieCure, Clinical and Scientific Division, Greenwood Village, CO, USA
- Department of Oncology, University of Calgary, Calgary, ON, Canada
- Internal Medicine-Medical Oncology, College of Medicine, The Ohio State University, Columbus , OH, USA
| | - Maryam B Lustberg
- Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA
- Medical Oncology Division, Yale Cancer Centre, New Haven, CT, USA
| | - Michelle Mollica
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Andrea L Smith
- The Daffodil Centre and University of Sydney: a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robin Zon
- Michiana Hematology-Oncology, Mishawaka, IN, USA
- Cincinnati Cancer Advisors, Norwood, OH, USA
| | - Meera R Agar
- IMPACCT Research Centre, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Elizondo Rodríguez N, La Rosa-Salas V, Leite ACAB, Domingo-Osle M, Nascimento LC, García-Vivar C. "Opportunistic Care": A Focus Group Study of Nurses' Perspective on Caring for Long-term Cancer Survivors and Their Families. Cancer Nurs 2024:00002820-990000000-00230. [PMID: 38498794 DOI: 10.1097/ncc.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The global population of long-term cancer survivors is increasing, thanks to advances in treatments and care. Healthcare systems are working to address the unique needs of these individuals. However, there remains a knowledge gap concerning nurses' view on cancer survivorship care. OBJECTIVE To identify nurses' perspective of care for long-term cancer survivors and their families. METHODS This qualitative descriptive study used 5 focus groups comprising 33 nurses from primary healthcare and specialized oncology care. Data analysis was conducted through thematic analysis, and the study received ethical approval. RESULTS Long-term cancer survivors and their families often remained unrecognized as a distinct group within the healthcare system. Consequently, nurses provide what can be termed as "opportunistic care" during nurse-survivor encounters, addressing health needs beyond the purpose of the initial healthcare visit. This absence of a systematic or structured approach for this patient group has prompted nurses to seek the establishment of a comprehensive framework through survivorship care plans, thus ensuring a continuum of care for this specific population. CONCLUSION The lack of a structured approach to caring for long-term cancer survivors and their families, often invisible as a distinct population group, results in nurses providing care on an opportunistic basis. IMPLICATIONS FOR PRACTICE It is crucial to develop and implement survivorship care plans tailored to this population's needs. Simultaneously, it is important to advance research in this area and establish an educational framework for nurses, enabling them to effectively address the care of long-term cancer survivors and their families.
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Affiliation(s)
- Nerea Elizondo Rodríguez
- Author Affiliations: Universidad de Navarra (Mrs Elizondo-Rodríguez and Drs Domingo-Osle and La Rosa-Salas); Universidad Pública de Navarra, Departamento de Ciencias de la Salud (Drs García-Vivar and Leite); and Instituto de Investigación Sanitaria de Navarra (IdiSNA) (Mrs Elizondo-Rodríguez and Drs Domingo-Osle, García-Vivar, La Rosa-Salas, and Leite), Pamplona, Spain; and Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (Dr Nascimento)
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Kantilal K, Hardeman W, Whiteside H, Karapanagioutou E, Small M, Bhattacharya D. Facilitating healthcare practitioners to deliver self-management support in adult cancer survivors: A realist review. Res Social Adm Pharm 2022; 18:3870-3883. [DOI: 10.1016/j.sapharm.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
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Elizondo Rodriguez N, Ambrosio L, La Rosa-Salas V, Domingo-Osle M, Garcia-Vivar C. Role of the nurse in the design, delivery, monitoring and coordination of cancer survivorship care plans: An integrative review. J Adv Nurs 2021; 78:48-62. [PMID: 34235775 DOI: 10.1111/jan.14962] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
AIM Survivorship care plans (SCPs) are recommended as a tool for the care of cancer survivors. SCPs have been implemented with a multidisciplinary approach; however, the specific role of nurses in the SCP is unknown. Our aim is to determine the role of nurses and their degree of participation in cancer SCPs. DESIGN Integrative review of the literature with systematic methodology. DATA SOURCES PubMed, CINAHL, PsycINFO, Web of Science, Cochrane and Cancerlit databases were reviewed. Articles published up to March 2021 were included. REVIEW METHOD Of the 2,638 publications identified, 22 studies met our inclusion criteria. Quality of included studies was assessed using Joanna Briggs Institute quality assessment tools. RESULTS The studies showed that nurses play a key role and participate in different phases of the SCP, including design, delivery, monitoring and coordination among different levels of care, with varying degrees of involvement and responsibility; design and delivery of the SCP are the phases with the highest nurse participation (18 out of 22 studies). The majority of SCPs are implemented in specialized, hospital-based care and focus on short-term cancer survivors, who are actively undergoing oncological treatments. CONCLUSION This review shows that nurses actively participate in the design, implementation and coordination of SCPs. However, SCPs focus on the acute survival and treatment phases, and there is a gap in their use in long-term cancer survivorship. This gap may be one reason the needs of long-term cancer survivors are not covered. IMPACT This review contributes to the current body of knowledge by addressing the role of nurses in cancer SCPs. We recommend the involvement of an advanced practice nurse as SCP coordinator to improve communication between cancer specialists and primary care providers and to promote continued care throughout the different phases of cancer survivorship, including long-term survival.
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Affiliation(s)
| | - Leire Ambrosio
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Marta Domingo-Osle
- Registered Nurse at University of Navarra Clinic and Lecturer at the Practical Teaching Unit, Faculty of Nursing, University of Navarra, Pamplona, Spain
| | - Cristina Garcia-Vivar
- Department of Health Sciences, Public University of Navarre, IdiSNA, Pamplona, Spain
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Challenges for Latina Breast Cancer Patient Survivorship Care in a Rural US-Mexico Border Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137024. [PMID: 34209191 PMCID: PMC8297307 DOI: 10.3390/ijerph18137024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/31/2022]
Abstract
Rural US Latina breast cancer patients experience language barriers, health literacy issues, and limited access to health care resources that negatively impact survivorship care. This study explored the challenges to survivorship care for rural Latina breast cancer (BC) patients and approaches to supporting survivorship care plans (SCP) from the stakeholders’ perspectives. Data were collected via eight focus groups (n = 40) and individual interviews (n = 4) with Latina BC patients, family caregivers, and health care professionals in a rural US-Mexico Border region. Interviews were audio-taped, transcribed, translated, and analyzed using thematic analysis. Themes related to the patient’s SCP challenges included: (1) lack of knowledge of treatment information, (2) lack of proactive health behavior, (3) gaps in information for care coordination, (4) psychological distress, and (5) difficulty retaining health information. Respondents expressed that the SCP document could fill patient information gaps as well as support patient communication with their clinicians and family. Rural BC patients demonstrated an acute need for information and active engagement in their survivorship care. The findings indicate the importance of addressing challenges for survivorship care on multiple dimensions: Cognitive, behavioral, social, and structural. Developing a culturally tailored SCP intervention will be imperative to support survivorship care.
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Fitch MI, Nicoll I, Lockwood G. Cancer survivor's perspectives on the major challenge in the transition to survivorship. PATIENT EDUCATION AND COUNSELING 2020; 103:2361-2367. [PMID: 32376142 DOI: 10.1016/j.pec.2020.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/11/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To understand cancer survivors' perspectives regarding the major challenge in transitioning from cancer treatment to follow-up care. Identification of major issues should inform survivorship care and help reduce suffering. METHODS A national survey was conducted to identify experiences with follow-up for cancer survivors one to three years post-treatment. The survey included open-ended questions for respondents to add topics of importance and details that offer deeper insight into their experiences. This publication presents analysis of the open-ended question about the major challenge faced by adult cancer population. RESULTS Of 13,534 unique adult survey respondents, 8706 respondents identified major challenges. Of those reporting challenges, 4727 (54.3 %) named a single challenge but 3979 (45.7 %) identified more than one. In total, 15,351 challenges were identified. Responses to open-ended questions are summarized under significant themes: major concerns are often more than singular issues; recovery and fear of recurrence; and information needs. CONCLUSIONS AND PRACTICE IMPLICATIONS Results indicate significant numbers of adult survivors have multiple concerns about physical, emotional, and practical issues but are not receiving assistance and/or appropriate information to help manage these concerns. It is important to determine how health care can be proactive in identifying and addressing needs of survivors.
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Affiliation(s)
- Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, 207 Chisholm Ave., Toronto, Ontario, M4C 4V9, Canada.
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Abstract
BACKGROUND Patient engagement (PE) is a key factor for early-stage breast cancer survivors during survivorship, yet little is known about what factors may contribute to PE. OBJECTIVES The aims of this study were to describe the relationship between sociodemographic factors, survivorship variables, and PE and explore how variations in these variables might contribute to PE in breast cancer survivors. METHODS A cross-sectional, web-based self-report national survey was conducted to assess sociodemographic factors and survivorship variables: health-related quality of life (HRQOL) as measured by 7-item Functional Assessment of Cancer Therapy-General, fear of cancer recurrence, cancer health literacy, and 2 measures of PE (Patient Activation and Knowing Participation in Change) in breast cancer survivors. One open-ended question assessed additional survivorship concerns. Data were analyzed via bivariate associations and backward linear regression modeling in SPSS. RESULTS The sample (N = 303), equally dispersed across the United States, was predominantly middle-aged (mean, 50.70 [SD, 14.01]), white, non-Hispanic women. Knowing Participation in Change and Patient Activation regression models indicate HRQOL was significantly associated with PE (P ≤ .001), whereas findings related to fear of cancer recurrence lacked significance. In the Knowing Participation in Change regression model, HRQOL, social support, and level of education were all significantly associated with PE (P ≤ .001). CONCLUSIONS Breast cancer survivors with higher HRQOL, greater social support, and higher levels of education were more likely to have higher levels of PE. IMPLICATIONS FOR PRACTICE Findings may provide insight as to which survivors may be ready to engage in SC and those who may need more specific tailoring of resources and support.
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Hua A, Sesto ME, Zhang X, Wassenaar TR, Tevaarwerk AJ. Impact of Survivorship Care Plans and Planning on Breast, Colon, and Prostate Cancer Survivors in a Community Oncology Practice. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:249-255. [PMID: 30610655 PMCID: PMC6609493 DOI: 10.1007/s13187-018-1457-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With a growing number of cancer survivors, survivorship care plans (SCPs) are recommended to communicate information about late effects of treatment and follow-up care. Community oncology practices follow 85% of adult cancer survivors but report more difficulty in providing SCPs compared to academic centers. Our objective was to evaluate the impact of delivering SCPs in a community oncology practice by examining awareness of SCP receipt as well as how provision affects survivors' perception of care quality and of their condition. Survivors who accepted a SCP as standard of care were recruited from a community oncology practice in the Midwest and completed surveys prior to SCP provision (baseline) and 4 weeks later (follow-up). Within-survivor changes in knowledge of SCP receipt, satisfaction and perceived care coordination were assessed. Thirty cancer survivors (breast, colon, and prostate) completed the baseline survey, while 24 completed the follow-up survey (80% response rate). Participants reported receiving SCPs and treatment summaries more frequently at follow-up after receiving a SCP. At follow-up, there was a significant increase in survivor activation and involvement in care along with satisfaction of knowledge of care. Communication about and during SCP provision may need to be clearer: 34% of survivors could not correctly identify SCP receipt in this study. This may place these survivors at a disadvantage, if this leads to less awareness of important information regarding follow-up surveillance and management. Of those aware of SCP receipt, SCP provision had positive impacts in this small, short-term study.
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Affiliation(s)
- Alexandra Hua
- University of Wisconsin, School of Medicine & Public Health, Madison, USA
| | - Mary E Sesto
- University of Wisconsin, School of Medicine & Public Health, Madison, USA
- Carbone Cancer Center, Madison, WI, USA
| | | | | | - Amye J Tevaarwerk
- University of Wisconsin, School of Medicine & Public Health, Madison, USA.
- Carbone Cancer Center, Madison, WI, USA.
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Kempa-Liehr AW, Lin CYC, Britten R, Armstrong D, Wallace J, Mordaunt D, O'Sullivan M. Healthcare pathway discovery and probabilistic machine learning. Int J Med Inform 2020; 137:104087. [PMID: 32126509 DOI: 10.1016/j.ijmedinf.2020.104087] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/15/2019] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Healthcare pathways define the execution sequence of clinical activities as patients move through a treatment process, and they are critical for maintaining quality of care. The aim of this study is to combine healthcare pathway discovery with predictive models of individualized recovery times. The pathway discovery has a particular emphasis on producing pathway models that are easy to interpret for clinicians without a sufficient background in process mining. The predictive model takes the stochastic volatility of pathway performance indicators into account. METHOD This study utilizes the business process-mining software ProM to design a process mining pipeline for healthcare pathway discovery and enrichment using hospital records. The efficacy of combining learned healthcare pathways with probabilistic machine learning models is demonstrated via a case study that applies the proposed process mining pipeline to discover appendicitis pathways from hospital records. Machine learning methodologies based on probabilistic programming are utilized to explore pathway features that influence patient recovery time. RESULTS The produced appendicitis pathway models are easy for clinical interpretation and provide an unbiased overview of patient movements through the treatment process. Analysis of the discovered pathway model enables reasons for longer than usual treatment times to be explored and deviations from standard treatment pathways to be identified. A probabilistic regression model that estimates patient recovery time based on the information extracted by the process mining pipeline is developed and has the potential to be very useful for hospital scheduling purposes. CONCLUSION This study establishes the application of the business process modelling tool ProM for the improvement of healthcare pathway mining methods. The proposed pipeline for healthcare pathway discovery has the potential to support the development of probabilistic machine learning models to further relate healthcare pathways to performance indicators such as patient recovery time.
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Affiliation(s)
- Andreas W Kempa-Liehr
- Department of Engineering Science, The University of Auckland, 70 Symonds St, Auckland, New Zealand.
| | - Christina Yin-Chieh Lin
- Department of Engineering Science, The University of Auckland, 70 Symonds St, Auckland, New Zealand
| | - Randall Britten
- Auckland District Health Board, 2 Park Road, Auckland, New Zealand; was at Orion Health, 181 Grafton Rd, Auckland, New Zealand
| | - Delwyn Armstrong
- Waitemata District Health Board, 124 Shakespeare Rd, Auckland, New Zealand
| | - Jonathan Wallace
- Waitemata District Health Board, 124 Shakespeare Rd, Auckland, New Zealand
| | - Dylan Mordaunt
- University of Adelaide and Flinders University, Adelaide, Australia; was at Waitemata District Health Board, 124 Shakespeare Rd, Auckland, New Zealand
| | - Michael O'Sullivan
- Department of Engineering Science, The University of Auckland, 70 Symonds St, Auckland, New Zealand
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Lipscomb J, Escoffery C, Gillespie TW, Henley SJ, Smith RA, Chociemski T, Almon L, Jiang R, Sheng X, Goodman M, Ward KC. Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030977. [PMID: 32033227 PMCID: PMC7037204 DOI: 10.3390/ijerph17030977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/24/2022]
Abstract
Women diagnosed with breast cancer at a relatively early age (≤45 years) or with bilateral disease at any age are at elevated risk for additional breast cancer, as are their female first-degree relatives (FDRs). We report on a randomized trial to increase adherence to mammography screening guidelines among survivors and FDRs. From the Georgia Cancer Registry, breast cancer survivors diagnosed during 2000–2009 at six Georgia cancer centers underwent phone interviews about their breast cancer screening behaviors and their FDRs. Nonadherent survivors and FDRs meeting all inclusion criteria were randomized to high-intensity (evidence-based brochure, phone counseling, mailed reminders, and communications with primary care providers) or low-intensity interventions (brochure only). Three and 12-month follow-up questionnaires were completed. Data analyses used standard statistical approaches. Among 1055 survivors and 287 FDRs who were located, contacted, and agreed to participate, 59.5% and 62.7%, respectively, reported breast cancer screening in the past 12 months and were thus ineligible. For survivors enrolled at baseline (N = 95), the proportion reporting adherence to guideline screening by 12 months post-enrollment was similar in the high and low-intensity arms (66.7% vs. 79.2%, p = 0.31). Among FDRs enrolled at baseline (N = 83), screening was significantly higher in the high-intensity arm at 12 months (60.9% vs. 32.4%, p = 0.03). Overall, about 72% of study-eligible survivors (all of whom were screening nonadherent at baseline) reported screening within 12 months of study enrollment. For enrolled FDRs receiving the high-intensity intervention, over 60% reported guideline screening by 12 months. A major conclusion is that using high-quality central cancer registries to identify high-risk breast cancer survivors and then working closely with these survivors to identify their FDRs represents a feasible and effective strategy to promote guideline cancer screening.
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Affiliation(s)
- Joseph Lipscomb
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
- Correspondence: ; Tel.: +404-727-4513; Fax: +404-727-9198
| | - Cam Escoffery
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
| | - Theresa W. Gillespie
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
- Department of Surgery and Department of Hematology and Medical Oncology, Emory University School of Medicine; Atlanta, GA 30322, USA
| | - S. Jane Henley
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention; Atlanta, GA 30341, USA;
| | - Robert A. Smith
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Cancer Control Program, American Cancer Society; Atlanta, GA 30303, USA
| | - Toni Chociemski
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Lyn Almon
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Renjian Jiang
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Xi Sheng
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Michael Goodman
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
| | - Kevin C. Ward
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
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12
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Chen Y, Patel MB, McNaughton CD, Malin BA. Interaction patterns of trauma providers are associated with length of stay. J Am Med Inform Assoc 2019; 25:790-799. [PMID: 29481625 DOI: 10.1093/jamia/ocy009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/26/2018] [Indexed: 01/08/2023] Open
Abstract
Background Trauma-related hospitalizations drive a high percentage of health care expenditure and inpatient resource consumption, which is directly related to length of stay (LOS). Robust and reliable interactions among health care employees can reduce LOS. However, there is little known about whether certain patterns of interactions exist and how they relate to LOS and its variability. The objective of this study is to learn interaction patterns and quantify the relationship to LOS within a mature trauma system and long-standing electronic medical record (EMR). Methods We adapted a spectral co-clustering methodology to infer the interaction patterns of health care employees based on the EMR of 5588 hospitalized adult trauma survivors. The relationship between interaction patterns and LOS was assessed via a negative binomial regression model. We further assessed the influence of potential confounders by age, number of health care encounters to date, number of access action types care providers committed to patient EMRs, month of admission, phenome-wide association study codes, procedure codes, and insurance status. Results Three types of interaction patterns were discovered. The first pattern exhibited the most collaboration between employees and was associated with the shortest LOS. Compared to this pattern, LOS for the second and third patterns was 0.61 days (P = 0.014) and 0.43 days (P = 0.037) longer, respectively. Although the 3 interaction patterns dealt with different numbers of patients in each admission month, our results suggest that care was provided for similar patients. Discussion The results of this study indicate there is an association between LOS and the extent to which health care employees interact in the care of an injured patient. The findings further suggest that there is merit in ascertaining the content of these interactions and the factors that induce these differences in interaction patterns within a trauma system.
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Affiliation(s)
- You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mayur B Patel
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, TN, USA.,Department of Electrical Engineering and Computer Science, School of Engineering, Vanderbilt University, Nashville, TN, USA
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13
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Hill RE, Wakefield CE, Cohn RJ, Fardell JE, Brierley MEE, Kothe E, Jacobsen PB, Hetherington K, Mercieca-Bebber R. Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes. Oncologist 2019; 25:e351-e372. [PMID: 32043786 DOI: 10.1634/theoncologist.2019-0184] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision. METHODS We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome. RESULTS Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects. CONCLUSION SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies. IMPLICATIONS FOR PRACTICE Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.
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Affiliation(s)
- Rebecca E Hill
- School of Women's and Children's Health, University of New South Wales (UNSW) Sydney, Randwick, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, University of New South Wales (UNSW) Sydney, Randwick, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, University of New South Wales (UNSW) Sydney, Randwick, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, University of New South Wales (UNSW) Sydney, Randwick, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Mary-Ellen E Brierley
- School of Women's and Children's Health, University of New South Wales (UNSW) Sydney, Randwick, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Emily Kothe
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Kate Hetherington
- School of Women's and Children's Health, University of New South Wales (UNSW) Sydney, Randwick, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Rebecca Mercieca-Bebber
- School of Women's and Children's Health, University of New South Wales (UNSW) Sydney, Randwick, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, Australia
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Abstract
Transition to cancer survivorship is frequent lexicon denoting the posttreatment phase of cancer treatment. The concept of being in transition to survivorship is not well defined. To critically analyze this concept, data sources (n = 63) (from 1985 to 2016) from nursing, sociology, medicine, and psychology were evaluated employing Rodgers evolutionary method. Transition to cancer survivorship is a turning point with a variable time period one passes through after treatment. It is an individualized experience with degrees of liminality, changes, and challenging consequences. Understanding this concept helps identify patient needs for targeted nursing interventions that can bridge safe passage to cancer survivorship.
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Pembroke M, Nemeth L, Bradley J. Radiation Therapy Survivorship: Healthcare Providers’ Perspectives on Education and Care. Clin J Oncol Nurs 2019; 23:E66-E72. [DOI: 10.1188/19.cjon.e66-e72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW The transition from primary cancer treatment to posttreatment follow-up care is seen as critical to the long-term health of survivors. However, relatively little attention has been paid to understanding this pivotal period. This review will offer a brief outline of the significant work surrounding this pivotal time published in the past year. RECENT FINDINGS The growing number of cancer survivors has stimulated an emphasis on finding new models of care, whereby responsibility for survivorship follow-up is transitioned to primary care providers. A variety of models and tools have emerged for follow-up care. Survivorship care plans are heralded as a key component of survivorship care and a vehicle for supporting transition. Uptake of survivorship care plans and implementation of evidence-based models of survivorship care has been slow, hindered by a range of barriers. SUMMARY Evaluation is needed regarding survivorship models in terms of feasibility, survivor friendliness, cost effectiveness, and achievement of sustainable outcomes. How, and when, to introduce plans for transition to the patient and determine transition readiness are important considerations but need to be informed by evidence. Additional study is needed to identify best practice for the introduction and application of survivorship care plans.
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17
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Tsui J, Hudson SV, Rubinstein EB, Howard J, Hicks E, Kieber-Emmons A, Bator A, Lee HS, Ferrante J, Crabtree BF. A mixed-methods analysis of the capacity of the Patient-Centered Medical Home to implement care coordination services for cancer survivors. Transl Behav Med 2018; 8:319-327. [PMID: 29800396 DOI: 10.1093/tbm/ibx059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
There are currently 15.5 million cancer survivors in USA who are increasingly relying on primary care providers for their care. Patient-Centered Medical Homes (PCMHs) have the potential to meet the unique needs of cancer survivors; but, few studies have examined PCMH attributes as potential resources for delivering survivorship care. This study assesses the current care coordination infrastructure in advanced PCMHs, known to be innovative, and explores their capacity to provide cancer survivorship care. We conducted comparative case studies of a purposive sample (n = 9) of PCMHs to examine current care coordination infrastructure and capacity through a mixed- methods analysis. Data included qualitative interviews, quantitative surveys, and fieldnotes collected during 10- to 12-day onsite observations at each practice. Case studies included practices in five states with diverse business models and settings. Eight of the nine practices had National Committee for Quality Assurance Level 3 PCMH recognition. No practices had implemented a systematic approach to cancer survivorship care. We found all practices had a range of electronic population health management tools, care coordinator roles in place for chronic conditions, and strategies or protocols for tracking and managing complex disease groups. We identified potential capacity, as well as barriers, to provide cancer survivorship care using existing care coordination infrastructure developed for other chronic conditions. This existing infrastructure suggests the potential to translate care coordination elements within primary care settings to accelerate the implementation of systematic survivorship care.
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Affiliation(s)
- Jennifer Tsui
- Division of Population Science, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Shawna V Hudson
- Division of Population Science, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Ellen B Rubinstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Jenna Howard
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Elisabeth Hicks
- Department of Family Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Autumn Kieber-Emmons
- Lehigh Valley Health Network/University of Southern Florida Morsani School of Medicine, Allentown, PA, USA
| | - Alicja Bator
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Heather S Lee
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Jeanne Ferrante
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Benjamin F Crabtree
- Division of Population Science, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
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Abstract
Objectives To determine whether the shared care model during the follow-up of cancer survivors is effective in terms of patient-reported outcomes, clinical outcomes, and continuity of care. Methods Using systematic review methods, studies were searched from six electronic databases-MEDLINE (n = 474), British Nursing Index (n = 320), CINAHL (n = 437), Cochrane Library (n = 370), HMIC (n = 77), and Social Care Online (n = 210). The review considered all health-related outcomes that evaluated the effectiveness of shared care for cancer survivors. Results Eight randomised controlled trials and three descriptive papers were identified. The results showed the likelihood of similar effectiveness between shared care and usual care in terms of quality of life, mental health outcomes, unmet needs, and clinical outcomes in cancer survivorship. The reviewed studies indicated that shared care overall is highly acceptable to cancer survivors and primary care practitioners, and shared care might be cheaper than usual care. Conclusions The results from this review suggest that the patient satisfaction of shared care is higher than usual care, and the effectiveness of shared care is similar to usual care in cancer survivorship. Interventions that formally involve primary care and improve the communication between primary care and hospital care could support the PCPs in the follow-up.
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Birken SA, Clary AS, Bernstein S, Bolton J, Tardif-Douglin M, Mayer DK, Deal AM, Jacobs SR. Strategies for Successful Survivorship Care Plan Implementation: Results From a Qualitative Study. J Oncol Pract 2018; 14:e462-e483. [PMID: 30004824 DOI: 10.1200/jop.17.00054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Care for US cancer survivors is often fragmented, contributing to poor health outcomes. Care and outcomes may improve when survivors and follow-up care providers receive survivorship care plans (SCPs), written documents containing information regarding cancer diagnosis, treatment, surveillance plans, and health promotion. However, implementing SCPs is challenging. As such, we sought to identify strategies for successfully implementing SCPs. METHODS We measured SCP implementation using performance data from cancer programs participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative, an oncologist-led quality assessment and improvement program. We used semistructured interviews with cancer program employees (eg, physicians) to identify strategies for successfully implementing SCPs by comparing approaches in cancer programs that, according to Quality Oncology Practice Initiative performance indicators, developed and delivered SCPs to a relatively small proportion of eligible survivors and their follow-up care providers (ie, low performers; n = 6 participants in five programs) with approaches among programs with better performance (ie, moderate performers; n = 15 participants in nine programs). RESULTS Ten of 14 cancer programs developed SCPs for ≥ 50% of eligible survivors; two of 14 delivered SCPs to any survivors; and eight of 14 delivered SCPs to ≥ 25% of follow-up care providers. We found that moderate performers proactively addressed SCP requirements, leveraged requirements to improve survivorship care, set internal targets, automated implementation, had active leaders and champions, and tasked appropriate employees with SCP implementation. CONCLUSION SCP implementation remains challenging. We identified strategies for successfully implementing SCPs. Future research should examine how cancer programs have achieved these strategies; findings could contribute to an understanding of the changes needed to implement comprehensive survivorship care.
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Affiliation(s)
- Sarah A Birken
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Alecia S Clary
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Shampa Bernstein
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Jamiyla Bolton
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Miriam Tardif-Douglin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Deborah K Mayer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Allison M Deal
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Sara R Jacobs
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
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Fitch M. [Not Available]. Can Oncol Nurs J 2018; 28:3. [PMID: 31148642 PMCID: PMC6516215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
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Fitch M. Transitioning to survivorship: An imperative for cancer nurses. Can Oncol Nurs J 2018; 28:2. [PMID: 31148633 PMCID: PMC6516216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
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Abstract
Roughly 436,000 survivors are living with a history of head and neck cancer (HNC), accounting for approximately 3% of all cancer survivors in the United States [1, 2]. With advances in treatment, long-term survival is increasingly common in HNC populations. Despite increasing awareness of survivorship issues, many challenges remain. These include lack of knowledge on late and long-term effects of treatment, and poor integration of survivorship care guidelines into oncology practice. Survivorship care plans (SCPs) are increasingly important for HNC survivors to improve quality of long-term survival. Quality survivorship care should focus on management of late and long-term effects of treatment, surveillance for cancer recurrence and second primaries, promotion of healthy lifestyle, and care coordination between providers. This chapter will describe common quality of life (QOL) issues in HNC survivorship, and review the current survivorship care guidelines in HNC.
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Affiliation(s)
- Denice Economou
- Division of Nursing Research and Education, Department of Populations Sciences, City of Hope, Duarte, CA, USA.
| | - Virginia Sun
- Division of Nursing Research and Education, Department of Populations Sciences, City of Hope, Duarte, CA, USA
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Oliveira RAAD, Zago MMF, Thorne SE. Interaction between professionals and cancer survivors in the context of Brazilian and Canadian care. Rev Lat Am Enfermagem 2017; 25:e2972. [PMID: 29267543 PMCID: PMC5738956 DOI: 10.1590/1518-8345.2253.2972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/07/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: analyze cancer survivors’ reports about their communication with health
professional team members and describe the similarities and differences in
interactional patterns between Brazilian and Canadian health care contexts. Method: This study adopted a qualitative health research approach to secondary analysis,
using interpretive description as the methodology, allowing us to elaborate a new
research question and look at the primary data from a different perspective. There
were in total eighteen participants; all of them were adults and elderly diagnosed
with urologic cancer. After being organized and read, the data sets were
classified into categories, and an analytic process was performed through
inductive thematic analysis. Results: This resulted in three categories of findings which we have framed as:
Communication between professional and survivor; The symptoms, the doubts, the
questions; and Actions and reaction. Conclusion: This comparative study allowed us to bring to the attention of health
professionals, especially nurses, findings regarding effective communication,
humanization and empathy, supporting both inside and outside support groups,
giving pieces of advice, and advocating for the survivor as is necessary. The
study also showed the importance of self-development of these professionals as
they fight for better quality in the health system for their patients.
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Affiliation(s)
- Rafaela Azevedo Abrantes de Oliveira
- Doctoral student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Scholarship holder at Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil
| | - Márcia Maria Fontão Zago
- PhD, Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Levis BE, Binkley PF, Shapiro CL. Cardiotoxic effects of anthracycline-based therapy: what is the evidence and what are the potential harms? Lancet Oncol 2017; 18:e445-e456. [DOI: 10.1016/s1470-2045(17)30535-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/04/2017] [Accepted: 01/12/2017] [Indexed: 01/07/2023]
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Kurtin S. Living with Multiple Myeloma: A Continuum-Based Approach to Cancer Survivorship. Semin Oncol Nurs 2017; 33:348-361. [DOI: 10.1016/j.soncn.2017.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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