1
|
Mariotto AB, Enewold L, Parsons H, Zeruto CA, Yabroff KR, Mayer DK. Workforce Caring for Cancer Survivors in the United States: Estimates and Projections of Utilization. J Natl Cancer Inst 2022; 114:837-844. [PMID: 35171249 DOI: 10.1093/jnci/djac036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/15/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aims to quantify the extent and diversity of the cancer care workforce, beyond medical oncologists, to inform future demand, as the number of cancer survivors is expected to grow in the US. METHODS SEER-Medicare data was used to evaluate healthcare utilization of cancer survivors diagnosed between 2000-2014 and enrolled in fee-for-service Medicare Parts A and B and 65 years or older in 2008-2015. We calculated percentage of cancer survivors who saw each clinician specialty and their average annual number of visits in each phase of care. We projected the national number of individuals receiving care and number of annual visits by clinician specialty and phase of care through 2040. RESULTS Cancer survivors had higher care utilization in the first year after diagnosis and last year of life phases. During the initial year after cancer diagnosis, most survivors were seen for cancer-related care by a medical oncologist (59.1%), primary care provider (55.9%) and/or other cancer-treating physicians (42.2%). The percentage of survivors with cancer-related visits to each specialty declined after the first year after diagnosis, plateauing after year 6-7. However, at 10 or more years after diagnosis, about 20% of cancer survivors had visits to medical oncologists and an average of 4 visits a year. CONCLUSIONS Cancer survivors had higher care utilization in the first year after diagnosis and last year of life. High levels of care utilization across specialty in all phases of care has important implications for models of survivorship care coordination and workforce planning.
Collapse
Affiliation(s)
- Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
| | - Lindsey Enewold
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
| | - Helen Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, US
| | | | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, US
| | - Deborah K Mayer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US.,School of Nursing, University of North Carolina Chapel Hill, Chapel Hill, NC, US.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, US
| |
Collapse
|
2
|
Schroeck FR, Ould Ismail AA, Perry GN, Haggstrom DA, Sanchez SL, Walker DR, Young J, Zickmund S, Zubkoff L. Determinants of Risk-Aligned Bladder Cancer Surveillance-Mixed-Methods Evaluation Using the Tailored Implementation for Chronic Diseases Framework. JCO Oncol Pract 2022; 18:e152-e162. [PMID: 34464159 PMCID: PMC8835627 DOI: 10.1200/op.21.00226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE For many patients with cancer, the frequency of surveillance after primary treatment depends on the risk for cancer recurrence or progression. Lack of risk-aligned surveillance means too many unnecessary surveillance procedures for low-risk patients and not enough for high-risk patients. Using bladder cancer as an example, we examined whether practice determinants differ between Department of Veterans Affairs sites where risk-aligned surveillance was more (risk-aligned sites) or less common (need improvement sites). METHODS We used our prior quantitative data to identify two risk-aligned sites and four need improvement sites. We performed semistructured interviews with 40 Veterans Affairs staff guided by the Tailored Implementation for Chronic Diseases framework that were deductively coded. We integrated quantitative data (risk-aligned site v need improvement site) and qualitative data from interviews, cross-tabulating salient determinants by site type. RESULTS There were 14 participants from risk-aligned sites and 26 participants from need improvement sites. Irrespective of site type, we found a lack of knowledge on guideline recommendations. Additional salient determinants at need improvement sites were a lack of resources ("the next available without overbooking is probably seven to eight weeks out") and an absence of routines to incorporate risk-aligned surveillance ("I have my own guidelines that I've been using for 35 years"). CONCLUSION Knowledge, resources, and lack of routines were salient barriers to risk-aligned bladder cancer surveillance. Implementation strategies addressing knowledge and resources can likely contribute to more risk-aligned surveillance. In addition, reminders for providers to incorporate risk into their surveillance plans may improve their routines.
Collapse
Affiliation(s)
- Florian R. Schroeck
- From the White River Junction VA Medical Center, White River Junction, VT,Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH,Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH,Florian R. Schroeck, MD, MS, VA Outcomes Group, WRJ VA Medical Center, 215 N Main St, White River Junction, VT 05009; e-mail:
| | | | - Grace N. Perry
- Department of Medicine, University of Utah, Salt Lake City, UT
| | - David A. Haggstrom
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN,Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN,Regenstrief Institute, Indianapolis, IN
| | - Steven L. Sanchez
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN
| | - DeRon R. Walker
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN
| | - Jeanette Young
- VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Susan Zickmund
- Department of Medicine, University of Utah, Salt Lake City, UT,VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Lisa Zubkoff
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL,Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
3
|
Alfieri S, Romanò R, Bologna M, Calareso G, Corino V, Mirabile A, Ferri A, Bellanti L, Poli T, Marcantoni A, Grosso E, Tarsitano A, Battaglia S, Blengio F, De Martino I, Valerini S, Vecchio S, Richetti A, Deantonio L, Martucci F, Grammatica A, Ravanelli M, Ibrahim T, Caruso D, Locati LD, Orlandi E, Bossi P, Mainardi L, Licitra LF. Prognostic role of pre-treatment magnetic resonance imaging (MRI)-based radiomic analysis in effectively cured head and neck squamous cell carcinoma (HNSCC) patients. Acta Oncol 2021; 60:1192-1200. [PMID: 34038324 DOI: 10.1080/0284186x.2021.1924401] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To identify and validate baseline magnetic resonance imaging (b-MRI) radiomic features (RFs) as predictors of disease outcomes in effectively cured head and neck squamous cell carcinoma (HNSCC) patients. MATERIALS AND METHODS Training set (TS) and validation set (VS) were retrieved from preexisting datasets (HETeCo and BD2Decide trials, respectively). Only patients with both pre- and post-contrast enhancement T1 and T2-weighted b-MRI and at least 2 years of follow-up (FUP) were selected. The combination of the best extracted RFs was used to classify low risk (LR) vs. high risk (HR) of disease recurrence. Sensitivity, specificity, and area under the curve (AUC) of the radiomic model were computed on both TS and VS. Overall survival (OS) and 5-year disease-free survival (DFS) Kaplan-Meier (KM) curves were compared for LR vs. HR. The radiomic-based risk class was used in a multivariate Cox model, including well-established clinical prognostic factors (TNM, sub-site, human papillomavirus [HPV]). RESULTS In total, 57 patients of TS and 137 of VS were included. Three RFs were selected for the signature. Sensitivity of recurrence risk classifier was 0.82 and 0.77, specificity 0.78 and 0.81, AUC 0.83 and 0.78 for TS and VS, respectively. VS KM curves for LR vs. HR groups significantly differed both for 5-year DFS (p<.0001) and OS (p=.0004). A combined model of RFs plus TNM improved prognostic performance as compared to TNM alone, both for VS 5-year DFS (C-index: 0.76 vs. 0.60) and OS (C-index: 0.74 vs. 0.64). CONCLUSIONS Radiomics of b-MRI can help to predict recurrence and survival outcomes in HNSCC.
Collapse
Affiliation(s)
- Salvatore Alfieri
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Rebecca Romanò
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Marco Bologna
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Giuseppina Calareso
- Radiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Valentina Corino
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Aurora Mirabile
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Ferri
- Department of Surgery, Maxillo-Facial Surgery Division, University Hospital of Parma, Parma, Italy
| | - Luca Bellanti
- Department of Surgery, Maxillo-Facial Surgery Division, University Hospital of Parma, Parma, Italy
| | - Tito Poli
- Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T.), Unit of Maxillo-Facial Surgery, University of Parma, Parma, Italy
| | | | - Enrica Grosso
- Division of Head and Neck Surgery, Istituto Europeo di Oncologia (IEO), Milan, Italy
| | - Achille Tarsitano
- Department of Biomedical and Neuromotor Sciences, Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Salvatore Battaglia
- Department of Biomedical and Neuromotor Sciences, Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fulvia Blengio
- Medical Oncology Department, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Iolanda De Martino
- Medical Oncology Department, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sara Valerini
- Neuroscience Head and Neck Department, Otolaryngology Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Stefania Vecchio
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonella Richetti
- Radiation Oncology Clinic Oncology, Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Switzerland
| | - Letizia Deantonio
- Radiation Oncology Clinic Oncology, Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Switzerland
| | - Francesco Martucci
- Radiation Oncology Clinic Oncology, Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Switzerland
| | - Alberto Grammatica
- Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Unit of Radiology, University of Brescia, Brescia, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Damiano Caruso
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Laura Deborah Locati
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Ester Orlandi
- Radiotherapy Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public, Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Luca Mainardi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Lisa F. Licitra
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
- University of Milan, Milan, Italy
| |
Collapse
|
4
|
Blackmer J, Amoline K, Amancher J, Vogan E, Zimmer H, Borton M, Earl M, Boyd A. Leveraging advanced preparation of oncology medications: Decreasing turnaround-times in an outpatient infusion center. J Oncol Pharm Pract 2020; 27:1454-1460. [PMID: 32970518 DOI: 10.1177/1078155220960222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Many oncology infusions are provided in hospital-based infusion centers. With hospital-based infusion centers seeing increased volumes, patient wait times continue to be a priority. Extended wait times for oncology infusions have been shown to lead to patient dissatisfaction. METHODS Advanced Preparation of oncology infusion medications allows pharmacy to verify and prepare specific medications the day before a patient's infusion appointment. Our study targeted lower cost, commonly used medications to prepare in advance. Data analyzed included turnaround time (TAT), medication waste, and oncology infusion preparation volumes. Implementation took place in two phases to allow time for the healthcare team to adjust to the new workflow. Phase I medications include a small amount of medications prepared manually by pharmacy technicians. Phase II medications included all phase I medications plus additional medications that were compounded in the intravenous (IV) robotic compounding system. RESULTS Our study demonstrated significant decrease in median TAT for medications prepared in advance. 537 infusions were prepared using the Advanced Preparation module with a median TAT of 24.2 minutes (IQR, 18.0-34.0). The pre-implementation median TAT was 45.0 minutes (IQR, 36.0-56.0), which represents a decrease of 20.8 minutes (46.2%) following implementation of the program, (p<0.001). There were a total of 149 advanced preparation doses that were wasted (21.7% of doses). CONCLUSION We have seen a statistically significant reduction in TAT for Advanced Preparation medications. Low volume of Advanced Preparation medications compared to total infusion volume limited impact on overall TAT.
Collapse
|
5
|
Imbimbo M, Alfieri S, Botta L, Bergamini C, Gloghini A, Calareso G, Orlandi E, Iacovelli NA, Guzzo M, Granata R, Resteghini C, Locati L, Volpi CC, Licitra L, Bossi P. Surveillance of Patients with Head and Neck Cancer with an Intensive Clinical and Radiologic Follow-up. Otolaryngol Head Neck Surg 2019; 161:635-642. [PMID: 31286827 DOI: 10.1177/0194599819860808] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE There is no consensus on the follow-up modalities in patients with head and neck cancer. This study aims to describe the pattern and survival outcomes of recurrences/second primary cancers in patients undergoing an intensive radiologic and clinical follow-up. STUDY DESIGN Retrospective analysis. SETTING Single academic tertiary care center. SUBJECTS AND METHODS All patients with stage III-IV head and neck cancer treated with chemoradiotherapy at our institution between 1998 and 2010 were retrospectively reviewed. Persistent/recurrent disease within 6 months since the curative treatment and second primary cancers outside the upper aerodigestive tract were excluded. Data were analyzed by descriptive statistics. Surveillance was planned every 3 months in the first year, then with increasing intervals till the fifth year. RESULTS A total of 326 patients were included. Out of all detected cancer recurrences (n = 106, 32%), 38 (36%) were locoregional, 44 (41%) were distant, and 24 (23%) were second primary cancers. Approximately 70% of recurrences were clinically and/or radiologically discovered, while 30% were diagnosed due to the patients' symptoms. Of all clinically and/or radiologically discovered recurrences/second primary cancers (n = 74), 26 (35%) were curatively treated, with respect to 9 of the 32 (28%) diagnosed by symptoms. Median overall survival of recurrent curable cases did not significantly differ according to the detection modality (89 months by clinical/radiologic examination vs 85 by symptoms). CONCLUSIONS Clinical and radiologic follow-up identified more recurrences/second primary cancers than the symptom-driven monitoring, but the curability of cancer recurrence was similar regardless of detection modality. Prospective trials are needed to define the most effective follow-up strategy in head and neck cancer.
Collapse
Affiliation(s)
- Martina Imbimbo
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Alfieri
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Botta
- Evaluative Epidemiology, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristiana Bergamini
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annunziata Gloghini
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppina Calareso
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ester Orlandi
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Marco Guzzo
- Head and Neck Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Granata
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Resteghini
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Locati
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Costanza Volpi
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | - Paolo Bossi
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
6
|
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.
Collapse
Affiliation(s)
| | | | - Nora Horick
- 1 Massachusetts General Hospital, Boston, MA
| | - Yvonne Lei
- 1 Massachusetts General Hospital, Boston, MA
| | | | | | | | | |
Collapse
|
7
|
Reyes C, Engel-Nitz NM, DaCosta Byfield S, Ravelo A, Ogale S, Bancroft T, Anderson A, Chen M, Matasar M. Cost of Disease Progression in Patients with Metastatic Breast, Lung, and Colorectal Cancer. Oncologist 2019; 24:1209-1218. [PMID: 30796156 DOI: 10.1634/theoncologist.2018-0018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/08/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION To reduce health care costs and improve care, payers and physician groups are piloting value-based and episodic or bundled-care payment models in oncology. Disease progression and associated costs may affect these models, particularly if such programs do not account for disease severity and progression risk across patient populations. This study estimated the incremental cost of disease progression in patients diagnosed with metastatic breast cancer (mBC), colorectal cancer (mCRC) and lung cancer (mLC) and compared costs among patients with and without progression. METHODS This was a retrospective study using U.S. administrative claims data from commercial and Medicare Advantage health care enrollees with evidence of mBC, mCRC, and mLC and systemic antineoplastic agent use from July 1, 2006, to August 31, 2014. Outcome measures included disease progression, 12-month health care costs, and 3-year cumulative predictive health care costs. RESULTS Of 5,709 patients with mBC, 3,707 patients with mCRC, and 5,201 patients with mLC, 56.8% of patients with mBC, 58.1% of those with mCRC, and 80.3% of those with mLC patients had evidence of disease progression over 12 months. Among patients with mBC and mCRC, adjusted and unadjusted health care costs were significantly higher among progressors versus nonprogressors. Per-patient-per-month costs, which accounted for variable follow-up time, were almost twice as high among progressors versus nonprogressors in patients with mBC, mCRC, and mLC. In each of the three cancer types, delays in progression were associated with lower health care costs. CONCLUSION Progression of mLC, mBC, and mCRC was associated with higher health care costs over a 12-month period. Delayed cancer progression was associated with substantial cost reductions in patients with each of the three cancer types. IMPLICATIONS FOR PRACTICE Data on the rates and incremental health care costs of disease progression in patients with solid tumor cancers are lacking. This study estimated the incremental costs of disease progression in patients diagnosed with lung cancer, breast cancer, and colorectal cancer and compared health care costs in patients with and without evidence of disease progression in a real-world population. The data obtained in our study quantify the economic value of delaying or preventing disease progression and may inform payers and physician groups about value-based payment programs.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - May Chen
- South Bay Oncology Hematology, San Jose, California, USA
| | - Matthew Matasar
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
8
|
Al-Mansour Z, Pang L, Bathini V. Novel Cancer Therapeutics in Geriatrics: What is Unique to the Aging Patient? Drugs Aging 2019; 36:1-11. [PMID: 30478744 DOI: 10.1007/s40266-018-0619-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
With the worldwide trend of aging populations, the number of older adults who develop and survive cancer is likely to increase. In the last decade, oncology drug development has shifted away from conventional chemotherapeutics towards agents that can 'target' a driver mutation of a specific cancer or 'unleash' the patient's native immune system to attack the cancer-so-called molecularly targeted therapies and immunotherapeutics. The basic algorithms of cancer treatment in elderly patients are essentially the same as in younger patients; however, one needs to pay exceptional attention to the effects of co-morbidities, interaction with other drugs, and the organ function reserve of an older individual before determining his/her 'eligibility' for a specific cancer treatment modality. Despite the growing evidence of safety and effectiveness of combination chemotherapy in fit elderly patients, the data are still lacking concerning the use of currently approved targeted agents and immunotherapies. The current evidence, though limited, suggests reasonable tolerability with comparable efficacy in patients > 65 years old treated with immune-based therapies to that in younger controls; however, it is unclear if this leads to significant patient-relevant gains such as improved survival with an acceptable quality of life. Nonetheless, these newer agents remain better tolerated than cytotoxic chemotherapy in clinical practice, particularly in older patients. Alternatively, a personalized approach for elderly patients with consideration of the incidence and management of adverse effects, as well as strategies for optimizing efficacy in the context of an aging immune system, would be of utmost value in our aging cancer population. Future trials should also explore immune markers to predict response to these therapeutics in elderly patients, taking into consideration the effects of immunosenescence and immune modulation in aging hosts.
Collapse
Affiliation(s)
- Zeina Al-Mansour
- Division of Hematology/Oncology, University of Massachusetts School of Medicine, Office #S5-726, 55 Lake Ave N, Worcester, MA, 01655, USA.
| | - Linda Pang
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Venu Bathini
- University of Massachusetts School of Medicine, Worcester, MA, USA
| |
Collapse
|
9
|
Signorelli C, Wakefield CE, Fardell JE, Foreman T, Johnston KA, Emery J, Thornton-Benko E, Girgis A, Lie HC, Cohn RJ. The Role of Primary Care Physicians in Childhood Cancer Survivorship Care: Multiperspective Interviews. Oncologist 2018; 24:710-719. [PMID: 30171066 DOI: 10.1634/theoncologist.2018-0103] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/16/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Primary care physicians (PCPs) are well placed to provide holistic care to survivors of childhood cancer and may relieve growing pressures on specialist-led follow-up. We evaluated PCPs' role and confidence in providing follow-up care to survivors of childhood cancer. SUBJECTS, MATERIALS, AND METHODS In Stage 1, survivors and parents (of young survivors) from 11 Australian and New Zealand hospitals completed interviews about their PCPs' role in their follow-up. Participants nominated their PCP for an interview for Stage 2. In Stage 2, PCPs completed interviews about their confidence and preparedness in delivering childhood cancer survivorship care. RESULTS Stage 1: One hundred twenty survivors (36% male, mean age: 25.6 years) and parents of young survivors (58% male survivors, survivors' mean age: 12.7 years) completed interviews. Few survivors (23%) and parents (10%) visited their PCP for cancer-related care and reported similar reasons for not seeking PCP-led follow-up including low confidence in PCPs (48%), low perceived PCP cancer knowledge (38%), and difficulty finding good/regular PCPs (31%). Participants indicated feeling "disconnected" from their PCP during their cancer treatment phase. Stage 2: Fifty-one PCPs (57% male, mean years practicing: 28.3) completed interviews. Fifty percent of PCPs reported feeling confident providing care to childhood cancer survivors. PCPs had high unmet information needs relating to survivors' late effects risks (94%) and preferred a highly prescriptive approach to improve their confidence delivering survivorship care. CONCLUSION Improved communication and greater PCP involvement during treatment/early survivorship may help overcome survivors' and parents' low confidence in PCPs. PCPs are willing but require clear guidance from tertiary providers. IMPLICATIONS FOR PRACTICE Childhood cancer survivors and their parents have low confidence in primary care physicians' ability to manage their survivorship care. Encouraging engagement in primary care is important to promote holistic follow-up care, continuity of care, and long-term surveillance. Survivors'/parents' confidence in physicians may be improved by better involving primary care physicians throughout treatment and early survivorship, and by introducing the concept of eventual transition to adult and primary services. Although physicians are willing to deliver childhood cancer survivorship care, their confidence in doing so may be improved through better communication with tertiary services and more appropriate training.
Collapse
Affiliation(s)
- Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's & Children's Health, UNSW Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's & Children's Health, UNSW Sydney, New South Wales, Australia
| | - Joanna E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's & Children's Health, UNSW Sydney, New South Wales, Australia
| | - Tali Foreman
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's & Children's Health, UNSW Sydney, New South Wales, Australia
| | - Karen A Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's & Children's Health, UNSW Sydney, New South Wales, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victorian Comprehensive Cancer Centre, Victoria, Australia
| | - Elysia Thornton-Benko
- Bondi Road Doctors, Bondi Junction, New South Wales, Australia
- Wellac Lifestyle: Wellness After, And during Cancer, New South Wales, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia
| | - Hanne C Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
- Department of Paediatric Medicine, Children's and Adolescents Division, Oslo University Hospital, Norway
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's & Children's Health, UNSW Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Proportion of patients with cancer among high-cost Medicare beneficiaries: Who they are and what drives their spending. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2018; 6:46-51. [PMID: 29398469 DOI: 10.1016/j.hjdsi.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/11/2017] [Accepted: 01/16/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND A small proportion of patients account for the majority of health care spending. Of this group, little is known about what proportion have a cancer diagnosis and how their spending pattern compares to those without cancer. METHODS Using national Medicare data of enrollees 65 or older, we identified patients in the top decile of spending in 2014 and designated them as high-cost. We used ICD-9 codes to identify patients with a cancer diagnosis and examined cancer prevalence among both high-cost and non-high-cost patients. We examined patterns of spending for high-cost patients with and without cancer. RESULTS While 14.8% of all Medicare beneficiaries have a cancer diagnosis, we found that the prevalence of a cancer diagnosis was much higher among high-cost patients (32.5% versus 12.9% of non-high-cost patients). Thus, having a cancer diagnosis was associated with a 3.1 times greater odds of being high-cost, even after accounting for age (odds ratio 3.09, 95% CI 3.07-3.11; P < 0.001). High-cost patients with cancer had higher total annual spending than high-cost patients without cancer ($66,685 vs. $59,427; p < 0.0001); costs among high-cost cancer patients were driven by greater use of outpatient treatments (19.2% of total spending vs. 13.6% among non-cancer high-cost patients, p < 0.0001) and more prescription drugs (11.9% vs. 9.9%; p < 0.0001). CONCLUSIONS There is a high prevalence of cancer diagnoses among high-cost Medicare patients. IMPLICATIONS Programs that target high-cost patients may need to customize interventions based on whether the patient has a cancer diagnosis.
Collapse
|
11
|
The rationale, design, and methods of a randomized, controlled trial to evaluate the effectiveness of collaborative telecare in preserving function among patients with late stage cancer and hematologic conditions. Contemp Clin Trials 2017; 64:254-264. [PMID: 28887068 DOI: 10.1016/j.cct.2017.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/18/2017] [Accepted: 08/24/2017] [Indexed: 12/21/2022]
Abstract
Disablement affects over 40% of patients with advanced stage cancer, devastates their quality of life (QoL), and increases their healthcare costs. Proactively treating the causes of disablement; physical impairments, pain, and immobility, can prolong functional independence, improve QoL and, potentially, reduce utilization. However rehabilitation service delivery models are reactive in nature and focus on catastrophic rather than incipient disability. A validated collaborative approach, the Three Component Model (TCM), optimizes important clinical outcomes and may provide an ideal framework to overcome barriers to proactively integrating rehabilitation into cancer care. A novel expansion of the TCM that targets disablement by engaging local physical therapists to address physical impairments and immobility, the TCM-Rehabilitation Services (TCM-RS), benefits and is well received by patients. However, its effectiveness has not been rigorously assessed. The 3-arm randomized COllaborative Care to Preserve PErformance in Cancer (COPE) Trial compared: 1) enhanced usual care, 2) rehabilitation services targeting physical impairments and immobility via the TCM-RS, and 3) TCM-RS plus conventional TCM pain management TCM-RS+Pain. Of the 516 participants, those randomized to arms 2 and 3 underwent an initial 4-week intervention period and were then followed for 6months with remote monitoring and monthly telephone calls. The trial's primary outcome, functional status, and secondary outcomes were assessed at baseline, 3, and 6months. Utilization was abstracted from clinical records. By estimating the effectiveness and cost-utility implications of the TCM-RS and TCM-RS+Pain, COPE will inform future delivery research, practice and policy in the means to reduce disablement in chronically diseased populations.
Collapse
|
12
|
Hoffmann RL, Klein SJ, Rosenzweig MQ. Creating Quality Online Materials for Specialty Nurse Practitioner Content: Filling a Need for the Graduate Nurse Practitioner. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:522-527. [PMID: 26781695 PMCID: PMC4949154 DOI: 10.1007/s13187-015-0980-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Nurse practitioners are entering specialized areas of practice immediately after graduation from nurse practitioner (NP) education and certification and are finding employment in specialized areas such as oncology. Rapidly achieving a knowledge base in this highly specialized area of medicine coupled with the stress of the new nurse practitioner role can lead to a very difficult orientation and transition period. There are several methods to provide specialized education to NPs during their orientation period. Unfortunately, limitations such as a lack of motivated mentors, limited opportunities to practice the desired skill set or a lack of structure in regards to curriculum quality, and the learning needs of the new nurse hinder the NP's transition to practice. In response to either inadequate or non-standardized orientation to the specialty role of the oncology NP (ONP), a web-enhanced educational tool, funded through the National Cancer Institute, was developed for use in the USA: Oncology Nurse Practitioner Web Education Resource (ONc-PoWER). The development of ONc-PoWER was based upon essential education for NPs new to cancer care, adult learning theory, Bloom's Taxonomy, and foundations of quality online education. The five interactive web-based modules provide specialized education for the nurse practitioner new to oncology along with an on-site mentor to assist the NP in applying the course content to clinical practice.
Collapse
Affiliation(s)
- Rosemary L Hoffmann
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Victoria Street, 336 Victoria Building, Pittsburgh, PA, 15261, USA.
| | - Sara Jo Klein
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Victoria Street, 336 Victoria Building, Pittsburgh, PA, 15261, USA
| | - Margaret Q Rosenzweig
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Victoria Street, 336 Victoria Building, Pittsburgh, PA, 15261, USA
| |
Collapse
|
13
|
Peters E, Anzeneder T, Jackisch C, Dimpfl T, Kunz G, Katalinic A, Waldmann A. The Treatment of Primary Breast Cancer in Older Women With Adjuvant Therapy: A Retrospective Analysis of Data From Over 3000 Patients From the PATH Biobank, With Two-Year Follow-up. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:577-84. [PMID: 26377529 DOI: 10.3238/arztebl.2015.0577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women in Germany. Mortality from breast cancer has declined over the past 15 years, but less so in women aged 70 or older than in younger women. The discrepancy might be explained by age-related differences in treatment. METHODS Data from the Patients' Tumor Bank of Hope (PATH) database of women who underwent adjuvant treatment for the treatment of an invasive primary tumor without distant metastases (year of diagnosis, 2006-2011) were retrospectively analyzed. The clinical and tumor-biological findings and treatment data over two years of follow-up were compared across three age groups (under age 50, ages 50 to 69, and ages 70 and up). Chi-square tests were carried out to reveal significant differences, and post-hoc multiple comparisons were performed with and without Bonferroni correction. Treatment data were adjusted for staging and grading and tested for age-dependence with logistic regression. RESULTS Follow-up data were available for 3257 (65% ) of 4981 women, of whom 61% were in the middle age group and 22% in the oldest. Compared to women aged 50 to 69, those aged 70 and up less commonly received breast-conserving treatment (68.8% vs. 86.4% ), chemotherapy (27.5% vs. 44.1% ), radiotherapy (81.8% vs. 92.4% ), and trastuzumab (52.9% vs. 79.3% ; p<0.001 for all differences). All differences remained significant after stastistical adjustment. CONCLUSION The cause of these age-related differences is unclear. It cannot be determined from these data whether concomitant disease, the older patients' individual decisions, or other factors were responsible for their not receiving treatment as often as the younger patients did.
Collapse
Affiliation(s)
- Elke Peters
- Institute of Social Medicine and Epidemiology, University Medical Center, Lübeck, PATH Biobank, Augsburg, Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Department of Obstetrics and Gynecology, Klinikum Kassel, Department of Obstetrics and Gynecology, St. Johannes Hospital, Dortmund, Institute for Cancer Epidemiology e.V., University of Lübeck
| | | | | | | | | | | | | |
Collapse
|
14
|
Saria MG, Courchesne N, Evangelista L, Carter J, MacManus DA, Gorman MK, Nyamathi AM, Phillips LR, Piccioni D, Kesari S, Maliski S. Cognitive dysfunction in patients with brain metastases: influences on caregiver resilience and coping. Support Care Cancer 2016; 25:1247-1256. [PMID: 27921222 PMCID: PMC10187463 DOI: 10.1007/s00520-016-3517-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Neurologic deficits that may be manifested as cognitive impairment contribute to the challenges faced by caregivers of patients with brain metastases. To better address their needs, we examined how caregivers respond to these challenges and explore the relationship between the patient's cognitive impairment and caregiver resilience and coping. METHODS We conducted a descriptive, cross-sectional study using self-reported data from 56 caregivers of patients with brain metastases. Study participants from a comprehensive cancer center were asked to complete a series of instruments that measured their perception of the patient's cognitive dysfunction (revised memory and behavior problems checklist, RMBC), their own personal resilience (Resilience Scale, RS), and their utilization of a broad range of coping responses (COPE inventory and Emotional-Approach Coping scale). RESULTS Caregivers reported that memory-related problems occurred more frequently in the patients they cared for compared to depression and disruptive behavior (mean scores 3.52 vs 2.34 vs. 1.32, respectively). Coping strategies most frequently used by caregivers were acceptance (3.28), planning (3.08), and positive reinterpretation and growth (2.95). Most caregivers scored moderate to high on the RS (77%). The coping strategy acceptance correlated significantly with the memory and disruptive behavior subscales of the RMBC. CONCLUSIONS Given the protective effect of problem-focused coping and the high rate of caregivers utilizing less effective coping strategies in instances of worsening cognitive dysfunction, healthcare professionals need to systematically assess the coping strategies of caregivers and deliver a more personalized approach to enhance effective coping among caregivers of patients with brain metastases.
Collapse
Affiliation(s)
- Marlon Garzo Saria
- School of Nursing, University of California, Los Angeles, Factor Bldg., 700 Tiverton Ave, Los Angeles, CA, 90095, USA. .,John Wayne Cancer Institute and Pacific Neuroscience Institute at Providence Saint John's Health Center, 2200 Santa Monica Boulevard, Santa Monica, CA, 90404, USA.
| | - Natasia Courchesne
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA
| | - Lorraine Evangelista
- Nursing Science, University of California, Irvine, 299E Berk Hall, Irvine, CA, 92697-3959, USA
| | - Joshua Carter
- Quintiles, 10 Waterview Boulevard, Parsippany, NJ, 07054, USA
| | - Daniel A MacManus
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA
| | - Mary Kay Gorman
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA
| | - Adeline M Nyamathi
- School of Nursing, University of California, Los Angeles, Factor Bldg., 700 Tiverton Ave, Los Angeles, CA, 90095, USA
| | - Linda R Phillips
- School of Nursing, University of California, Los Angeles, Factor Bldg., 700 Tiverton Ave, Los Angeles, CA, 90095, USA
| | - David Piccioni
- School of Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA
| | - Santosh Kesari
- John Wayne Cancer Institute and Pacific Neuroscience Institute at Providence Saint John's Health Center, 2200 Santa Monica Boulevard, Santa Monica, CA, 90404, USA
| | - Sally Maliski
- School of Nursing, University of California, Los Angeles, Factor Bldg., 700 Tiverton Ave, Los Angeles, CA, 90095, USA.,School of Nursing, University of Kansas Medical Center, Mail Stop 2029, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| |
Collapse
|
15
|
Chinese medicine for outcomes in colorectal cancer patients: A retrospective clinical study. Chin J Integr Med 2016; 23:648-653. [DOI: 10.1007/s11655-016-2581-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Indexed: 01/05/2023]
|
16
|
Dunbar A, Tai E, Nielsen DB, Shropshire S, Richardson LC. Preventing infections during cancer treatment: development of an interactive patient education website. Clin J Oncol Nurs 2016; 18:426-31. [PMID: 25095295 DOI: 10.1188/14.cjon.426-431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite advances in oncology care, infections from both community and healthcare settings remain a major cause of hospitalization and death among patients with cancer receiving chemotherapy. Neutropenia (low white blood cell count) is a common and potentially dangerous side effect in patients receiving chemotherapy treatments and may lead to higher risk of infection. Preventing infection during treatment can result in significant decreases in morbidity and mortality for patients with cancer. As part of the Centers for Disease Control and Prevention's (CDC's) Preventing Infections in Cancer Patients public health campaign, a public-private partnership was formed between the CDC Foundation and Amgen, Inc. The CDC's Division of Cancer Prevention and Control developed and launched an interactive website, www.PreventCancerInfections.org, designed for patients with cancer undergoing chemotherapy. The site encourages patients to complete a risk assessment for developing neutropenia during their treatment. After completing the assessment, patients receive information about how to lower the risk for infection and keep themselves healthy while receiving chemotherapy.
Collapse
Affiliation(s)
- Angela Dunbar
- Centers for Disease Control and Prevention (CDC) Foundation, Atlanta, GA
| | - Eric Tai
- Centers for Disease Control and Prevention (CDC) Foundation, Atlanta, GA
| | | | | | | |
Collapse
|
17
|
Nayir E, Ata A, Erdogdu S, Salman T, Sungur MA, Abalı H, Arican A. A snapshot of residents in medical oncology in Turkey: A Nationwide survey on profile and key problems. JOURNAL OF ONCOLOGICAL SCIENCES 2016. [DOI: 10.1016/j.jons.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
18
|
McFarland DC, Holland J, Holcombe RF. Inpatient Hematology-Oncology Rotation Is Associated With a Decreased Interest in Pursuing an Oncology Career Among Internal Medicine Residents. J Oncol Pract 2015; 11:289-95. [DOI: 10.1200/jop.2015.003798] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An inpatient hematology-oncology ward rotation does not lead to increased interest and, for some residents, may lead to decreased interest in the field.
Collapse
Affiliation(s)
- Daniel C. McFarland
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; and Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jimmie Holland
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; and Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Randall F. Holcombe
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; and Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
19
|
Lamm MH, Eckel S, Daniels R, Amerine LB. Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times. Am J Health Syst Pharm 2015; 72:1138-46. [DOI: 10.2146/ajhp140453] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Matthew H. Lamm
- Department of Pharmacy, University of North Carolina (UNC) Hospitals—Hillsborough Campus, Chapel Hill
| | - Stephen Eckel
- UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC, Chapel Hill
| | - Rowell Daniels
- UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC
| | - Lindsey B. Amerine
- Department of Pharmacy, UNC Hospitals, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC
| |
Collapse
|
20
|
Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers. J Cancer Surviv 2015; 10:96-102. [PMID: 26070279 DOI: 10.1007/s11764-015-0454-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/23/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Delivery of follow-up care to breast cancer survivors is an important public health issue due to their increasing number and the anticipated shortage of oncology providers. This study evaluated adherence to American Society of Clinical Oncology (ASCO)-recommended surveillance tests in a bi-ethnic cohort of long-term breast cancer survivors. METHODS Women (n = 298) in Arizona and Colorado who had previously participated in a population-based study of breast cancer were enrolled into a follow-up survey approximately 6 years post-diagnosis. ASCO-recommended surveillance (mammogram, clinical breast, and physical exam), other non-recommended tests (e.g. tumor markers, imaging scans), and patients' beliefs were compared by provider type using multivariate logistic regression. RESULTS No significant differences in patient self-report of physical exam or mammography prevalence by provider type was observed after adjustment for covariates. Receipt of surveillance tests not recommended by ASCO was higher among survivors who saw an oncologist (tumor marker tests: OR = 3.0, 95 % CI 1.5-5.8; and other blood tests: OR = 2.0, 95 % CI 1.1-3.5) as compared to those who routinely see a primary care physician. These observed differences persisted after adjustment for age, stage, lapse in insurance, education, or ethnicity. CONCLUSIONS Although overutilization of non-recommended tests was observed among women who saw an oncologist, the majority of breast cancer survivors received ASCO-recommended surveillance regardless of provider type. IMPLICATIONS FOR CANCER SURVIVORS Most breast cancer survivors receive recommended surveillance tests, whether their care is managed by a primary care physician or an oncologist, but some women receive unnecessary testing. Women should talk with their providers about tests recommended based on their past breast cancer diagnosis.
Collapse
|
21
|
Boekhout AH, Maunsell E, Pond GR, Julian JA, Coyle D, Levine MN, Grunfeld E. A survivorship care plan for breast cancer survivors: extended results of a randomized clinical trial. J Cancer Surviv 2015; 9:683-91. [PMID: 25896265 DOI: 10.1007/s11764-015-0443-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/18/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Prevailing wisdom suggests that implementation of a survivorship care plan (SCP) will address deficits in survivorship care planning and delivery for cancer patients. Here, we present 24-month results of a randomized clinical trial on health service and patient-reported outcomes among breast cancer patients transferred to their primary care physician for follow-up care. The 24-month assessments represent the long-term benefit and sustainability of the implantation of a SCP. METHODS In all, 408 patients with early-stage breast cancer were randomized to the SCP or control group. Patient self-completed questionnaires, supplemented with telephone interviews, during the 24-month study period assessed health service and patient-reported outcomes. The primary outcome was cancer-specific distress. Secondary outcomes included health-related quality of life, patient satisfaction, continuity and coordination of care, and health service outcomes such as adherence to guidelines. RESULTS Over the course of 24 months, there were no differences between both groups in health service and patient-reported outcomes. Women from Quebec compared to those from Western Canada (p < 0.001), women within 2 years of completion of primary treatment compared to a longer period (p = 0.013), and those with a higher SF-36 mental component score compared to a lower score (p = 0.044) were positively associated with adherence to guidelines. CONCLUSION The implementation of a SCP in the transition of survivorship care from cancer center to primary care did not contribute to improved health service or patient-reported outcomes in this study population. Therefore, additional research is needed before widespread implementation of a SCP in clinical practice. IMPLICATIONS OF CANCER SURVIVORS The transition of survivorship care from cancer center to the primary care setting showed no negative effect on health service and patient-reported outcomes.
Collapse
Affiliation(s)
- Annelies H Boekhout
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. .,Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Elizabeth Maunsell
- Center de Recherché du CHU de Québec, Québec, Québec, Canada.,Département de Médecine Sociale et Préventive, Université Laval, Québec, Québec, Canada
| | - Gregory R Pond
- Ontario Clinical Oncology Group, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jim A Julian
- Ontario Clinical Oncology Group, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Doug Coyle
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark N Levine
- Ontario Clinical Oncology Group, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | |
Collapse
|
22
|
Shen MJ, Binz-Scharf M, D'Agostino T, Blakeney N, Weiss E, Michaels M, Patel S, McKee MD, Bylund CL. A mixed-methods examination of communication between oncologists and primary care providers among primary care physicians in underserved communities. Cancer 2014; 121:908-15. [PMID: 25377382 DOI: 10.1002/cncr.29131] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 09/16/2014] [Accepted: 10/10/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Research has demonstrated that communication and care coordination improve cancer patient outcomes. To improve communication and care coordination, it is important to understand primary care providers' (PCPs') perceptions of communication with oncologists as well as PCPs' communication needs. METHODS A mixed-methods approach was used in the present study. In the qualitative phase of the study, 18 PCPs practicing in underserved, minority communities were interviewed about their experiences communicating with oncologists. In the quantitative phase of the study, 128 PCPs completed an online survey about their preferences, experiences, and satisfaction with communication with oncologists. RESULTS Results indicated a PCP-oncologist gap in communication occurred between diagnosis and treatment. PCPs wanted more communication with oncologists, updates on their patients' prognosis throughout treatment, and to be contacted via telephone or email and saw their role as crucial in providing supportive care for their patients. CONCLUSIONS Although PCPs recognize that they play a critical, proactive role in supporting patients throughout the continuum of their cancer care experience, existing norms regarding postreferral engagement and oncologist-PCP communication often hinder activation of this role among PCPs. Expected standards regarding the method, frequency, and quality of postreferral communication should be jointly articulated and made accountable between PCPs and oncologists to help improve cancer patients' quality of care, particularly in minority communities.
Collapse
Affiliation(s)
- Megan Johnson Shen
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Ben-Ami E, Merom H, Sikron F, Livneh J, Sadetzki S, Wolf I. Involvement of the family physician in the care of chemotherapy-treated patients with cancer: patients' perspectives. J Oncol Pract 2014; 10:298-305. [PMID: 24781366 DOI: 10.1200/jop.2013.001182] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Increasing numbers of patients receive active ambulatory oncology treatment over prolonged periods of time. Many of these patients suffer from additional comorbidities and require comprehensive medical care. We aimed to assess the perception of patients with cancer regarding the role of the family physician and the oncologist in their care during times of active cancer treatment. PATIENTS AND METHODS A survey was conducted among 265 consecutive chemotherapy-treated patients at the daycare oncology clinic. RESULTS All the patients were affiliated with one of four Israeli health maintenance organizations, 96% had a regular family physician, and 70% had met with him during the preceding month. Only one third of the patients thought their family physician was trained to or was willing to treat medical problems that occurred during chemotherapy treatment. Yet most patients, irrespective of clinical or socioeconomic variables, stated that involvement of the family physician was important to them. Only 30% stated that the oncologist communicated with the family physician. Accordingly, 72% of the patients stated that in the case of an urgent problem they would turn first to the oncology clinic; only 9% would consult their family physician. CONCLUSIONS Our data point to a lack of communication between team members and inadequate medical training as major barriers for comprehensive medical care for chemotherapy-treated patients with cancer. Communication between treating teams may improve medical care for oncology patients with multiple treating practitioners.
Collapse
Affiliation(s)
- Eytan Ben-Ami
- Chaim Sheba Medical Center; Gertner Institute, Chaim Sheba Medical Center, Ramat Gan; Medical Corps, Israeli Defense Forces; Tel Aviv University; and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hadar Merom
- Chaim Sheba Medical Center; Gertner Institute, Chaim Sheba Medical Center, Ramat Gan; Medical Corps, Israeli Defense Forces; Tel Aviv University; and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Fabienne Sikron
- Chaim Sheba Medical Center; Gertner Institute, Chaim Sheba Medical Center, Ramat Gan; Medical Corps, Israeli Defense Forces; Tel Aviv University; and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jessica Livneh
- Chaim Sheba Medical Center; Gertner Institute, Chaim Sheba Medical Center, Ramat Gan; Medical Corps, Israeli Defense Forces; Tel Aviv University; and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Siegal Sadetzki
- Chaim Sheba Medical Center; Gertner Institute, Chaim Sheba Medical Center, Ramat Gan; Medical Corps, Israeli Defense Forces; Tel Aviv University; and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Chaim Sheba Medical Center; Gertner Institute, Chaim Sheba Medical Center, Ramat Gan; Medical Corps, Israeli Defense Forces; Tel Aviv University; and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
24
|
Waldmann A, Anzeneder T, Katalinic A. Patients and Methods of the PATH Biobank - A Resource for Breast Cancer Research. Geburtshilfe Frauenheilkd 2014; 74:361-369. [PMID: 25076793 DOI: 10.1055/s-0033-1360263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/21/2013] [Accepted: 11/19/2013] [Indexed: 12/29/2022] Open
Abstract
Introduction: The foundation PATH (Patients' Tumour Bank of Hope) collects in a tumour bank samples of blood, tumour, and tumour-near normal tissue from breast cancer patients and supplements them systematically with health-care data. Material and Methods: For patients from the diagnosis years 2006-2009 quantitative data were evaluated with the help of mean values and standard deviations while for qualitative data absolute and relative incidences were assessed. Demographic and clinical features of women who used different numbers of information sources were tested for statistical significance by means of ANOVA and χ2 tests. The benchmark report of the WBC and two DMP reports were used to compare oncological care. Results: For research purposes tumour tissue samples are available for 59 % of the cases, normal tissue for 62 % and blood serum samples for 92 %. From 3573 women (diagnoses 2006-2009), a total of 2697 women (75.5 %) took part in follow-up. The characteristics of the follow-up patients did not relevantly differ from those of all the patients. The responsible physician was named as the most important source of information about the disease. Young women in particular consulted several sources and also used the internet to obtain information. Discussion: Compared with data on therapy from WBC and the DMP breast cancer in Bavaria or, respectively, North Rhineland reports, the PATH patients represent an only slightly selected sample. The PATH biobank is a (still) poorly used data and sample source, which is made available upon request and positive evaluation of the study protocol. Thus, it is possible to address current questions in a short time without having to undertake extensive recruiting procedures.
Collapse
Affiliation(s)
- A Waldmann
- Institut für Sozialmedizin und Epidemiologie, Lübeck
| | | | - A Katalinic
- Institut für Sozialmedizin und Epidemiologie, Lübeck ; Institut für Krebsepidemiologie e. V., Lübeck
| |
Collapse
|
25
|
Nekhlyudov L, Aziz NM, Lerro C, Virgo KS. Oncologists' and primary care physicians' awareness of late and long-term effects of chemotherapy: implications for care of the growing population of survivors. J Oncol Pract 2014; 10:e29-36. [PMID: 24222054 PMCID: PMC3948708 DOI: 10.1200/jop.2013.001121] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The population of cancer survivors is large and growing. Yet after successful completion of treatment, many experience chemotherapy-related late or long-term effects (LEs). The extent to which physicians are aware of LEs is unknown. METHODS We conducted a nationally representative survey of 1,130 oncologists and 1,072 primary care providers (PCPs). Respondents were asked to select the LEs they had either observed or seen reported for five chemotherapy agents used to treat breast and colon cancers. We described and compared oncologists' and PCPs' awareness of the specified LEs. Using multivariate logistic regression models, we determined predictors of physicians' awareness of the main LEs associated with the agents. RESULTS Almost all oncologists (95%) reported awareness of cardiac dysfunction as an LE of doxorubicin and peripheral neuropathy as an LE of paclitaxel (97%) and oxaliplatin (97%). These LEs were reported by 55%, 27%, and 22% of PCPs, respectively. Most oncologists reported awareness of premature menopause (71%) and secondary malignancies (62%) as LEs of cyclophosphamide, compared with only 15% and 17% of PCPs, respectively. Main LEs associated with all four agents were identified by 65% of oncologists and only 6% of PCPs. CONCLUSION Although more than half of PCPs were aware of cardiac dysfunction as an LE of doxorubicin, awareness of other LEs was limited. Because PCPs may not be directly exposed to chemotherapy-related LEs, oncologists must communicate this information to PCPs as patients transition to primary care settings. Education for all providers caring for the growing population of cancer survivors is needed.
Collapse
Affiliation(s)
- Larissa Nekhlyudov
- Harvard Medical School and Harvard Vanguard Medical Associates, Boston MA; National Institute of Nursing Research, Bethesda, MD; Yale University School of Public Health, New Haven, CT; and Rollins School of Public Health, Emory University, Atlanta, GA
| | - Noreen M. Aziz
- Harvard Medical School and Harvard Vanguard Medical Associates, Boston MA; National Institute of Nursing Research, Bethesda, MD; Yale University School of Public Health, New Haven, CT; and Rollins School of Public Health, Emory University, Atlanta, GA
| | - Catherine Lerro
- Harvard Medical School and Harvard Vanguard Medical Associates, Boston MA; National Institute of Nursing Research, Bethesda, MD; Yale University School of Public Health, New Haven, CT; and Rollins School of Public Health, Emory University, Atlanta, GA
| | - Katherine S. Virgo
- Harvard Medical School and Harvard Vanguard Medical Associates, Boston MA; National Institute of Nursing Research, Bethesda, MD; Yale University School of Public Health, New Haven, CT; and Rollins School of Public Health, Emory University, Atlanta, GA
| |
Collapse
|
26
|
Friese CR, Martinez KA, Abrahamse P, Hamilton AS, Graff JJ, Jagsi R, Griggs JJ, Hawley ST, Katz SJ. Providers of follow-up care in a population-based sample of breast cancer survivors. Breast Cancer Res Treat 2014; 144:179-84. [PMID: 24481682 DOI: 10.1007/s10549-014-2851-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
To describe which providers provide breast cancer survivorship care, we conducted a longitudinal survey of nonmetastatic breast cancer patients identified by the SEER registries of Los Angeles and Detroit. Multinomial logistic regression examined the adjusted odds of surgeon compared with a medical oncologist follow-up or primary care provider compared with medical oncologist follow-up, adjusting for age, race/ethnicity, insurance, tumor stage, receipt of chemotherapy, endocrine therapy use, and visit to a medical oncologist at the time of diagnosis. Results were weighted to account for sample selection and nonresponse. 844 women had invasive disease and received chemotherapy or endocrine therapy. 65.2 % reported medical oncologists as their main care provider at 4 years, followed by PCP/other physicians (24.3 %) and surgeons (10.5 %). Black women were more likely to receive their follow-up care from surgeons (OR 2.47, 95 % CI 1.16-5.27) or PCP/other physicians (OR 2.62, 95 % CI 1.47-4.65) than medical oncologists. Latinas were more likely to report PCP/other physician follow-up than medical oncologists (OR 2.33, 95 % CI 1.15-4.73). Compared with privately insured women, Medicaid recipients were more likely to report PCP/other physician follow-up (OR 2.52, 95 % CI 1.24-5.15). Women taking endocrine therapy 4 years after diagnosis were less likely to report surgeons or PCP/other physicians as their primary provider of breast cancer follow-up care. Different survivorship care patterns emerge on race/ethnicity and insurance status. Interventions are needed to inform patients and providers on the recommended sources of breast cancer follow-up.
Collapse
Affiliation(s)
- Christopher R Friese
- School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA,
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
de Azambuja E, Ameye L, Paesmans M, Zielinski CC, Piccart-Gebhart M, Preusser M. The landscape of medical oncology in Europe by 2020. Ann Oncol 2014; 25:525-8. [PMID: 24425791 DOI: 10.1093/annonc/mdt559] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the United States, there will be a shortage of medical oncologists (MO) by 2020. However, this information is not available for Europe. The aim of this study was to assess the current number of MO in the 27 European Union (27-EU) countries and to predict their availability by 2020. MATERIAL AND METHODS Between June 2012 and January 2013, a survey was submitted to health authorities, medical oncology societies, and personal contacts in all 27-EU countries in order to gather annual data on the number of practicing MO. Data were collected by e-mail, telephone contact, or through research on official websites. Data regarding cancer incidence in 2008 and projections for 2015 and 2020 were obtained through Globocan. The mean annual increase in the number of MO was calculated for each country. The total number of MO by 2015 and 2020 was estimated, and the ratio of new cancer cases versus number of MO was calculated for 2008, 2015, and 2020. RESULTS Twelve countries provided sufficient data. The average mean annual increase in the total number of MO was 5.3% (range 1.8%-8.7%), with Belgium being the lowest and UK the highest. The 2008 ratio of cancer cases versus MO was lowest in Hungary (113) and highest in UK (1067). A favorable decrease in this ratio was estimated in most countries. CONCLUSION Our estimates, based on incidence and not on prevalence, indicate that MO availability will probably meet the projected need in most of the 12 countries analyzed, provided that: (i) these countries maintain their rate of annual increase in MO; and (ii) no unforeseen changes occur in cancer incidence. Unfortunately, minimal information is available for Eastern Europe. Our data call for the prospective surveillance of the cancer burden and MO availability to ensure adequate and equal care for cancer patients throughout Europe.
Collapse
Affiliation(s)
- E de Azambuja
- Medical Oncology Clinic and BrEAST Data Center, Jules Bordet Institute, Brussels
| | | | | | | | | | | |
Collapse
|
28
|
Salz T, McCabe MS, Onstad EE, Baxi SS, Deming RL, Franco RA, Glenn LA, Harper GR, Jumonville AJ, Payne RM, Peters EA, Salner AL, Schallenkamp JM, Williams SR, Yiee K, Oeffinger KC. Survivorship care plans: is there buy-in from community oncology providers? Cancer 2013; 120:722-30. [PMID: 24327371 DOI: 10.1002/cncr.28472] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/16/2013] [Accepted: 09/13/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Institute of Medicine recommended that survivors of cancer and their primary care providers receive survivorship care plans (SCPs) to summarize cancer treatment and plan ongoing care. However, the use of SCPs remains limited. METHODS Oncology providers at 14 National Cancer Institute Community Cancer Centers Program hospitals completed a survey regarding their perceptions of SCPs, including barriers to implementation, strategies for implementation, the role of oncology providers, and the importance of topics in SCPs (diagnosis, treatment, recommended ongoing care, and the aspects of ongoing care that the oncology practice will provide). RESULTS Among 245 providers (response rate of 70%), 52% reported ever providing any component of an SCP to patients. The most widely reported barriers were lack of personnel and time to create SCPs (69% and 64% of respondents, respectively). The most widely endorsed strategy among those using SCPs was the use of a template with prespecified fields; 94% of those who used templates found them helpful. For each topic of an SCP, although 87% to 89% of oncology providers believed it was very important for primary care providers to receive the information, only 58% to 65% of respondents believed it was very important for patients to receive the information. Furthermore, 33% to 38% of respondents reported mixed feelings regarding whether it was the responsibility of oncology providers to provide SCPs. CONCLUSIONS Practices need additional resources to overcome barriers to implementing SCPs. We found resistance toward SCPs, particularly the perceived value for the survivor and the idea that oncology providers are responsible for SCP dissemination.
Collapse
Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Fracasso PM, Goodner SA, Creekmore AN, Morgan HP, Foster DM, Hardmon AA, Engel SJ, Springer BC, Mathews KJ, Fisher EB, Walker MS. Coaching intervention as a strategy for minority recruitment to cancer clinical trials. J Oncol Pract 2013; 9:294-9. [PMID: 24130255 PMCID: PMC3825290 DOI: 10.1200/jop.2013.000982] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lack of trust and rapport with health care providers has been identified in the under-representation of racial/ethnic minorities within clinical trials. Our study used a coach to promote trust among minority patients with advanced cancer. PATIENTS AND METHODS Minority patients with advanced breast, colorectal, lung, or prostate carcinoma were randomly assigned to receive a coach Intervention (CI) or usual care (UC). All patients completed baseline and 6-month telephone interviews to assess demographics, trust in health care providers, attitudes toward clinical trials, and quality of life. Patients randomly assigned to CI were assigned a coach, who made biweekly contacts for 6 months to address general issues, progress or development in cancer care, and available resources. Patients randomly assigned to UC received the standard of care, without this intervention. Clinical trial enrollment was assessed. RESULTS Over 21 months, we screened 268 patients and enrolled 73 African Americans and two Asian Americans. Patients were randomly assigned to CI (n = 38) or to UC (n = 37). Longitudinal analyses were conducted on 69 patients who completed the 6-month follow-up assessment. Trial enrollment was 16 and 13 patients for the CI and UC groups, respectively. This difference was not significant (P = .351). Higher quality of life (1-point odds ratio on Functional Assessment of Cancer Treatment-General = 1.033, P = .036) and positive attitudes toward trials predicted enrollment. There was no significant difference between these groups in quality of life, attitudes toward clinical trials, perceptions of racism, trust in doctors, or depression. CONCLUSIONS Quality of life and positive attitude toward trials predicted trial enrollment, regardless of assignment to CI or UC.
Collapse
Affiliation(s)
- Paula M. Fracasso
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Sherry A. Goodner
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Allison N. Creekmore
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Helen P. Morgan
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Denise M. Foster
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Angela A. Hardmon
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Seth J. Engel
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Brian C. Springer
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Katherine J. Mathews
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Edwin B. Fisher
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Mark S. Walker
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| |
Collapse
|
30
|
Abstract
PURPOSE To investigate the impact of the involvement of primary care physicians (PCPs) on the receipt of preventive follow-up care after a breast cancer (BC) diagnosis among a low-income population. METHODS Multiple logistic regression analyses were performed to identify potential factors associated with receipt of preventive care among 579 low-income women with BC. The main outcome variables at 36 months after BC diagnosis were receipt of annual mammography, Papanicolaou smear in the past 2 years, and ever had colonoscopy for those who were at least 50 years old. The main independent variable was type of provider visit in the past 12 months. RESULTS Women with a PCP visit only or both PCP and surgeon/cancer specialist visits in the past 12 months were more likely to have had annual mammography (adjusted odds ratio [AOR], 2.67; P = .109 and AOR, 2.20, P = .0008, respectively), a Papanicolaou smear in the past 2 years (AOR, 2.90; P = .04 and AOR, 2.24, P = .009, respectively), and colonoscopy (AOR, 2.99; P = .041 and AOR, 2.17; P = .026, respectively) than those who only visited surgeons/cancer specialists. Indeed, women who saw only a PCP for their follow-up care had the highest odds ratio of receiving each clinical care service. CONCLUSIONS The involvement of PCPs in the medical care of low-income BC survivors results in better preventive follow-up care. Getting PCPs involved in the care of cancer survivors might be particularly pertinent for low-income populations because of lower costs and ease of access compared with cancer specialist-provided care.
Collapse
|
31
|
The Practice of Medical Oncology in Morocco: The National Study of the Moroccan Group of Trialist in Medical Oncology (EVA-Onco). ISRN ONCOLOGY 2013; 2013:341565. [PMID: 24223311 PMCID: PMC3817705 DOI: 10.1155/2013/341565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/02/2013] [Indexed: 11/20/2022]
Abstract
Objective. To determine the current shortfall of medical oncologists (MOs) and the projected supply. Background. Morocco, the medical oncology (MO) is a relatively new specialty. Medical oncology was recognized as a separate specialty in 1994 but the real taking-off was done only since the 2000s after the creation of the chair of medical oncology in the University of Rabat. The GRIOMM (Moroccan group of trialist in medical oncology) was created in 2011 and conducted its first study, EVA-onco, concerning the practice of medical oncology in Morocco in 2011. Design. EVA-onco is a prospective study concerning the practice of medical oncology in Morocco in 2011. Results. The entire public cancer centers completed the survey. There were no missing data. The number of medical oncologist per 100000/habitants in Morocco was 0.09. The average number of new patients seen per medical oncologist was 718 patients (ranging by state from 97 to 1875). The shortfall of MOs was estimated at 26 at least in 2011 according to the national recommendations. Conclusions. Since 2010, a national strategy to increase the capacity of MO workforce existed. The current shortfall of MO is expected to disappear in the future.
Collapse
|
32
|
Yu XQ, Clements M, O’Connell D. Projections of cancer prevalence by phase of care: a potential tool for planning future health service needs. J Cancer Surviv 2013; 7:641-51. [DOI: 10.1007/s11764-013-0303-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
|
33
|
Schulman KL, Berenson K, Tina Shih YC, Foley KA, Ganguli A, de Souza J, Yaghmour NA, Shteynshlyuger A. A checklist for ascertaining study cohorts in oncology health services research using secondary data: report of the ISPOR oncology good outcomes research practices working group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:655-669. [PMID: 23796301 DOI: 10.1016/j.jval.2013.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The ISPOR Oncology Special Interest Group formed a working group at the end of 2010 to develop standards for conducting oncology health services research using secondary data. The first mission of the group was to develop a checklist focused on issues specific to selection of a sample of oncology patients using a secondary data source. METHODS A systematic review of the published literature from 2006 to 2010 was conducted to characterize the use of secondary data sources in oncology and inform the leadership of the working group prior to the construction of the checklist. A draft checklist was subsequently presented to the ISPOR membership in 2011 with subsequent feedback from the larger Oncology Special Interest Group also incorporated into the final checklist. RESULTS The checklist includes six elements: identification of the cancer to be studied, selection of an appropriate data source, evaluation of the applicability of published algorithms, development of custom algorithms (if needed), validation of the custom algorithm, and reporting and discussions of the ascertainment criteria. The checklist was intended to be applicable to various types of secondary data sources, including cancer registries, claims databases, electronic medical records, and others. CONCLUSIONS This checklist makes two important contributions to oncology health services research. First, it can assist decision makers and reviewers in evaluating the quality of studies using secondary data. Second, it highlights methodological issues to be considered when researchers are constructing a study cohort from a secondary data source.
Collapse
|
34
|
Cheung WY, Aziz N, Noone AM, Rowland JH, Potosky AL, Ayanian JZ, Virgo KS, Ganz PA, Stefanek M, Earle CC. Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists. J Cancer Surviv 2013; 7:343-54. [PMID: 23526165 DOI: 10.1007/s11764-013-0281-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 03/08/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE New strategies for delivering cancer follow-up care are needed. We surveyed primary care providers (PCPs) and oncologists to assess how physician attitudes toward and self-efficacy with cancer follow-up affect preferences for different cancer survivorship models. METHODS The survey of physician attitudes regarding the care of cancer survivors was mailed to a randomly selected national sample of PCPs and oncologists to evaluate their perspectives regarding physician roles, knowledge about survivorship care processes, and views on cancer surveillance. Multinomial logistic regression models were constructed to examine how physician attitudes towards, and self-efficacy with, their own skills affected preferences for different cancer survivorship care models. RESULTS Of 3,434 physicians identified, a total of 2,026 participants provided eligible responses: 938 PCPs and 1,088 oncologists. Most PCPs (51 %) supported a PCP/shared care model; whereas, the majority of specialists (59 %) strongly endorsed an oncologist-based model (p < 0.001). Less than a quarter of PCPs and oncologists preferred specialized survivor clinics. A significant proportion of oncologists (87 %) did not feel that PCPs should take on the primary role of cancer follow-up. Most PCPs believed that they were better able to perform breast and colorectal cancer follow-up (57 %), detect recurrent cancers (74 %), and offer psychosocial support (50 %), but only a minority (32 %) was willing to assume primary responsibility. PCPs already involved with cancer surveillance (43 %) were more likely to prefer a PCP/shared care than oncologist-based survivorship model (OR, 2.08; 95 % CI, 1.34-3.23). CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS PCPs and oncologists have different preferences for models of cancer survivorship care. Prior involvement with cancer surveillance was one of the strongest predictors of PCPs' willingness to assume this responsibility.
Collapse
Affiliation(s)
- Winson Y Cheung
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Influenza vaccination among cancer survivors: disparities in prevalence between blacks and whites. J Cancer Surviv 2013; 7:183-90. [PMID: 23315210 DOI: 10.1007/s11764-012-0257-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/22/2012] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cancer survivors are at increased risk for influenza-related complications. Racial disparities in preventive health services have not been extensively studied among cancer survivors. Our objective is to compare influenza vaccination prevalence among black and white cancer survivors METHODS We performed a secondary data analysis of 41,346 white and black cancer survivors (excluding non-melanoma skin cancer) from the 2009 Behavioral Risk Factor Surveillance System survey. Respondents were asked whether they had received an influenza vaccination in the previous year. Multivariable logistic regression was used to estimate the odds of having influenza vaccine by race. RESULTS Sixty-five percent of whites reported receiving the vaccine in the last year compared to 50 % of blacks. Blacks had significantly lower odds of vaccination after controlling for covariates significantly associated with the odds of influenza vaccination. Higher education, having health insurance, having a primary care provider, and having a routine check-up in the last year increased the odds of receiving an influenza vaccine. CONCLUSIONS Our analysis supports that racial disparities in vaccine coverage persist among cancer survivors, a group strongly recommended to receive annual influenza vaccine, even when predictors significantly associated with increased vaccination are controlled for. IMPLICATIONS FOR CANCER SURVIVORS As a nationally representative survey with a large sample size, our study provides a picture of self-reported vaccine coverage among cancer survivors in the USA and the disparity that exists between blacks and whites in this population. Care teams can use these findings to better target follow-up care for cancer survivors.
Collapse
|
36
|
Shulman LN, Jacobs LA, Greenfield S, Jones B, McCabe MS, Syrjala K, Diller L, Shapiro CL, Marcus AC, Campbell M, Santacroce S, Kagawa-Singer M, Ganz PA. Cancer care and cancer survivorship care in the United States: will we be able to care for these patients in the future? J Oncol Pract 2013; 5:119-23. [PMID: 20856750 DOI: 10.1200/jop.0932001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2008] [Indexed: 11/20/2022] Open
Abstract
The combination of a shortfall in oncologists and primary care physicians and an increased number of patients using more health care resources raises concerns about our health care system's ability to accommodate future patients with cancer and cancer survivors.
Collapse
|
37
|
|
38
|
Rosenzweig M, Giblin J, Mickle M, Morse A, Sheehy P, Sommer V, Bridging The Gap Working Group. Bridging the gap: a descriptive study of knowledge and skill needs in the first year of oncology nurse practitioner practice. Oncol Nurs Forum 2012; 39:195-201. [PMID: 22374493 DOI: 10.1188/12.onf.195-201] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To identify the knowledge and skill needs of oncology nurse practitioners (ONPs) as they enter cancer care practice, and to identify necessary educational resources. DESIGN Cross-sectional, descriptive. SETTING A national e-mail survey. SAMPLE 610 self-described ONPs from the Oncology Nursing Society's database. METHODS The project team developed a 28-item electronic survey. The survey was randomly distributed via e-mail. MAIN RESEARCH VARIABLES ONPs' feelings of preparedness in the first year of ONP practice. FINDINGS In the first year of practice, 90% of ONPs rated themselves as prepared or very prepared in obtaining patient history, performing physical examination, and documenting findings. ONPs rated themselves as not at all or somewhat prepared in clinical issues of chemotherapy/biotherapy competency (n = 81, 78%), recognizing and managing oncologic emergencies, (n = 77, 70%), and recognizing and managing drug toxicities (n = 63, 61%). The primary source of oncology education for ONPs new to practice was almost exclusively the collaborating or supervising physician (n = 84, 81%). CONCLUSIONS Specific knowledge and skills, such as information about chemotherapy, oncologic emergencies, and side effects of therapy, are needed before an ONP enters a cancer care practice. IMPLICATIONS FOR NURSING Cancer-specific education should be made available to new ONPs as they begin independent practice.
Collapse
|
39
|
Gerber LH, Stout NL, Schmitz KH, Stricker CT. Integrating a prospective surveillance model for rehabilitation into breast cancer survivorship care. Cancer 2012; 118:2201-6. [PMID: 22488694 DOI: 10.1002/cncr.27472] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
At some point during or after treatment, breast cancer may be considered a chronic illness, presenting many choices for managing the disease, its adverse treatment-related effects, other medical comorbidities as well as the biobehavioral burden of having a life-threatening disease, even for individuals with potentially curable breast cancer. Health care models, such as the chronic care model, the medical home, and the shared care model, provide a context for building survivorship health care models. Goals and characteristics of recently proposed shared care models for cancer survivorship health care delivery closely align with the goals and concepts of the prospective surveillance model (PSM) proposed elsewhere in this supplement to the journal Cancer. Given these similarities, along with the growth and expansion of survivorship care models and impending mandates for delivery, there is merit to considering how implementation of the PSM can be integrated with models of survivorship care delivery. The PSM model will likely face many similar challenges and barriers that have impeded widespread dissemination of other survivorship models of care. There exist opportunities to integrate lessons learned as well as to align efforts to achieve greater impact on the shared goal of improving health outcomes for breast cancer survivors.
Collapse
Affiliation(s)
- Lynn H Gerber
- George Mason University, Center for Study of Chronic Illness and Disability, Fairfax, Virginia 22030, USA.
| | | | | | | |
Collapse
|
40
|
Becker K, Dörr W, Leiter-Stöppke U. [Cancer surveillance: A lot of effort with unclear benefits]. ONKOLOGIE 2012; 35 Suppl 2:8-12. [PMID: 22517065 DOI: 10.1159/000337700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Klaus Becker
- Onkologie Lerchenfeld, Onkologische Allianz Hamburg, Deutschland
| | | | | |
Collapse
|
41
|
Ortiz-Oshiro E, Sánchez-Egido I, Moreno-Sierra J, Pérez CF, Díaz JS, Fernández-Represa JÁ. Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery: systematic review and meta-analysis. Int J Med Robot 2012; 8:360-70. [PMID: 22438060 DOI: 10.1002/rcs.1426] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND We hypothesized that robotic assistance (RARS) could provide better intraoperative and short-term outcomes than a traditional laparoscopic approach (LARS) to rectal cancer surgery. METHODS Systematic review of the literature, including electronic searches and communications to international robotic meetings. INCLUSION CRITERIA studies involving rectal cancer patients and comparing outcomes of robotic surgery vs laparoscopic surgery. Primary end-points: conversion and postoperative short-term complications. Meta-analysis performed using Review Manager 5.0 software. RESULTS Five case-control studies involving 486 patients (203 RARS-283 LARS) were finally included. Conversion to open rate (RR = 0.31; 95% CI 0.12,0.78) was lower for RARS. No differences were found in oncological outcomes, hospital stay or anastomotic leakage. CONCLUSIONS This meta-analysis of available non-randomized studies suggests that conversion to open rate may be reduced when using RARS instead of LARS for rectal cancer.
Collapse
Affiliation(s)
- Elena Ortiz-Oshiro
- General and Digestive Surgery Department, Methodology and Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
42
|
Chubak J, Tuzzio L, Hsu C, Alfano CM, Rabin BA, Hornbrook MC, Spegman A, Von Worley A, Williams A, Nekhlyudov L. Providing care for cancer survivors in integrated health care delivery systems: practices, challenges, and research opportunities. J Oncol Pract 2012; 8:184-9. [PMID: 22942814 DOI: 10.1200/jop.2011.000312] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2011] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Optimal approaches to cancer survivorship care are needed. This study sought to identify practices, barriers, and research opportunities in meeting the care needs of cancer survivors in integrated health care delivery systems. METHODS This study was conducted at 10 sites within the Cancer Research Network, a National Cancer Institute-funded consortium of integrated health care delivery systems providing care for nearly 11 million enrollees. We identified 48 clinical leaders, administrators, and providers in oncology, primary care, nursing administration, and specialty care. Forty (83%) completed semi-structured, audio-recorded, transcribed telephone interviews, which we analyzed using an immersion-crystallization approach. RESULTS Respondents were aware of the needs of cancer survivors and the difficulties they face in transitioning from treatment to follow-up care. Respondents from all sites reported that oncology and primary care are jointly responsible for the care of cancer survivors, often through the use of electronic medical records. Many respondents were not familiar with standardized survivorship care plans. Only two sites had formal cancer survivorship programs in place, and two were developing such programs. Respondents at sites with and without programs acknowledged existing gaps in evidence on the effectiveness of formal survivorship care and expressed a desire for additional research. CONCLUSION Our exploratory study suggests an awareness of cancer survivorship care in integrated health care delivery systems, although approaches to providing such care vary across systems. These settings may offer a unique opportunity to develop, test, and implement innovative models of care, which can be systematically evaluated to inform and enhance cancer survivorship care in diverse health care settings.
Collapse
Affiliation(s)
- Jessica Chubak
- Group Health Research Institute; University of Washington School of Public Health, Seattle, WA; National Cancer Institute, Bethesda, MD; Kaiser Permanente, Denver, CO, Portland, OR, and Honolulu, HI; Geisinger Health System, Danville, PA; Health Services Research Division, LCF Research, Albuquerque, NM; Harvard Medical School and Harvard Pilgrim HealthCare Institute; and Harvard Vanguard Medical Associates, Boston, MA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Blinman PL, Grimison P, Barton MB, Crossing S, Walpole ET, Wong N, Francis K, Koczwara B. The shortage of medical oncologists: the Australian Medical Oncologist Workforce Study. Med J Aust 2012; 196:58-61. [DOI: 10.5694/mja11.10363] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Euan T Walpole
- Cancer Services, Princess Alexandra Hospital, Brisbane, QLD
| | - Nora Wong
- Medical Oncology Group of Australia, Sydney, NSW
| | - Kay Francis
- Medical Oncology Group of Australia, Sydney, NSW
| | - Bogda Koczwara
- Medical Oncology, Flinders Medical Centre, Flinders University, Adelaide, SA
| |
Collapse
|
44
|
Lu HJ, Chen KW, Tzeng CH, Liu JH, Chiou TJ, Yen CC, Chao TC, Teng HW, Chen MH, Liu CY, Wang WS, Chang PMH, Yang MH. Evaluation of Prognosis for Carcinoma of Unknown Origin in Elderly Patients. Oncology 2012; 83:24-30. [DOI: 10.1159/000337983] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 03/05/2012] [Indexed: 01/07/2023]
|
45
|
Potosky AL, Han PKJ, Rowland J, Klabunde CN, Smith T, Aziz N, Earle C, Ayanian JZ, Ganz PA, Stefanek M. Differences between primary care physicians' and oncologists' knowledge, attitudes and practices regarding the care of cancer survivors. J Gen Intern Med 2011; 26:1403-10. [PMID: 21785923 PMCID: PMC3235622 DOI: 10.1007/s11606-011-1808-4] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 06/17/2011] [Accepted: 06/30/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND The growing number of cancer survivors combined with a looming shortage of oncology specialists will require greater coordination of post-treatment care responsibilities between oncologists and primary care physicians (PCPs). However, data are limited regarding these physicians' views of cancer survivors' care. OBJECTIVE To compare PCPs and oncologists with regard to their knowledge, attitudes, and practices for follow-up care of breast and colon cancer survivors. DESIGN AND SUBJECTS Mailed questionnaires were completed by a nationally representative sample of 1,072 PCPs and 1,130 medical oncologists in 2009 (cooperation rate = 65%). Sampling and non-response weights were used to calculate estimates to reflect practicing US PCPs and oncologists. MAIN MEASURES PCPs and oncologists reported their 1) preferred model for delivering cancer survivors' care; 2) assessment of PCPs' ability to perform follow-up care tasks; 3) confidence in their knowledge; and 4) cancer surveillance practices. KEY RESULTS Compared with PCPs, oncologists were less likely to believe PCPs had the skills to conduct appropriate testing for breast cancer recurrence (59% vs. 23%, P < 0.001) or to care for late effects of breast cancer (75% vs. 38%, P < 0.001). Only 40% of PCPs were very confident of their own knowledge of testing for recurrence. PCPs were more likely than oncologists to endorse routine use of non-recommended blood and imaging tests for detecting cancer recurrence, with both groups departing substantially from guideline recommendations. CONCLUSION There are significant differences in PCPs' and oncologists' knowledge, attitudes, and practices with respect to care of cancer survivors. Improving cancer survivors' care may require more effective communication between these two groups to increase PCPs' confidence in their knowledge, and must also address oncologists' attitudes regarding PCPs' ability to care for cancer survivors.
Collapse
Affiliation(s)
- Arnold L Potosky
- Lombardi Comprehensive Cancer Center, Cancer Control Program, Georgetown University Medical Center, Washington, DC 20007, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Campo RA, Rowland JH, Irwin ML, Nathan PC, Gritz ER, Kinney AY. Cancer Prevention after Cancer: Changing the Paradigm—a Report from the American Society of Preventive Oncology. Cancer Epidemiol Biomarkers Prev 2011; 20:2317-24. [DOI: 10.1158/1055-9965.epi-11-0728] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
47
|
Boyle DA. Are You a Mid-Level Provider, a Physician Extender, or a Nurse? Oncol Nurs Forum 2011; 38:497. [DOI: 10.1188/11.onf.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
48
|
Trigg ME, Flanigan-Minnick A. Mechanisms of action of commonly used drugs to treat cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1548-5315(12)70051-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
49
|
Britell JC. Role of advanced nurse practitioners and physician assistants in washington state. J Oncol Pract 2011; 6:37-8. [PMID: 20539731 DOI: 10.1200/jop.091068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In response to the looming oncology manpower shortage, the Washington State Medical Oncology Society (Vancouver, WA) surveyed medical oncology practices in Washington regarding employment patterns for advanced nurse practitioners (ANPs) and physician assistants (PAs) in oncology. METHODS Funded by a 2008 ASCO State Affiliate Grant and using Surveymonkey.com as a platform, practices were queried regarding practice demographics, employment patterns, and functions of ANPs and PAs. RESULTS Of the total queried, 25 practices (50%) responded, representing the spectrum of single-specialty (n = 8), multispecialty (n = 7), hospital-based (n = 6), and academic practices (n = 4). Sixty-eight percent of practices employed ANPs and/or PAs. Compared with PAs, ANPs were more likely to work independent of supervision (64% v 0%), perform follow-up in the outpatient setting (93% v 77%), evaluate patients in infusion centers (71% v 62%), and provide genetic counseling (42% v 0%). PAs were more likely to see hospitalized patients (62% v 42%) and supervise infusion centers (15% v 7%). New patient consultations were performed with similar frequency (PAs, 29% and ANPs, 31%). ANPs were more likely to review research eligibility (25% v 15%), obtain informed consent (33% v 15%), and monitor compliance (13% v 8%). CONCLUSION Washington practices have embraced advanced practitioners. Given the diversity of practice patterns, practices can learn from one another how to maximize ANP/NP roles. Practices need to promote practice-based educational opportunities to attract ANPs/PAs to medical oncology.
Collapse
|
50
|
Friese CR, Hawley ST, Griggs JJ, Jagsi R, Graff J, Hamilton AS, Janz NK, Katz SJ. Employment of nurse practitioners and physician assistants in breast cancer care. J Oncol Pract 2011; 6:312-6. [PMID: 21358962 DOI: 10.1200/jop.2010.000039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We sought to examine the employment of nurse practitioners (NPs) and physician assistants (PAs) in surgical, medical, and radiation oncology practices and to identify correlates of NP and PA employment. METHODS We conducted a mailed survey of attending surgeons, medical oncologists, and radiation oncologists who cared for a population-based sample of women diagnosed with breast cancer between June 2005 and February 2007 in Los Angeles, CA, and Detroit, MI. In addition to information about whether practices employed NPs and/or PAs, physician and practice characteristics were obtained. We estimated the likelihood of the employment of NPs and PAs with multivariable logistic regression. RESULTS Overall, 39.6% of physicians reported that NPs and PAs were employed in their practice, although there were significant differences across specialty: medical oncologists (56.3%), radiation oncologists (40.0%), and surgeons (28.7%; P < .01). The likelihood of NP and PA employment increased for medical oncologists (compared with surgeons; odds ratio [OR], 2.63; 95% CI, 1.73 to 3.99), physicians with 10 or fewer years in practice (OR, 1.94; 95% CI, 1.18 to 3.16), and practices with university affiliations (OR, 2.20; 95% CI, 1.44 to 3.37). Physicians with fewer than 25% of their patients diagnosed with breast cancer (OR, 0.48; 95% CI, 0.25 to 0.92) and practices with fewer than three physicians (OR, 0.14; 95% CI 0.09, to 0.24) were less likely to employ NPs and PAs. CONCLUSIONS NP and PA employment was higher with newer physicians and in more heavily resourced practices. Employment of NPs and PAs was relatively modest, which suggests an opportunity for physicians to employ these providers to alleviate workloads.
Collapse
Affiliation(s)
- Christopher R Friese
- University of Michigan, Ann Arbor; Karmanos Cancer Center; Wayne State University; Metropolitan Detroit Cancer Surveillance System, Detroit, MI; Keck School of Medicine, University of Southern California; Los Angeles County Cancer Surveillance Program, Los Angeles, CA
| | | | | | | | | | | | | | | |
Collapse
|