1
|
Liang LJ, Li L. Measuring health care continuum with multifaceted indicators for people who use drugs in Vietnam. AIDS Care 2024; 36:161-167. [PMID: 38289581 PMCID: PMC11283981 DOI: 10.1080/09540121.2024.2308747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
Continuum of care is a concept that has been widely applied in HIV prevention and treatment studies. However, measuring care continuum can be challenging because it involves multiple stages and multiple components or domains at each stage of care. In this study, we introduced an analytical framework to (1) estimate intervention effects overall and by domain using a multi-level modeling approach, and (2) learn possible patterns of domains over time utilizing a multi-layer heatmap visualization. Longitudinal data from an intervention study conducted among people who use drugs in Vietnam were used to construct Seek, Test, Treat, and Retain (STTR) domain and overall scores. Findings from the adjusted analysis showed that people who use drugs in the intervention exhibited a significantly greater improvement in the overall STTR score than those in the control (p-values < .0001). The multi-layer heatmap revealed different patterns of the individual domains over time and the inter-relationships among the individual domains. This study demonstrates the feasibility of constructing a general fulfillment score and domain specific scores to measure care continuum among people who use drugs. The analytical framework can be readily extended to evaluate service fulfillment outcomes in health services and treatment studies for other key populations.
Collapse
Affiliation(s)
- Li-Jung Liang
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| |
Collapse
|
2
|
Tarver WL, Justice Z, Jonnalagadda P, Rahurkar S, Obeng-Gyasi S, Krok-Schoen JL, Petrecca A, Paskett ED. A scoping review of the evidence on survivorship care plans among minority, rural, and low-income populations. J Cancer Surviv 2024:10.1007/s11764-024-01609-z. [PMID: 38907799 DOI: 10.1007/s11764-024-01609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 04/19/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE Despite recent advances in cancer control and the number of cancer survivors increasing substantially over the past years, some cancer survivors continue to experience disparities due to barriers to recommended survivorship care. The use of survivorship care plans (SCPs) may be a way to help care for these individuals and their respective issues after they complete their primary treatment. The purpose of this scoping review is to understand the evidence on SCPs among minority, rural, and low-income populations: groups that experience disproportionately poorer cancer health outcomes. METHODS Computer-based searches were conducted in four academic databases. We included peer-reviewed studies published in the English language and conducted in the USA. We systematically extracted information from each paper meeting our inclusion criteria. RESULTS Our search identified 45 articles. The 4 major themes identified were (1) disparities in the receipt of SCPs where populations experience unmet needs; (2) benefits of SCPs, including improved care coordination and self-management of cancer; (3) needs and preferences for survivorship care; and (4) barriers and facilitators to using SCPs. CONCLUSIONS Despite the potential benefits, underserved cancer survivors experience disparities in the receipt of SCPs and continue to have unmet needs in their survivorship care. Survivorship care may benefit from a risk-stratified approach where SCPs are prioritized to survivors belonging to high-risk groups. IMPLICATIONS FOR CANCER SURVIVORS SCPs are a tool to deliver quality care for cancer survivors. While evidence is mixed on SCPs' benefits among the general population, SCPs show promise for underserved populations when it comes to proximal outcomes that contribute to disparities.
Collapse
Affiliation(s)
- Willi L Tarver
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | | | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Abigail Petrecca
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
3
|
van Maaren MC, van Hoeve JC, Korevaar JC, van Hezewijk M, Siemerink EJM, Zeillemaker AM, Klaassen-Dekker A, van Uden DJP, Volders JH, Drossaert CHC, Siesling S. The effectiveness of personalised surveillance and aftercare in breast cancer follow-up: a systematic review. Support Care Cancer 2024; 32:323. [PMID: 38695938 PMCID: PMC11065941 DOI: 10.1007/s00520-024-08530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/27/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE Breast cancer follow-up (surveillance and aftercare) varies from one-size-fits-all to more personalised approaches. A systematic review was performed to get insight in existing evidence on (cost-)effectiveness of personalised follow-up. METHODS PubMed, Scopus and Cochrane were searched between 01-01-2010 and 10-10-2022 (review registered in PROSPERO:CRD42022375770). The inclusion population comprised nonmetastatic breast cancer patients ≥ 18 years, after completing curative treatment. All intervention-control studies studying personalised surveillance and/or aftercare designed for use during the entire follow-up period were included. All review processes including risk of bias assessment were performed by two reviewers. Characteristics of included studies were described. RESULTS Overall, 3708 publications were identified, 64 full-text publications were read and 16 were included for data extraction. One study evaluated personalised surveillance. Various personalised aftercare interventions and outcomes were studied. Most common elements included in personalised aftercare plans were treatment summaries (75%), follow-up guidelines (56%), lists of available supportive care resources (38%) and PROs (25%). Control conditions mostly comprised usual care. Four out of seven (57%) studies reported improvements in quality of life following personalisation. Six studies (38%) found no personalisation effect, for multiple outcomes assessed (e.g. distress, satisfaction). One (6.3%) study was judged as low, four (25%) as high risk of bias and 11 (68.8%) as with concerns. CONCLUSION The included studies varied in interventions, measurement instruments and outcomes, making it impossible to draw conclusions on the effectiveness of personalised follow-up. There is a need for a definition of both personalised surveillance and aftercare, whereafter outcomes can be measured according to uniform standards.
Collapse
Affiliation(s)
- Marissa C van Maaren
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Jolanda C van Hoeve
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
- The Hague University of Applied Sciences, The Hague, the Netherlands
| | | | | | | | - Anneleen Klaassen-Dekker
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | | | - José H Volders
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Constance H C Drossaert
- Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| |
Collapse
|
4
|
Restrepo E, Ko N, Warner ET. An evaluation of readability and understandability of online education materials for breast cancer survivors. J Cancer Surviv 2024; 18:457-465. [PMID: 35913680 DOI: 10.1007/s11764-022-01240-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE We aimed to determine the availability of existing web-based educational materials on breast cancer survivorship and assess their readability and understandability. METHODS We identified materials eligible for review in two ways: (1) reviews of websites of major cancer-related organizations (e.g., American Cancer Society); (2) Google searches for breast cancer survivorship, breast cancer, breast cancer follow-up care, and cancer survivorship. We measured Flesch-Kincaid and New Dale Readability of existing breast cancer and breast cancer survivorship materials. Readability grade levels 5 to 8 were considered ideal to acceptable. We used the Patient Education Materials Assessment Tool (PEMAT) to measure the understandability of 53 videos and 152 written materials, such as booklets and manuals. A resource was considered understandable and/or actionable if it scored ≥ 70% on either the understandability section or the actionability section of the PEMAT. RESULTS We identified a total of 205 existing materials including brochures, booklets, facts sheets, websites, and videos in English. The average Flesch-Kincaid grade score of written educational materials was 9.7 (range 3.5-16.4), which translates to a 9th grade reading level. According to the New Dale-Chall readability assessment, most of the materials were in the 9 to 10 grade level range. The average PEMAT score was 88.6% (range 56-100%). CONCLUSION Patient educational materials are available online as printable, written materials, and videos and they focus on a wide selection of survivorship-related topics. Most of the breast cancer educational materials that are available online were above an 8th grade reading level. The PEMAT results, however, suggest that materials are easy to understand regarding word choice and style, use of numbers, organization, layout and design, and use of visual aids. IMPLICATIONS FOR CANCER SURVIVORS Understandable patient education materials are essential for guiding breast cancer survivors towards improving their health outcomes and optimizing their quality of life.
Collapse
Affiliation(s)
- Emily Restrepo
- Department of Medicine, Mongan Institute, Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Naomi Ko
- Belkin Breast Health Center, Boston Medical Center, Boston, MA, USA
| | - Erica T Warner
- Department of Medicine, Mongan Institute, Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
5
|
Elizondo Rodríguez N, La Rosa-Salas V, Leite ACAB, Domingo-Osle M, Nascimento LC, García-Vivar C. "Opportunistic Care": A Focus Group Study of Nurses' Perspective on Caring for Long-term Cancer Survivors and Their Families. Cancer Nurs 2024:00002820-990000000-00230. [PMID: 38498794 DOI: 10.1097/ncc.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The global population of long-term cancer survivors is increasing, thanks to advances in treatments and care. Healthcare systems are working to address the unique needs of these individuals. However, there remains a knowledge gap concerning nurses' view on cancer survivorship care. OBJECTIVE To identify nurses' perspective of care for long-term cancer survivors and their families. METHODS This qualitative descriptive study used 5 focus groups comprising 33 nurses from primary healthcare and specialized oncology care. Data analysis was conducted through thematic analysis, and the study received ethical approval. RESULTS Long-term cancer survivors and their families often remained unrecognized as a distinct group within the healthcare system. Consequently, nurses provide what can be termed as "opportunistic care" during nurse-survivor encounters, addressing health needs beyond the purpose of the initial healthcare visit. This absence of a systematic or structured approach for this patient group has prompted nurses to seek the establishment of a comprehensive framework through survivorship care plans, thus ensuring a continuum of care for this specific population. CONCLUSION The lack of a structured approach to caring for long-term cancer survivors and their families, often invisible as a distinct population group, results in nurses providing care on an opportunistic basis. IMPLICATIONS FOR PRACTICE It is crucial to develop and implement survivorship care plans tailored to this population's needs. Simultaneously, it is important to advance research in this area and establish an educational framework for nurses, enabling them to effectively address the care of long-term cancer survivors and their families.
Collapse
Affiliation(s)
- Nerea Elizondo Rodríguez
- Author Affiliations: Universidad de Navarra (Mrs Elizondo-Rodríguez and Drs Domingo-Osle and La Rosa-Salas); Universidad Pública de Navarra, Departamento de Ciencias de la Salud (Drs García-Vivar and Leite); and Instituto de Investigación Sanitaria de Navarra (IdiSNA) (Mrs Elizondo-Rodríguez and Drs Domingo-Osle, García-Vivar, La Rosa-Salas, and Leite), Pamplona, Spain; and Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (Dr Nascimento)
| | | | | | | | | | | |
Collapse
|
6
|
Lui F, Lewicka M, Bao GC, Moyer A, Boyce L, Leng J. A systematic review and meta-analysis of psychosocial interventions for immigrant and limited English proficient cancer patients. Psychooncology 2023; 32:516-557. [PMID: 36792931 PMCID: PMC10410571 DOI: 10.1002/pon.6110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Immigrants, particularly those who are less acculturated and limited English proficient (LEP), often lack access to culturally and linguistically appropriate psychosocial care in cancer survivorship. We sought to determine what psychosocial interventions are available for immigrant and/or LEP cancer patients and to assess treatment and patient factors that may correlate with better psychosocial outcomes for this population. METHODS We conducted a systematic review and meta-analysis of studies published through August 2022 of interventions conducted with immigrant and/or LEP cancer patients aimed at improving psychosocial outcomes (i.e., quality of life, depression, cancer-related distress, and anxiety). Using Covidence, a software program for systematic review management, four independent raters screened 16,123 records with a systematic process for reconciling disagreement, yielding 48 articles (45 studies) for systematic review and 21 studies for meta-analysis. RESULTS Most studies were conducted with Spanish-speaking patients with breast cancer. Study participants (N = 5400) were primarily middle-aged (mean = 53 years old), female (90.0%), and Hispanic (67.0%). The weighted average effect size (g) across studies was 0.14 (95% CI 0.03-0.26) for quality of life (18 studies), 0.04 (95% CI -0.08 to 0.17) for depression (8 studies), 0.14 (95% CI -0.03 to 0.31) for cancer-related distress (6 studies), and 0.03 (95% CI -0.11 to 0.16) for anxiety (5 studies). CONCLUSION The interventions under review had small but beneficial effects on psychosocial outcomes for immigrant and LEP cancer patients. Notably, effect sizes were smaller than those found in previous meta-analyses of psychosocial interventions conducted in majority U.S.-born, non-Hispanic White, English-speaking cancer patient samples. More research is needed to identify key components and adaptations of interventions that benefit immigrant and LEP cancer patients to strengthen their effects for this growing yet underserved population.
Collapse
Affiliation(s)
- Florence Lui
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center; Department of Psychiatry, Weill Cornell Medical College
| | - Malwina Lewicka
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - George C. Bao
- Department of Medicine, Weill Cornell Medical College
| | - Anne Moyer
- Department of Psychology, Stony Brook University
| | - Lindsay Boyce
- Medical Library, Memorial Sloan Kettering Cancer Center
| | - Jennifer Leng
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center; Department of Healthcare Policy and Research, Weill Cornell Medical College
| |
Collapse
|
7
|
Ramírez-Morera A, Tristán M, Salazar-Vargas J, Rivera-Chavarría AL. Effects of evidence-based clinical practice guidelines for breast cancer in health care quality improvements. A second systematic review. F1000Res 2022; 11:1213. [PMID: 36619604 PMCID: PMC9780606 DOI: 10.12688/f1000research.126126.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Traditionally, EB-CPGs have been believed to mainly improve the quality and consistency of health care, but this claim must be conclusively proven. We used the Donabedian three-dimensional model (structure, process, and patient outcomes) to assess improvements in the quality of medical care derived from implementing EB-CPGs. This study corresponds to the second systematic review carried out as a series of studies on different clinical issues that aim to evaluate the effectiveness of the application of the EB-CPG for improving the quality of care. Methods: We followed the methods described by the Cochrane Handbook and presented a descriptive analysis because of the high heterogeneity found across the included studies. We searched the Cochrane Central Register of Controlled Trials, PubMed, and EBSCO Host databases, as well as the grey literature, between 1990 and April 2021. No language restrictions were applied. Only randomised clinical trials (RCTs) were selected. Results: Of the total of 364 interventions included in the eleven RCTs evaluated, 11 (3%) were related to healthcare structure, 51 (14%) to the healthcare delivery process and 302 (83%) to patient outcomes. Regarding the impact of using the EB-CPGs, in 303 interventions (83%), there were no significant differences between the control and experimental groups. In 4 interventions (1%), the result favoured the control and intervention groups in 57 of the interventions (16%). Conclusions: Our study showed that EB-CPGs slightly enhanced the quality of health care in the three dimensions described by Donabedian. Future RCTs should improve their design and methodological rigour by considering the certainty of the evidence supporting the EB-CPGs recommendations. In that context, broader analyses could be performed, having more concise hypotheses for further research. Registration: PROSPERO CRD42020205594.
Collapse
Affiliation(s)
- Anggie Ramírez-Morera
- Cochrane Central America & Caribbean Spanish, IHCAI Foundation, San José, San José, 10101, Costa Rica,Universitat Autònoma de Barcelona, Barcelona, Catalunya, 08041, Spain,Caja Costarricense de Seguro Social, San José, San José, 10105, Costa Rica,
| | - Mario Tristán
- Cochrane Central America & Caribbean Spanish, IHCAI Foundation, San José, San José, 10101, Costa Rica
| | | | - Ana Leonor Rivera-Chavarría
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Tres Ríos, Cartago, 42250, Costa Rica
| |
Collapse
|
8
|
Thompson T, Davis M, Pérez M, Jonson-Reid M, Jeffe DB. "We're in this together": Perceived effects of breast cancer on African American survivors' marital relationships. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2022; 13:789-815. [PMID: 36687398 PMCID: PMC9850417 DOI: 10.1086/713478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Objective We examined married African American breast cancer survivors' perceptions of how cancer affected their marriage, social support from their spouses, and spouses' physical and mental health. Method We conducted a thematic analysis of semi-structured interviews with 15 married African American breast cancer survivors who had participated in a larger randomized controlled trial. Interviews were professionally transcribed and then independently coded by two coders. Results Themes emerged related to the challenges of maintaining mutually supportive relationships. There was variability in the perceived effects of cancer on relationships, as well as uncertainty about cancer's effects on their husbands' emotional and physical health and the adequacy of emotional and tangible support from their husbands. Participants described husbands' key role in promoting wives' positive body image, as well as the challenges of negotiating sexual activity. Participants were receptive to help from medical professionals in dealing with relationship issues. Conclusions Findings show variability in couples' responses to cancer, with some patients and couples adapting well and others needing additional support. During treatment and at follow-up, oncology social workers can assess patients' and family members' social support needs, provide mental health services, and provide patient navigation to help patients and caregivers access health care and community resources.
Collapse
Affiliation(s)
- Tess Thompson
- Brown School of Social Work, Washington University in St. Louis
| | - Maxine Davis
- School of Social Work, The University of Texas at Arlington
| | - Maria Pérez
- School of Medicine, Washington University in St. Louis
| | | | | |
Collapse
|
9
|
Ko E, Woodruff SI, Zúñiga ML, Cardenas V, Lizarraga M, Urias A. Culturally-tailored survivorship care planning for rural Latina breast cancer patients: a pilot study. J Psychosoc Oncol 2022; 41:475-486. [PMID: 36357323 PMCID: PMC10169530 DOI: 10.1080/07347332.2022.2141168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore the feasibility and acceptability of Proyecto Mariposa, a culturally-tailored survivorship care program for rural Latina breast cancer patients. DESIGN Single group mixed-method approach. METHODS Feasibility of recruitment, intervention and evaluation, and perceptions about the intervention were assessed with 18 rural Latina breast cancer patients from the US/Mexico border region. Pre-post assessments evaluated change in patients' knowledge and concerns about survivorship care, and their self-efficacy about patient-physician interaction and managing chronic disease. FINDINGS Feasibility was generally promising but affected by the COVID-19 outbreak. Participants found the intervention to be acceptable and useful, particularly with regard to information provision and encouraging proactive behavior. There was modest pre-post improvement on self-efficacy for managing disease. CONCLUSIONS This pilot study suggested feasibility and acceptability of Proyecto Mariposa for rural Latina breast cancer patients. Change in outcomes was small indicating the need for research with a larger sample to establish reliable findings.
Collapse
Affiliation(s)
- Eunjeong Ko
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Susan I Woodruff
- School of Social Work, San Diego State University, San Diego, CA, USA
| | | | - Veronica Cardenas
- Department of Psychiatry, University of California, San Diego, Moores Cancer Center, San Diego, CA, USA
| | | | - Aday Urias
- Cancer Resource Center of the Desert, El Centro, CA, USA
| |
Collapse
|
10
|
Chu AK, Mutsaers B, Lebel S. The Association between Survivorship Care Plans and Patient-Reported Satisfaction and Confidence with Follow-Up Cancer Care Provided by Primary Care Providers. Curr Oncol 2022; 29:7343-7354. [PMID: 36290854 PMCID: PMC9600139 DOI: 10.3390/curroncol29100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/15/2022] Open
Abstract
Survivorship care plans aim to facilitate a smooth transition from tertiary to primary care settings after primary cancer treatment is completed. This study sought to identify the sociodemographic factors associated with receiving a survivorship care plan and examine the relationship between receiving a plan and confidence in follow-up care delivered by primary care providers. A cross-sectional analysis of the Canadian Partnership Against Cancer's Experiences of Cancer Patients in Transition Study was conducted (n = 9970). Separate adjusted multinomial logistic regression models assessed the relationship between survivorship care plans and follow-up care outcomes. Proportion of survivors more likely to receive a survivorship care plan varied by numerous sociodemographic and medical factors, such as cancer type (colorectal and prostate), gender (male), and education (high school or less). In unadjusted and adjusted models, individuals who received a Survivorship Care Plan had significantly higher odds of: having felt their primary care providers were involved; agreeing that their primary care providers understood their needs, knew where to find supports and services, and were able to refer them directly to services; and were confident that their primary care provider could meet their follow-up care needs.
Collapse
|
11
|
Morken C, Tevaarwerk AJ, Juckett MB, Swiecichowski AK, Haine JE, Zhang X, Williams ZT, Norslien K, Campbell B, Wassenaar T, Sesto ME. Barriers and facilitators to the use of survivorship care plans by hematopoietic stem cell transplant survivors and clinicians. Support Care Cancer 2022; 30:1323-1330. [PMID: 34482447 PMCID: PMC8732291 DOI: 10.1007/s00520-021-06492-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/07/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Survivors of hematopoietic stem cell transplants (HSCT) have complex care needs for the remainder of their lives, known as the survivorship period. Survivorship care plans (SCPs) have been proposed to improve care coordination and ultimately survivorship outcomes. We explored the barriers and facilitators of SCP use among HSCT survivors and their clinicians in order to develop more useful SCPs for the HSCT context. METHODS Analogous surveys regarding perceived barriers to and facilitators of SCP use based on a sample SCP for a female allogenic HSCT survivor were administered to HSCT survivors and non-transplant oncology and primary care clinicians. RESULTS Twenty-seven HSCT survivors and 18 clinicians completed the survey. The main barriers to SCP use were lack of awareness of SCP existence, uncertainty regarding where to find SCP, unclear roles and responsibilities among healthcare teams, length of SCP, and difficultly understanding SCPs. The facilitators of SCP use were increased understanding of survivorship care needs, clarified roles and responsibilities of survivors and clinicians, SCPs that are readily available and searchable in electronic health record, increased awareness of SCP existence and provision to all survivors, and if the SCP is survivor-specific and up-to-date. CONCLUSIONS Much of the work regarding SCPs has looked at barriers to creation and provision; however, our study examines factors influencing use of SCPs. By determining the barriers and facilitators surrounding SCP use for HSCT survivors and their clinicians, we can create SCP templates and clinical workflows to optimize SCP use, ideally leading to better outcomes for HSCT survivors.
Collapse
Affiliation(s)
| | - Amye J Tevaarwerk
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Mark B Juckett
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | - James E Haine
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Xiao Zhang
- Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | | | | | | | - Mary E Sesto
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| |
Collapse
|
12
|
Rutkowski N, MacDonald-Liska C, Baines KA, Samuel V, Harris C, Lebel S. Standardized versus personalized survivorship care plans for breast cancer survivors: A program evaluation. Can Oncol Nurs J 2021; 31:451-456. [PMID: 34786462 DOI: 10.5737/23688076314451456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Wellness Beyond Cancer Program provides survivorship care plans (SCPs) to cancer survivors, as they transition from cancer centres back to their primary care provider (PCP) upon treatment completion. A program evaluation examined whether standardized SCPs resulted in comparable outcomes on perceived knowledge and patient activation as personalized SCPs. Breast cancer survivors who received either standardized or personalized SCPs completed pre- and post-surveys during their discharge appointment, which included an in-house measure on perceived knowledge, The Perceived Efficacy in Patient-Physician Interactions, and The Patient Activation Measure. Eighty-seven breast cancer survivors completed the surveys (personalized SCP n = 43; standardized SCP n = 44). Standardized SCPs resulted in comparable knowledge and activation outcomes as personalized SCPs. Cost-efficient standardized SCPs may help alleviate human resource constraints and may be considered for further evaluation and implementation in cancer centres.
Collapse
Affiliation(s)
- Nicole Rutkowski
- Doctoral Student, School of Psychology, University of Ottawa, Ottawa, ON
| | | | - Kelly-Anne Baines
- Wellness Beyond Cancer Program, The Ottawa Hospital Ottawa Cancer Centre, Ottawa, ON
| | - Vicky Samuel
- Wellness Beyond Cancer Program, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - Cheryl Harris
- CPsych Clinician Investigator, Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON
| | - Sophie Lebel
- PPsych, Professor, School of Psychology, University of Ottawa, Ottawa, ON
| |
Collapse
|
13
|
Rutkowski N, MacDonald-Liska C, Baines KA, Samuel V, Harris C, Lebel S. Plans de soins de suivi normalisés et individualisés dédiés aux survivantes du cancer du sein : Évaluation du programme. Can Oncol Nurs J 2021; 31:457-462. [PMID: 34786463 DOI: 10.5737/23688076314457462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Le Programme de bien-être au-delà du cancer fournit des plans de soins de suivi (PSS) aux survivants qui passent du centre de cancérologie à leur médecin traitant une fois leurs traitements terminés. L’évaluation de ce programme a permis de vérifier si les PSS normalisés stimulent autant les connaissances et l’activation des patients que les PSS personnalisés. Les survivantes d’un cancer du sein qui ont reçu un PSS (normalisé ou personnalisé) ont répondu à un premier sondage avant le « rendez-vous de transition » puis à un autre à la fin de la rencontre. On leur demandait alors d’autoévaluer leurs connaissances et de répondre aux questions sur l’Efficacité perçue de la relation médecin-patient (PEPPI) et la Mesure d’activation du patient (MAP). Au total, quatre-vingt-sept survivantes du cancer du sein ont répondu aux sondages (PSS personnalisé, n = 43; PSS normalisé, n = 44). Dans les deux cas, les résultats sur les connaissances et l’activation des patientes étaient comparables. Les PSS normalisés, plus rentables, pourraient donc contribuer à alléger les contraintes relatives aux ressources humaines et faire l’objet d’évaluations plus poussées en vue d’être intégrés dans les centres de cancérologie.
Collapse
Affiliation(s)
- Nicole Rutkowski
- Doctorante, École de psychologie, Université d'Ottawa, Ottawa (Ontario)
| | - Carrie MacDonald-Liska
- Coordonnatrice des soins, Centre de cancérologie de L'Hôpital d'Ottawa, Ottawa (Ontario)
| | - Kelly-Anne Baines
- Programme de bien-être au-delà du cancer, Centre de cancérologie de L'Hôpital d'Ottawa, Ottawa (Ontario)
| | - Vicky Samuel
- Programme de bien-être au-delà du cancer, Centre de cancérologie de L'Hôpital d'Ottawa, Ottawa (Ontario)
| | - Cheryl Harris
- Psychologue, chercheuse-clinicienne, Programme de thérapeutique anticancéreuse, Institut de recherche de L'Hôpital d'Ottawa, Ottawa (Ontario)
| | - Sophie Lebel
- Psychologue, professeure, École de psychologie, Université d'Ottawa, Ottawa (Ontario)
| |
Collapse
|
14
|
Phansuwon K, Cindy Tan SY, Kerin-Ayres K, Malalasekera A, L Vardy J. Evaluation of survivorship care plans in patients attending the Sydney Cancer Survivorship Centre. Support Care Cancer 2021; 30:2207-2213. [PMID: 34704156 DOI: 10.1007/s00520-021-06636-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The transitioning of cancer survivors from active treatment to surveillance care has been described as uncoordinated, with lack of communication between healthcare professionals. Survivorship care plans (SCP) are recommended to bridge this transitioning period and help improve coordination of care. SCP contain individualized information about a survivor's cancer diagnosis, treatment, and recommendations for managing treatment-related side effects and improving lifestyle risk factors for cancer recurrence and chronic disease. The aims of the study were to assess the delivery, usefulness, and compliance with SCP of survivors attending a multidisciplinary survivorship clinic and to determine patient suggestions regarding how to improve SCP. METHODS A total of 110 survivors were interviewed in-person or by phone regarding their SCP following a script with formalized questions. Data were analyzed quantitatively using descriptive statistics. RESULTS Overall, 65% of participants (72/110) acknowledged having received a SCP and 86% found them useful. Only 11% of survivors (8/72) showed their SCP to other health professionals and about half (33/72) showed it to family/friends. Ninety percent of survivors (65/72) reported following at least one recommendation in their SCP. CONCLUSION Survivors found SCP helpful but did not share them with other healthcare providers, which questions their usefulness in coordinating care. There were challenges with SCP delivery. Survivors reported they were compliant with SCP lifestyle recommendations. Further research is required to address the utility of SCP to other stakeholders, such as general practitioners, to determine whether they receive the SCP, if they find them helpful, and their expectations regarding SCP.
Collapse
Affiliation(s)
- Kain Phansuwon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sim Yee Cindy Tan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia.,Nutrition and Dietetics Department, Concord Repatriation General Hospital, Concord West, NSW, Australia
| | - Kim Kerin-Ayres
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia
| | - Ashanya Malalasekera
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia
| | - Janette L Vardy
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia. .,Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia.
| |
Collapse
|
15
|
Arem H, Pratt-Chapman ML, Landry M, Berg C, Mead KH. Quality of life among cancer survivors by model of cancer survivorship care. J Psychosoc Oncol 2021; 40:561-573. [PMID: 34348589 DOI: 10.1080/07347332.2021.1947937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There were an estimated 16.9 million cancer survivors in the United States in 2019, but there is wide variation in survivorship care. Patient-reported outcomes associated with distinct care models are unknown. Thus, we examined differences in quality of life by cancer survivorship care model. MATERIALS AND METHODS We conducted a comparative effectiveness trial, recruiting 32 Commission on Cancer-accredited centers in 2015-2016. Sites were characterized as one of three models: 1) Single Consultative visit, 2) Specialized Longitudinal care with ongoing visits at predetermined intervals, 3) Oncology-Embedded care with visits as needed. We included breast, prostate, and colorectal cancer survivors who had completed active treatment but had not yet attended a survivorship visit (n = 991). Quality of life was assessed using 20 physical, 14 social/emotional, and 7 practical concerns, adapted from the Quality of Life-Breast Cancer Survivors and Functional Living Index Cancer scales.1,2 We used frequencies to describe prevalent symptoms and ANOVA to test for global differences in concerns by survivorship care model, post-hoc Tukey's test for pairwise comparisons, and mixed-effects models to describe changes in quality of life by care model over six-months. RESULTS While unadjusted results suggested that nearly all concerns worsened over six months, no differences were observed in quality of life concerns by care model for physical or practical concerns. At baseline, social/emotional concerns showed a global difference by model (p = 0.008; pairwise results showed fewer concerns among Oncology-Embedded survivors compared to Specialized Consultative survivors; 12.1 vs 15.2, p < 0.05), but no differences were found at six months (global p = 0.311). Mixed effects models showed no change in quality of life by model over six-months. CONCLUSIONS Our results do not support an association between quality of life and care model over six-months. Still, participants reported many quality of life concerns across domains that must be addressed, regardless of care model.
Collapse
Affiliation(s)
- Hannah Arem
- Healthcare Delivery Research Program, Medstar Health Research Institute, Washington, DC, USA
| | - Mandi L Pratt-Chapman
- GW Cancer Center, Washington, DC, USA.,School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Megan Landry
- Milken Institute School of Public Health, Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - Carla Berg
- GW Cancer Center, Washington, DC, USA.,Milken Institute School of Public Health, Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - Katherine Holly Mead
- Milken Institute School of Public Health, Department of Health Policy and Management, George Washington University, Washington, DC, USA
| |
Collapse
|
16
|
Snyder C, Choi Y, Blackford AL, DeSanto J, Mayonado N, Rall S, White S, Bowie J, Cowall DE, Johnston F, Joyner RL, Mischtschuk J, Peairs KS, Thorner E, Tran PT, Wolff AC, Smith KC. Simplifying Survivorship Care Planning: A Randomized Controlled Trial Comparing 3 Care Plan Delivery Approaches. J Natl Cancer Inst 2021; 114:139-148. [PMID: 34302474 DOI: 10.1093/jnci/djab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Survivorship care plans seek to improve the transition to survivorship, but the required resources present implementation barriers. This randomized controlled trial aimed to identify the simplest, most effective approach for survivorship care planning. METHODS Stage 1-3 breast, colorectal, and prostate cancer patients aged 21+ completing treatment were recruited from an urban-academic and rural-community cancer center. Participants were randomized, stratified by recruitment site and cancer type, 1:1:1 to (a)mailed plan, (b)plan delivered during one-time transition visit, or (c)plan delivered during transition visit plus 6-month follow-up visit. Health service use data were collected from participants and medical records for 18 months. The primary outcome, receipt of all plan-recommended care, was compared across intervention arms using logistic regression adjusting for cancer type and recruitment site with p < 0.05 considered statistically significant. RESULTS Of 378 participants randomized, 159 (42.1%) were breast, 142 (37.6%) prostate, 77 (20.4%) colorectal cancer survivors; 207 (54.8%) from the academic site, 171 (45.2%) from the community site; 316 analyzable for the primary outcome. There was no difference across arms in the proportion of participants receiving all plan-recommended care: 45.2% mail, 50.5% one-visit, 42.7% two-visit (2-sided P = 0.60). Adherence by cancer type for mail, one-visit, and two-visit, respectively, was 52.2%, 53.3%, 40.0% for breast cancer; 48.6%, 64.1%, 57.1% for prostate cancer; and 23.8%, 19.0%, 26.1% for colorectal cancer. There were no statistically significant interactions by recruitment site or cancer type. CONCLUSIONS This study did not find differences in receipt of recommended follow-up care by plan delivery approach. Feasibility and other factors may determine the best approach for survivorship care planning.
Collapse
Affiliation(s)
- Claire Snyder
- Johns Hopkins University School of Medicine.,Johns Hopkins Bloomberg School of Public Health.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | | | | | | | - Susan Rall
- TidalHealth Richard A. Henson Research Institute
| | | | | | | | - Fabian Johnston
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | | | - Kimberly S Peairs
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | - Phuoc T Tran
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - Antonio C Wolff
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - Katherine C Smith
- Johns Hopkins Bloomberg School of Public Health.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | |
Collapse
|
17
|
Elizondo Rodriguez N, Ambrosio L, La Rosa-Salas V, Domingo-Osle M, Garcia-Vivar C. Role of the nurse in the design, delivery, monitoring and coordination of cancer survivorship care plans: An integrative review. J Adv Nurs 2021; 78:48-62. [PMID: 34235775 DOI: 10.1111/jan.14962] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
AIM Survivorship care plans (SCPs) are recommended as a tool for the care of cancer survivors. SCPs have been implemented with a multidisciplinary approach; however, the specific role of nurses in the SCP is unknown. Our aim is to determine the role of nurses and their degree of participation in cancer SCPs. DESIGN Integrative review of the literature with systematic methodology. DATA SOURCES PubMed, CINAHL, PsycINFO, Web of Science, Cochrane and Cancerlit databases were reviewed. Articles published up to March 2021 were included. REVIEW METHOD Of the 2,638 publications identified, 22 studies met our inclusion criteria. Quality of included studies was assessed using Joanna Briggs Institute quality assessment tools. RESULTS The studies showed that nurses play a key role and participate in different phases of the SCP, including design, delivery, monitoring and coordination among different levels of care, with varying degrees of involvement and responsibility; design and delivery of the SCP are the phases with the highest nurse participation (18 out of 22 studies). The majority of SCPs are implemented in specialized, hospital-based care and focus on short-term cancer survivors, who are actively undergoing oncological treatments. CONCLUSION This review shows that nurses actively participate in the design, implementation and coordination of SCPs. However, SCPs focus on the acute survival and treatment phases, and there is a gap in their use in long-term cancer survivorship. This gap may be one reason the needs of long-term cancer survivors are not covered. IMPACT This review contributes to the current body of knowledge by addressing the role of nurses in cancer SCPs. We recommend the involvement of an advanced practice nurse as SCP coordinator to improve communication between cancer specialists and primary care providers and to promote continued care throughout the different phases of cancer survivorship, including long-term survival.
Collapse
Affiliation(s)
| | - Leire Ambrosio
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Marta Domingo-Osle
- Registered Nurse at University of Navarra Clinic and Lecturer at the Practical Teaching Unit, Faculty of Nursing, University of Navarra, Pamplona, Spain
| | - Cristina Garcia-Vivar
- Department of Health Sciences, Public University of Navarre, IdiSNA, Pamplona, Spain
| |
Collapse
|
18
|
Joshi A, Larkins S, Evans R, Moodley N, Brown A, Sabesan S. Use and impact of breast cancer survivorship care plans: a systematic review. Breast Cancer 2021; 28:1292-1317. [PMID: 34146242 DOI: 10.1007/s12282-021-01267-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Survivorship care plan (SCP) comprising a treatment summary and plan for follow-up care is recommended by various organizations to address long-term needs of an increasing number of breast cancer survivors. Although there have been previous systematic reviews of SCPs in cancer, none has focused on breast cancer exclusively. This systematic review evaluates the use and impact of SCP in breast cancer survivors. METHODS Randomized (RCTs) and non-randomized (non-RCT) studies evaluating health care and patient-related outcomes after implementation of SCPs for survivors were identified by searching databases (MEDLINE, EMBASE, CINHAL, and Scopus). Data were extracted, quality assessed, and summarized on the basis of qualitative synthesis. RESULTS Ten non-RCTs and 14 RCTs met the inclusion criteria. Although the overall quality of RCTs was superior to non-RCTs with mean quality score of 81.5% vs 64.3%, two mixed-methods non-RCTs which were individualized and included both provider and patient perspectives had comparable scores like RCTs. Several models of SCP were evaluated (paper based/online, oncologist/nurse/primary-care physician-delivered, and different templates). Descriptive information from non-RCTs suggests improvement in survivorship knowledge, satisfaction with care, and improved communication with providers. Findings from RCTs were variable. Potential gaps existed in content of SCP including unclear recommendation on frequency and ownership of follow-up. Levels of survivor satisfaction with, and self-reported understanding of, their SCP were high. Distal outcomes like health care delivery measures including costs and efficiency were mostly mixed, but heterogeneous study designs make interpretation difficult. CONCLUSIONS Existing research provides positive impact of SCPs on more proximal outcomes of patient experience and care delivery but mixed results for health outcomes in breast cancer survivors. Future research should focus on better defining SCP content and ensuring follow-up recommendations are acted upon, and provider feedback is included and use of novel tools to empower stakeholders.
Collapse
Affiliation(s)
| | | | | | | | - Amy Brown
- Townsville Hospital, Townsville, Australia
| | | |
Collapse
|
19
|
Sun V, Reb A, Debay M, Fakih M, Ferrell B. Rationale and Design of a Telehealth Self-Management, Shared Care Intervention for Post-treatment Survivors of Lung and Colorectal Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:414-420. [PMID: 33415649 PMCID: PMC7994229 DOI: 10.1007/s13187-021-01958-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 05/05/2023]
Abstract
Survivors of lung and colorectal cancer have high post-treatment needs; the majority are older and suffer from greater comorbidities and poor quality of life (QOL). They remain underrepresented in research, leading to significant disparities in post-treatment outcomes. Personalized post-treatment follow-up care and care coordination among healthcare teams is a priority for survivors of lung and colorectal cancer. However, there are few evidence-based interventions that address survivors' post-treatment needs beyond the use of a follow-up care plan. This paper describes the rationale and design of an evidence-informed telehealth intervention that integrates shared care coordination between oncology/primary care and self-management skills building to empower post-treatment survivors of lung and colorectal cancer. The intervention design was informed by (1) contemporary published evidence on cancer survivorship, (2) our previous research in lung and colorectal cancer survivorship, (3) the chronic care self-management model (CCM), and (4) shared post-treatment follow-up care between oncology and primary care. A two-arm, parallel randomized controlled trial will determine the efficacy of the telehealth intervention to improve cancer care delivery and survivor-specific outcomes. ClinicalTrials.gov Identifier: NCT04428905.
Collapse
Affiliation(s)
- Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, CA, USA.
- Department of Surgery, City of Hope, Duarte, CA, USA.
| | - Anne Reb
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Marc Debay
- Department of Family Medicine, University of California, Riverside, CA, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Betty Ferrell
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| |
Collapse
|
20
|
Samtani G, Bassford TL, Williamson HJ, Armin JS. Are Researchers Addressing Cancer Treatment and Survivorship Among People With Intellectual and Developmental Disabilities in the U.S.? A Scoping Review. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:141-154. [PMID: 33793784 PMCID: PMC9272790 DOI: 10.1352/1934-9556-59.2.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 01/22/2020] [Indexed: 06/12/2023]
Abstract
People with intellectual and developmental disabilities (PWIDD) often encounter barriers in the health care system when seeking general and specialized medical care. Literature has shown that PWIDD experience a lack of proper screening for and prevention of cancer compared to the general population. However, less is known regarding the cancer care and survivorship of PWIDD, especially in the United States. In this review, we examine what is currently known about the primary, psychosocial, and palliative care of PWIDD diagnosed with cancer. Our analyses reveal an immediate need for improvement in caregiver support, collaboration among health care providers, and ethical approaches to information disclosure for this population, as well as the establishment of more reliable standards of care through additional research with PWIDD.
Collapse
|
21
|
Developing a survivorship care plan (SCP) delivery process for patients and primary care providers serving poor, rural, and minority patients with cancer. Support Care Cancer 2021; 29:5021-5028. [PMID: 33587174 PMCID: PMC7883333 DOI: 10.1007/s00520-021-06043-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
Background Survivorship care plans (SCPs) summarize patients’ treatment and act as an education and communication tool between oncologists and primary care providers (PCPs). But creation and delivery of SCPs are challenging, labor intensive, and costly. The University of New Mexico Comprehensive Cancer Center (UNM CCC) treats a poor, rural, and minority patient population, and our purpose was to implement and evaluate a process to create and deliver SCPs to patients and PCPs. Methods Providers placed an electronic SCP order, basic information was imported, and staff compiled treatment details. Flagged SCPs were then ready for delivery, providers approved of and delivered the SCP at the next encounter, and the SCP was sent to the PCP. Results By April 2020, 283 SCPs were ordered, 241 (85.2%) were created by the designated staff, and 97 (34.2%) were given to patients after definitive therapy for breast cancer (59.1%), gynecological cancers (10.8%), prostate cancer (7.4%), colorectal cancer (5.1%), and lymphomas (4.8%). Of 97 SCPs eligible to be sent to PCPs, 75 (77.3%) were mailed or sent via EMR. Of the 41 (48.9%) SCPs sent via mail or fax, only 8 (8.3%) were received and 5 (5.2%) integrated. Conclusions This study shows that SCPs can be delivered to patients in a poor, rural, and minority patient population but that PCP receipt and integration of SCPs are poor. Future efforts need to ensure that an oncologist to PCP education and communication tool is able reach and be integrated by PCPs.
Collapse
|
22
|
Design of a study to implement population-based risk assessment for hereditary cancer genetic testing in primary care. Contemp Clin Trials 2020; 101:106257. [PMID: 33373667 DOI: 10.1016/j.cct.2020.106257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022]
Abstract
Identifying patients with high genetic risk for cancer has important clinical ramifications, but hereditary cancer risk is often not identified because of testing barriers at both the provider and patient level. It is unknown how to best implement appropriate genetic testing and follow-up care into an operating primary care clinic. Implementation studies to date have been conducted in high resourced facilities under optimal conditions, often not at the clinic level. This study aims to compare and evaluate two population-wide engagement strategies for identifying members of a primary care clinic's population with a family or personal history of cancer and offering high-risk individuals genetic testing for cancer susceptibility mutations. The two engagement strategies are: 1) point of care screening (POC), conducted when a patient is scheduled for an appointment and 2) direct patient engagement (DPE), where outreach provides the patient an opportunity to complete screening online on their own time. The study will identify changes, problems, and inefficiencies in clinical flow during and after the implementation of risk assessment and genomic testing for cancer risk across primary care clinics. It will also evaluate the effects of the two engagement strategies on patient, provider, and clinic leader outcomes, including perceptions of benefits, harms, and satisfaction with the engagement strategy and process of cancer risk assessment and genetic testing, across gender, racial/ethnic, socioeconomic, and genetic literacy divides. Finally, the study will evaluate the cost-effectiveness and budget impact of each engagement strategy.
Collapse
|
23
|
Essential oncology nursing care along the cancer continuum. Lancet Oncol 2020; 21:e555-e563. [PMID: 33212045 DOI: 10.1016/s1470-2045(20)30612-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022]
Abstract
Oncology nurses are at the heart of tackling the increasing global burden of cancer. Their contribution is unique because of the scale and the diversity of care roles and responsibilities in cancer care. In this Series paper, to celebrate the International Year of the Nurse and Midwife, we highlight the contribution and impact of oncology nurses along the cancer care continuum. Delivering people-centred integrated care and optimal communication are essential components of oncology nursing care, which are often played down. More oncology nurses using, doing, and leading research will further show the key nursing impact on care as part of a team. The oncology nurse influence in saving lives through prevention and early detection of cancer is noteworthy. Supportive care, the central pillar of oncology nursing, enables and empowers people to self-manage where possible. Globally, oncology nurses make a great positive difference to cancer care worldwide; their crucial contribution throughout the continuum of care warrants the inclusion and promotion of nursing in every country's cancer strategy. 2020 is the year of the nurse: let us take this learning to the future.
Collapse
|
24
|
Yi JC, Sullivan B, Leisenring WM, Majhail NS, Jim H, Loren A, Uberti J, Whalen V, Flowers MED, Lee SJ, Maynard K, Syrjala KL. Who Enrolls in an Online Cancer Survivorship Program? Reach of the INSPIRE Randomized Controlled Trial for Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant 2020; 26:1948-1954. [PMID: 32599215 PMCID: PMC7529848 DOI: 10.1016/j.bbmt.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/10/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022]
Abstract
The internet can be a valuable tool in delivering survivorship care to hematopoietic cell transplantation (HCT) cancer survivors. We describe the reach of INSPIRE, an Internet and social media-based randomized controlled trial, to address healthcare and psychosocial needs of HCT survivors. All survivors 2-10 years after HCT for hematologic malignancy or myelodysplasia from 6 transplantation centers in the US were approached by mail and follow-up calls. Eligible participants had access to the Internet, an email address, and did not have active disease in the past 2 years. We used logistic regression to determine characteristics of eligible survivors who were more or less likely to enroll. Of 2578 eligible HCT survivors, 1065 (41%) enrolled in the study. The mean age of enrollees was 56.3 ± 12.6 years (range, 19 to 89 years), 52% were male, and 94% were white. Survivors less likely to enroll included those who were male, age <40 years, and who received an autologous transplant (all P < .001). Compared with white survivors, African Americans were less likely to enroll (P < .001), whereas Native Americans/Alaska Natives were more likely to join the study (P = .03). The reach of the INSPIRE program was broad, including to survivors who traditionally have less access to resources, such as Native Americans/Alaskan Natives and rural residents. Strategies are still needed to improve the enrollment of online studies of survivorship resources for males, young adults, African American, and autologous HCT survivors because their use may improve outcomes.
Collapse
Affiliation(s)
- Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Brie Sullivan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Navneet S Majhail
- Cleveland Clinic, Blood and Marrow Transplant Program, Cleveland, Ohio
| | | | - Alison Loren
- University of Pennsylvania, Blood & Marrow Transplant, Cell Therapy & Transplant Program, Philadelphia, Pennsylvania
| | - Joseph Uberti
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Victoria Whalen
- University of Nebraska, Blood & Marrow Stem Cell Transplant Program, Omaha, Nebraska
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Katie Maynard
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
25
|
The use of survivorship care plans by female racial and ethnic minority breast cancer survivors: a systematic review. J Cancer Surviv 2020; 14:806-825. [PMID: 32514908 DOI: 10.1007/s11764-020-00894-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Racial/ethnic breast cancer survivorship disparities persist as minority breast cancer survivors (MBCSs) report fragmentation in survivorship care, namely in the access and delivery of survivorship care plans (SCPs). To better understand care coordination of MCBS, this review elucidated concerns of female MBCS about their preparation for post-treatment survivorship care, the preferred practices for the delivery of a SCP, and the associated content to improve post-treatment survivorship care understanding. METHODS A systematic search of articles from PubMed, Ovid-Medline, CINAHL databases, and bibliographic reviews included manuscripts using keywords for racial/ethnic minority groups and breast cancer survivorship care coordination terms. Salient themes and article quality were analyzed from the extracted data. RESULTS Fourteen included studies represented 5,854 participants and over 12 racial/ethnic groups. The following themes of post-treatment MBCS were identified from the review: (1) uncertainty about post-treatment survivorship care management is a consequence of sub-optimal patient-provider communication; (2) access to SCPs and related materials are desired, but sporadic; and (3) advancements to the delivery and presentation of SCPs and related materials are desired. CONCLUSIONS Representation of only 14 studies indicates that the MBCSs' perspective post-treatment survivorship care is underrepresented in the literature. Themes from this review support access to, and implementation of, culturally tailored SCP for MBCS. There was multi-ethnic acceptance of SCPs as a tool to help improve care coordination. IMPLICATIONS FOR CANCER SURVIVORS These findings highlight the importance of general education about post-treatment survivorship, post-treatment survivorship needs identification, and the elucidation of gaps in effective SCP delivery among MBCS.
Collapse
|
26
|
Integrative review of breast cancer survivors’ transition experience and transitional care: dialog with transition theory perspectives. Breast Cancer 2020; 27:810-818. [DOI: 10.1007/s12282-020-01097-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/15/2020] [Indexed: 12/16/2022]
|
27
|
Hua A, Sesto ME, Zhang X, Wassenaar TR, Tevaarwerk AJ. Impact of Survivorship Care Plans and Planning on Breast, Colon, and Prostate Cancer Survivors in a Community Oncology Practice. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:249-255. [PMID: 30610655 PMCID: PMC6609493 DOI: 10.1007/s13187-018-1457-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With a growing number of cancer survivors, survivorship care plans (SCPs) are recommended to communicate information about late effects of treatment and follow-up care. Community oncology practices follow 85% of adult cancer survivors but report more difficulty in providing SCPs compared to academic centers. Our objective was to evaluate the impact of delivering SCPs in a community oncology practice by examining awareness of SCP receipt as well as how provision affects survivors' perception of care quality and of their condition. Survivors who accepted a SCP as standard of care were recruited from a community oncology practice in the Midwest and completed surveys prior to SCP provision (baseline) and 4 weeks later (follow-up). Within-survivor changes in knowledge of SCP receipt, satisfaction and perceived care coordination were assessed. Thirty cancer survivors (breast, colon, and prostate) completed the baseline survey, while 24 completed the follow-up survey (80% response rate). Participants reported receiving SCPs and treatment summaries more frequently at follow-up after receiving a SCP. At follow-up, there was a significant increase in survivor activation and involvement in care along with satisfaction of knowledge of care. Communication about and during SCP provision may need to be clearer: 34% of survivors could not correctly identify SCP receipt in this study. This may place these survivors at a disadvantage, if this leads to less awareness of important information regarding follow-up surveillance and management. Of those aware of SCP receipt, SCP provision had positive impacts in this small, short-term study.
Collapse
Affiliation(s)
- Alexandra Hua
- University of Wisconsin, School of Medicine & Public Health, Madison, USA
| | - Mary E Sesto
- University of Wisconsin, School of Medicine & Public Health, Madison, USA
- Carbone Cancer Center, Madison, WI, USA
| | | | | | - Amye J Tevaarwerk
- University of Wisconsin, School of Medicine & Public Health, Madison, USA.
- Carbone Cancer Center, Madison, WI, USA.
| |
Collapse
|
28
|
Parker PA, Banerjee SC, Matasar MJ, Bylund CL, Schofield E, Li Y, Jacobsen PB, Astrow AB, Leventhal H, Horwitz S, Kissane D. Cancer worry and empathy moderate the effect of a survivorship-focused intervention on quality of life. Psychooncology 2020; 29:1012-1018. [PMID: 32128909 DOI: 10.1002/pon.5371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/13/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study examined the impact of a survivorship planning consultation (SPC) for patients with Hodgkin's lymphoma and diffuses large B-cell lymphoma on quality of life (QOL). We specifically assessed two potential moderators, cancer worry and perceived empathy, of the intervention effects on QOL. METHODS This cluster randomized, four-site trial examined the efficacy of a SPC; physicians received communication skills training and applied these skills in a survivorship-focused office visit using a care plan vs a control arm in which physicians were trained to and subsequently provided a time-controlled, manualized wellness rehabilitation consultation focused only on discussion of healthy nutrition and exercise. We examined the effect of the intervention on patients' QOL and examined potential moderators-cancer worry and perceived physician empathy. RESULTS Forty-two physicians and 198 patients participated. There was no main effect of the intervention on any of the QOL dimensions (ps > 0.10). However, cancer worry was a significant moderator of the effects of the intervention on three QOL domains (physical P = .04; social P = .04; spiritual P = .01) and perceived empathy was a significant moderator of QOL (physical P = .004; psychological P = .04; social P = .01). Specifically, the beneficial effects of the intervention were more pronounced among patients who initially reported higher levels of cancer worry and lower levels of physician empathy. CONCLUSIONS This study identified two factors, perceived empathy and cancer worry, that were found to impact the QOL of patients who participated in this communication-based survivorship intervention.
Collapse
Affiliation(s)
- Patricia A Parker
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Smita C Banerjee
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Matthew J Matasar
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Carma L Bylund
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.,STEM Translational Communication Center, University of Florida, Gainesville, Florida, USA
| | - Elizabeth Schofield
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Yuelin Li
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Paul B Jacobsen
- Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Alan B Astrow
- Department of Medicine, New York Methodist Hospital, Hematology and Oncology, Weill Cornell Medical College, New York, New York, USA
| | - Howard Leventhal
- Department of Psychology, Rutgers University, New Brunswick, New Jersey, USA
| | - Steven Horwitz
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - David Kissane
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA.,University of Notre Dame Australia, School of Medicine, and the Cunningham Centre for Palliative Care Research, St Vincent's Hospital, Sydney, Australia
| |
Collapse
|
29
|
Haslam A, Herrera-Perez D, Gill J, Prasad V. Patient Experience Captured by Quality-of-Life Measurement in Oncology Clinical Trials. JAMA Netw Open 2020; 3:e200363. [PMID: 32129865 PMCID: PMC7057133 DOI: 10.1001/jamanetworkopen.2020.0363] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Quality of life (QoL) is an important consideration in cancer medicine, especially because drugs are becoming more costly and may only result in modest gains in overall survival. However, there has been no descriptive analysis for the points at which QoL is measured in cancer trials. OBJECTIVE To estimate the prevalence of studies that measure QoL at different points and see how many studies measure QoL for the entirety of a patient's life. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis includes all articles on oncology clinical trials in the 3 highest-impact oncology journals, published between July 2015 and June 2018, that reported QoL outcomes. MAIN OUTCOMES AND MEASURES Data were abstracted on when QoL was assessed and the characteristics of these studies. RESULTS For all 149 studies that met inclusion criteria, QoL assessment was high during treatment (104 articles [69.8%]), during follow-up (81 articles [54.4%]), and after the end of the intervention (68 articles [45.6%]). In 5 of the 149 studies (3.4%), QoL was assessed until death, including in only 1 of the 74 studies on metastatic or incurable cancers. Among these 5 studies, only 1 (20%) used a drug intervention, 1 (20%) used a behavioral intervention, and 2 (40%) used a radiation intervention; only 1 of 5 was in the metastatic setting. The number of studies that reported a positive QoL outcome (ie, QoL outcome was more favorable in the intervention group than in the control group) was between 42 of 81 articles (51.9%) and 16 of 28 articles (57.1%) for most QoL assessment points but only 1 of 5 articles (20%) for studies measuring QoL until death. CONCLUSIONS AND RELEVANCE This study found that most clinical trials assessed QoL during the treatment or intervention and often during a given amount of follow-up but infrequently assessed QoL on disease progression and rarely followed QoL until the end of the patient's life. Most studies reporting QoL until the end of life reported worse QoL outcomes for the intervention group than the control group. Future research and policy recommendations should consider not just short-term QoL outcomes but QoL outcomes throughout the patient's cancer care.
Collapse
Affiliation(s)
- Alyson Haslam
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | | | - Jennifer Gill
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
- Center for Health Care Ethics, Oregon Health & Science University, Portland
- Division of General Medicine, Department of Medicine, Oregon Health & Science University, Portland
| |
Collapse
|
30
|
Impact of treatment summaries for cancer survivors: a systematic review. J Cancer Surviv 2020; 14:405-416. [PMID: 32030627 DOI: 10.1007/s11764-020-00859-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE As a treatment summary (TS) documents information for follow-up care, it is believed to be an important communication tool for the patient, their GP, and other health professionals. The aim of this systematic review (SR) was to evaluate the impact of receiving a TS for cancer survivors when compared to receiving standard care and to identify knowledge gaps to inform future research. METHODS A systematic search of electronic databases and grey literature was undertaken from August 2018 to October 2018. Studies were included if participants (cancer survivors) were over 18 years of age and had received a TS, and if outcomes for TS could be separated from other survivorship interventions. The McMaster Critical Appraisal Tool was used to evaluate the methodological quality of the included studies. A narrative synthesis of the study outcomes was then conducted. RESULTS Seven studies (one prospective cohort and six cross-sectional studies) met the inclusion criteria. The impact of TS was assessed using widely varied outcomes in these studies. Overall, receipt of a TS was related to greater patient understanding and perception of the quality of care provided. However, caution is required when interpreting these results due to methodological limitations. CONCLUSIONS This systematic review found that TS may have a positive impact on patient understandings about and perceptions of cancer care. However, more robust research including perspectives of cancer survivors is required. IMPLICATIONS FOR CANCER SURVIVORS TS could play an important role for cancer survivors especially in terms of knowledge of cancer care.
Collapse
|
31
|
McDowell BD, Klemp J, Blaes A, Cohee AA, Trentham-Dietz A, Kamaraju S, Otte JL, Mott SL, Chrischilles EA. The association between cancer care coordination and quality of life is stronger for breast cancer patients with lower health literacy: A Greater Plains Collaborative study. Support Care Cancer 2020; 28:887-895. [PMID: 31168710 PMCID: PMC6893112 DOI: 10.1007/s00520-019-04894-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/22/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Health literacy (HL) and cancer care coordination (CCC) were examined for their relationship to quality of life (QOL) among breast cancer survivors. CCC was hypothesized to have a stronger relationship to QOL for women with lower HL. METHODS Women (N = 1138) who had completed treatment for Stage 0-III, ductal carcinoma breast cancer between January 2013 and May 2014 at one of eight large medical centers responded to a mailed questionnaire. Responses to questions about survivorship care planning and presence of professional care coordinator were combined to form an index of CCC. An index of HL was also derived. QOL was measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B) scales. RESULTS 74.3% (N = 845) of patients reported having a health professional coordinate their care during treatment and 78.8% (N = 897) reported receiving survivorship care planning. CCC was classified as none, partial, or high for 7.1%, 32.7%, and 60.2% of the patients, respectively. Except for emotional well-being, the interaction between HL and CCC was significant for all QOL domains (p < .05); the effect of CCC on FACT-B scores was largest for people with lower HL. For the 39.8% of patients with less than high CCC, 111 (27.3%) had a level of HL associated with clinically meaningful lower QOL. CONCLUSIONS The association between CCC and later QOL is strongest for people who have lower HL. Prioritizing care coordination for patients with lower health literacy may be an effective strategy in a setting of limited resources.
Collapse
Affiliation(s)
- Bradley D McDowell
- 5240 MERF, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA.
| | - Jennifer Klemp
- Department of Medicine, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, KS, USA
| | - Anne Blaes
- Division of Hematology, Oncology and Transplantation, 420 Delaware St SE, MMC 480, Minneapolis, MN, 55455, USA
| | - Andrea A Cohee
- Community and Health Systems, Nursing W433, Indiana University, Indianapolis, IN, 47405, USA
| | - Amy Trentham-Dietz
- Carbone Cancer Center and Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St., WARF Room 307, Madison, WI, 53726, USA
| | - Sailaja Kamaraju
- Division of Hematology, Oncology and Transplantation, Medical College of Wisconsin, Watertown Plank Road, 4th Fl Cancer Center, Milwaukee, WI, 53226, USA
| | - Julie L Otte
- Science of Nursing Care, Nursing W401, Indiana University, Indianapolis, IN, 46220, USA
| | - Sarah L Mott
- N319 CPHB, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
| | | |
Collapse
|
32
|
Hill RE, Wakefield CE, Cohn RJ, Fardell JE, Brierley ME, Kothe E, Jacobsen PB, Hetherington K, Mercieca‐Bebber R. Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes. Oncologist 2020; 25:e351-e372. [PMID: 32043786 PMCID: PMC7011634 DOI: 10.1634/theoncologist.2019-0184] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision. METHODS We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome. RESULTS Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects. CONCLUSION SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies. IMPLICATIONS FOR PRACTICE Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.
Collapse
Affiliation(s)
- Rebecca E. Hill
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Claire E. Wakefield
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Richard J. Cohn
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Joanna E. Fardell
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Mary‐Ellen E. Brierley
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Emily Kothe
- School of Psychology, Deakin UniversityGeelongAustralia
| | | | - Kate Hetherington
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Rebecca Mercieca‐Bebber
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of SydneyCamperdownAustralia
| |
Collapse
|
33
|
Høeg BL, Bidstrup PE, Karlsen RV, Friberg AS, Albieri V, Dalton SO, Saltbæk L, Andersen KK, Horsboel TA, Johansen C. Follow-up strategies following completion of primary cancer treatment in adult cancer survivors. Cochrane Database Syst Rev 2019; 2019:CD012425. [PMID: 31750936 PMCID: PMC6870787 DOI: 10.1002/14651858.cd012425.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most cancer survivors receive follow-up care after completion of treatment with the primary aim of detecting recurrence. Traditional follow-up consisting of fixed visits to a cancer specialist for examinations and tests are expensive and may be burdensome for the patient. Follow-up strategies involving non-specialist care providers, different intensity of procedures, or addition of survivorship care packages have been developed and tested, however their effectiveness remains unclear. OBJECTIVES The objective of this review is to compare the effect of different follow-up strategies in adult cancer survivors, following completion of primary cancer treatment, on the primary outcomes of overall survival and time to detection of recurrence. Secondary outcomes are health-related quality of life, anxiety (including fear of recurrence), depression and cost. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases and two trials registries on 11 December 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We included all randomised trials comparing different follow-up strategies for adult cancer survivors following completion of curatively-intended primary cancer treatment, which included at least one of the outcomes listed above. We compared the effectiveness of: 1) non-specialist-led follow-up (i.e. general practitioner (GP)-led, nurse-led, patient-initiated or shared care) versus specialist-led follow-up; 2) less intensive versus more intensive follow-up (based on clinical visits, examinations and diagnostic procedures) and 3) follow-up integrating additional care components relevant for detection of recurrence (e.g. patient symptom education or monitoring, or survivorship care plans) versus usual care. DATA COLLECTION AND ANALYSIS We used the standard methodological guidelines by Cochrane and Cochrane Effective Practice and Organisation of Care (EPOC). We assessed the certainty of the evidence using the GRADE approach. For each comparison, we present synthesised findings for overall survival and time to detection of recurrence as hazard ratios (HR) and for health-related quality of life, anxiety and depression as mean differences (MD), with 95% confidence intervals (CI). When meta-analysis was not possible, we reported the results from individual studies. For survival and recurrence, we used meta-regression analysis where possible to investigate whether the effects varied with regards to cancer site, publication year and study quality. MAIN RESULTS We included 53 trials involving 20,832 participants across 12 cancer sites and 15 countries, mainly in Europe, North America and Australia. All the studies were carried out in either a hospital or general practice setting. Seventeen studies compared non-specialist-led follow-up with specialist-led follow-up, 24 studies compared intensity of follow-up and 12 studies compared patient symptom education or monitoring, or survivorship care plans with usual care. Risk of bias was generally low or unclear in most of the studies, with a higher risk of bias in the smaller trials. Non-specialist-led follow-up compared with specialist-led follow-up It is uncertain how this strategy affects overall survival (HR 1.21, 95% CI 0.68 to 2.15; 2 studies; 603 participants), time to detection of recurrence (4 studies, 1691 participants) or cost (8 studies, 1756 participants) because the certainty of the evidence is very low. Non-specialist- versus specialist-led follow up may make little or no difference to health-related quality of life at 12 months (MD 1.06, 95% CI -1.83 to 3.95; 4 studies; 605 participants; low-certainty evidence); and probably makes little or no difference to anxiety at 12 months (MD -0.03, 95% CI -0.73 to 0.67; 5 studies; 1266 participants; moderate-certainty evidence). We are more certain that it has little or no effect on depression at 12 months (MD 0.03, 95% CI -0.35 to 0.42; 5 studies; 1266 participants; high-certainty evidence). Less intensive follow-up compared with more intensive follow-up Less intensive versus more intensive follow-up may make little or no difference to overall survival (HR 1.05, 95% CI 0.96 to 1.14; 13 studies; 10,726 participants; low-certainty evidence) and probably increases time to detection of recurrence (HR 0.85, 95% CI 0.79 to 0.92; 12 studies; 11,276 participants; moderate-certainty evidence). Meta-regression analysis showed little or no difference in the intervention effects by cancer site, publication year or study quality. It is uncertain whether this strategy has an effect on health-related quality of life (3 studies, 2742 participants), anxiety (1 study, 180 participants) or cost (6 studies, 1412 participants) because the certainty of evidence is very low. None of the studies reported on depression. Follow-up strategies integrating additional patient symptom education or monitoring, or survivorship care plans compared with usual care: None of the studies reported on overall survival or time to detection of recurrence. It is uncertain whether this strategy makes a difference to health-related quality of life (12 studies, 2846 participants), anxiety (1 study, 470 participants), depression (8 studies, 2351 participants) or cost (1 studies, 408 participants), as the certainty of evidence is very low. AUTHORS' CONCLUSIONS Evidence regarding the effectiveness of the different follow-up strategies varies substantially. Less intensive follow-up may make little or no difference to overall survival but probably delays detection of recurrence. However, as we did not analyse the two outcomes together, we cannot make direct conclusions about the effect of interventions on survival after detection of recurrence. The effects of non-specialist-led follow-up on survival and detection of recurrence, and how intensity of follow-up affects health-related quality of life, anxiety and depression, are uncertain. There was little evidence for the effects of follow-up integrating additional patient symptom education/monitoring and survivorship care plans.
Collapse
Affiliation(s)
- Beverley L Høeg
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Pernille E Bidstrup
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Randi V Karlsen
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Anne Sofie Friberg
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Rigshospitalet, Copenhagen University HospitalDepartment of OncologyCopenhagenDenmark
| | - Vanna Albieri
- Danish Cancer Society Research CenterStatistics and Pharmaco‐Epidemiology UnitStrandboulevarden 49CopenhagenDenmark
| | - Susanne O Dalton
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Zealand University HospitalDepartment of OncologyNæstvedDenmark
| | - Lena Saltbæk
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Zealand University HospitalDepartment of OncologyNæstvedDenmark
| | - Klaus Kaae Andersen
- Danish Cancer Society Research CenterStatistics and Pharmaco‐Epidemiology UnitStrandboulevarden 49CopenhagenDenmark
| | - Trine Allerslev Horsboel
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Christoffer Johansen
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Rigshospitalet, Copenhagen University HospitalDepartment of OncologyCopenhagenDenmark
| | | |
Collapse
|
34
|
Sanft T, Denlinger CS, Armenian S, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Hudson M, Khakpour N, Koura D, Lally RM, Langbaum TS, McDonough AL, Melisko M, Mooney K, Moore HCF, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Peterson L, Pirl W, Rodriguez MA, Ruddy KJ, Smith S, Syrjala KL, Tevaarwerk A, Urba SG, Zee P, McMillian NR, Freedman-Cass DA. NCCN Guidelines Insights: Survivorship, Version 2.2019. J Natl Compr Canc Netw 2019; 17:784-794. [PMID: 31319383 PMCID: PMC7094216 DOI: 10.6004/jnccn.2019.0034] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of cancer and cancer treatment to aid healthcare professionals who work with survivors of adult-onset cancer. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors and to facilitate care coordination to ensure that all needs are addressed. These NCCN Insights summarize some of the topics discussed by the NCCN Survivorship Panel during the 2019 update of the guidelines, including the survivorship population addressed, ways to improve care coordination, and pain management.
Collapse
Affiliation(s)
- Tara Sanft
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Mindy Goldman
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Melissa Hudson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | | | - Kathi Mooney
- Huntsman Cancer Institute at the University of Utah
| | - Halle C F Moore
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Lindsay Peterson
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Phyllis Zee
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University; and
| | | | | |
Collapse
|
35
|
Efficacy of a web-based women's health survivorship care plan for young breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 2019; 176:579-589. [PMID: 31054032 DOI: 10.1007/s10549-019-05260-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/26/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Breast cancer survivorship care plans (SCP) have limited content addressing women's health issues. This trial tested if young breast cancer survivors who receive a web-based, women's health SCP were more likely to improve on at least one of the four targeted issues (hot flashes, fertility-related concerns, contraception, and vaginal symptoms) compared to attention controls. METHODS A randomized controlled trial recruited female survivors ages 18-45 at diagnosis, 18-50 at enrollment, completed primary cancer treatment, and had a significant women's health issue: moderate or higher fertility-related concerns; ≥ 4 hot flashes/day with ≥ 1 of moderate severity; ≥ 1 moderate vaginal atrophy symptoms; or not contracepting/using less effective methods. Survivors underwent stratified, block randomization with equal allocation to intervention and control groups. The intervention group accessed the online SCP; controls accessed curated resource lists. In intention-to-treat analysis, the primary outcome of improvement in at least one issue by 24 weeks was compared by group. RESULTS 182 participants (86 intervention, 96 control), mean age 40.0 ± 5.9 and 4.4 ± 3.2 years since diagnosis, were randomized. 61 intervention group participants (70.9%) improved, compared to 55 controls (57.3%) (OR 1.82, 95% CI 0.99-3.4, p = 0.057). The following issue-specific improvements were observed in the intervention versus control arms: fertility-related concerns (27.9% vs. 14.6%, OR 2.3, 95% CI 1.1-4.8); hot flashes (58.5% vs. 55.8%, OR 1.1, 95% CI 0.57-2.2); vaginal symptoms (42.5% vs. 40.7%, OR 1.1, 95% CI 0.6-2.0); contraception (50% vs. 42.6%, OR 1.4, 95% CI 0.74-2.5). CONCLUSIONS In young breast cancer survivors, a novel, web-based SCP did not result in more change in the primary outcome of improvement in at least one of the four targeted women's health issues, than the attention control condition. The intervention was associated with improved infertility concerns, supporting efficacy of disseminating accessible, evidence-based women's health information to this population.
Collapse
|
36
|
Ivanics T, Proctor E, Chen Y, Ali H, Severson D, Nasser H, Colbert S, Susick L, Walker E, Petersen L, Bensenhaver J, Loutfi R, Nathanson SD, Newman LA. Evaluation of a Multidisciplinary Team Approach for Generating Survivorship Care Plan Treatment Summaries in Patients With Breast Cancer. J Oncol Pract 2019; 15:e467-e474. [DOI: 10.1200/jop.18.00509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION: The optimal structure for survivorship care plan (SCP) programs and methodology for generating treatment summaries (TSs) has not yet been defined, but the Commission on Cancer and the National Accreditation Program for Breast Centers both mandate that participating oncology programs implement SCP-TS processes for patients that have completed treatment. METHODS: We used the Institute for Healthcare Improvement’s Plan-Do-Study-Act model for conducting a quality improvement project evaluating two different SCP-TS programs implemented at the Henry Ford Health System/Henry Ford Cancer Institute’s Breast Oncology Program in Detroit, Michigan. System I involved TSs drafted by nonspecialist breast clinic staff; System II involved TSs vetted through a multidisciplinary breast specialist conference approach. Accuracy of basic documentation entries related to dates and components of treatment were compared for the two approaches. RESULTS: Seventy-one System I and 93 System II documents were reviewed. Documentation was accurate in at least 90% of documents for both systems regarding delivery of chemotherapy and/or endocrine therapy and for documenting the identity of the various members of the cancer treatment team. Both systems had notable inaccuracies in documenting type of surgery performed, but System II had fewer inaccuracies than System I (33.78% v 51.67%, respectively; P = .05). System II, compared with System I, had fewer inaccuracies in documenting date of diagnosis (9.68% v 25.35%, respectively; P = .01) and had less missing information for dose of radiation delivered (9.33% v 33.9%, respectively; P < .01). CONCLUSION: A multidisciplinary team approach to drafting and reviewing SCP-TS documents improved content accuracy for our program, but ongoing education regarding documentation of various surgical procedures is warranted.
Collapse
Affiliation(s)
- Tommy Ivanics
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | - Erica Proctor
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | - Yalei Chen
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | - Haythem Ali
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | - Dawn Severson
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | - Hassan Nasser
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | - Sonja Colbert
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | - Laura Susick
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | - Eleanor Walker
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | - Lindsay Petersen
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | | | - Randa Loutfi
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
| | | | - Lisa A. Newman
- Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI
- Weill Cornell Medicine, New York NY
| |
Collapse
|
37
|
Viscuse P, Yost KJ, Jenkins S, Lackore K, Habermann T, Thanarajasingam G, Thompson C. Impact of lymphoma survivorship clinic visit on patient-centered outcomes. J Cancer Surviv 2019; 13:344-352. [PMID: 31028525 DOI: 10.1007/s11764-019-00756-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Cancer survivors may experience physical, social, and emotional effects of cancer and its treatments. National Comprehensive Cancer Network (NCCN) guidelines recommend the development of a survivorship care plan (SCP) for cancer patients following completion of treatment with curative intent. Our institution developed a lymphoma survivorship clinic (SC) to assess patient needs, provide education, and create and deliver SCPs. This study analyzed the impact of a SC visit on patient-centered outcomes. METHODS Surveys were sent to lymphoma patients at Mayo Clinic Rochester within 4 weeks of their post-treatment visit to the SC that queried patient-reported outcomes, including experience of care, quality of life (QOL), and distress. We compared survey responses between those who attended the SC and those who were eligible but did not attend. RESULTS From November 2013 to May 2015, 236 lymphoma patients were surveyed, 96 of whom had a SC visit and 140 of who were eligible but did not attend. Those who attended the SC were more likely to "definitely" recall discussion on improving health, preventing illness, and making changes in habits/lifestyle, diet, and exercise. There were no differences in QOL or distress. Adjusted analyses revealed that SC attendance was associated with better self-reported overall health among younger patients and better physical well-being in Hodgkin lymphoma patients compared to those with other subtypes of lymphoma. CONCLUSIONS Participation in the lymphoma SC improved patient education on survivorship issues, particularly health behaviors. There may be a particular benefit in younger patients. However, there were no differences in QOL or distress. Further study is needed to determine if improved survivorship education and SCP delivery leads to long-term health benefits in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Our study evaluates the clinical impact of a SC in patients treated for lymphoma. We demonstrate that a SC visit improves patient education regarding health behaviors.
Collapse
Affiliation(s)
- Paul Viscuse
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Sarah Jenkins
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Kandace Lackore
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Thomas Habermann
- Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Gita Thanarajasingam
- Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Carrie Thompson
- Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW The transition from primary cancer treatment to posttreatment follow-up care is seen as critical to the long-term health of survivors. However, relatively little attention has been paid to understanding this pivotal period. This review will offer a brief outline of the significant work surrounding this pivotal time published in the past year. RECENT FINDINGS The growing number of cancer survivors has stimulated an emphasis on finding new models of care, whereby responsibility for survivorship follow-up is transitioned to primary care providers. A variety of models and tools have emerged for follow-up care. Survivorship care plans are heralded as a key component of survivorship care and a vehicle for supporting transition. Uptake of survivorship care plans and implementation of evidence-based models of survivorship care has been slow, hindered by a range of barriers. SUMMARY Evaluation is needed regarding survivorship models in terms of feasibility, survivor friendliness, cost effectiveness, and achievement of sustainable outcomes. How, and when, to introduce plans for transition to the patient and determine transition readiness are important considerations but need to be informed by evidence. Additional study is needed to identify best practice for the introduction and application of survivorship care plans.
Collapse
|
39
|
A cross-sectional population-based survey looking at the impact of cancer survivorship care plans on meeting the needs of cancer survivors in the posttreatment stage. Support Care Cancer 2019; 27:3785-3792. [PMID: 30721368 DOI: 10.1007/s00520-019-04685-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to determine the impact of receiving a survivorship care plan (SCP) on meeting cancer survivors' overall, informational, physical, emotional, and practical needs. Since the recommendation for implementation of SCPs, there have been numerous studies on their effectiveness with mostly inconclusive results. METHODS All Nova Scotia survivors meeting specific inclusion and exclusion criteria were identified from the Nova Scotia Cancer Registry and sent the 83-item survey to assess experiences and needs across five domains (overall, informational, physical, emotional, and practical). Descriptive statistics (frequencies, percentages) and chi-square analyses were used to examine and report survey findings. RESULTS The response rate was 44.6%, with 1514 respondents. SCPs were significantly associated (p < 0.00001) with receiving timely help and support to meet survivors' overall, informational, physical, emotional, and practical needs posttreatment. For the most part, survivors' clinical characteristics, such as cancer type, time since treatment, chronic comorbidities, and metastases, did not result in differences among the five outcomes. CONCLUSIONS Those who received a SCP reported higher agreement on all five outcomes in comparison to those who did not receive a SCP. Further work should evaluate the delivery of SCPs and the components of SCPs that are most likely to contribute to positive survivor outcomes.
Collapse
|
40
|
Stark SS, Natarajan L, Chingos D, Ehren J, Gorman JR, Krychman M, Kwan B, Mao JJ, Myers E, Walpole T, Pierce JP, Su HI. Design of a randomized controlled trial on the efficacy of a reproductive health survivorship care plan in young breast cancer survivors. Contemp Clin Trials 2019; 77:27-36. [PMID: 30553078 PMCID: PMC6754982 DOI: 10.1016/j.cct.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/01/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Young breast cancer survivors (YBCS) have unmet needs for managing hot flashes, fertility-related concerns, sexual health, and contraception. PURPOSE Describe the design and participant characteristics of a randomized controlled trial testing the efficacy of the survivorship care plan on reproductive health (SCP-R) intervention on improving hot flashes, fertility-related concerns, sexual health, and contraception in YBCS. METHODS SCP-R is a web-based intervention with text message support encompassing evidence- based practices on four reproductive health issues. YBCS with ≥1 reproductive health issue are randomized to intervention (full SCP-R access) or attention control (access to list of online resources) arms with 24-week follow-up. The primary outcome will be improvement of at least one reproductive health issue measured by validated self-report instruments. Each YBCS nominated one healthcare provider (HCP), who can access the same materials as their patient. HCP outcomes are preparedness and confidence in discussing each issue. RESULTS Among 318 YBCS screened, 57.2% underwent randomization. Mean age was 40.0 (SD 5.9), and mean age at cancer diagnosis was 35.6 (SD 5.4). Significant hot flashes, fertility-related concerns, vaginal symptoms, and inadequate contraception were reported by 50.5%, 50%, 46.7%, 62.1% of YBCS, respectively; 70.9% had multiple issues. Among 165 nominated HCPs, 32.7% enrolled. The majority of HCPs reported preparedness (68.5-90.7%) and confidence (50.0-74.1%) in discussing reproductive health issues with YBCS. HCPs were least likely to report preparedness or confidence in discussing fertility-related concerns. CONCLUSION Conducting a trial for improving YBCS reproductive health online is feasible, providing a mechanism to disseminate evidence-based management.
Collapse
Affiliation(s)
- Shaylyn S Stark
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr. La Jolla, CA 92093-090, USA.
| | - Loki Natarajan
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr. La Jolla, CA 92093-090, USA; Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0628, USA.
| | - Diana Chingos
- Patient Advocate & Representative, Young Survival Coalition, 10995 Wrightwood Lane, Studio City, CA 91604, USA
| | - Jennifer Ehren
- Department of Chemical and Biomolecular Engineering, University of Notre Dame, 172 Fitzpatrick Hall, Notre Dame, IN 46556-5637, USA.
| | - Jessica R Gorman
- School of Social and Behavioral Health Sciences, Oregon State University College of Public Health and Human Sciences, 160 SW 26(th) St, Corvallis, OR 97331, USA.
| | - Michael Krychman
- Southern California Center for Sexual Health and Survivorship Medicine, 1501 Superior Ave, Suite 201, Newport Beach, CA 92663, USA
| | - Brian Kwan
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr. La Jolla, CA 92093-090, USA.
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Emily Myers
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr. La Jolla, CA 92093-090, USA.
| | - Tom Walpole
- Trials.ai, 4250 Executive Square Suite 200, La Jolla, CA 92037, USA.
| | - John P Pierce
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr. La Jolla, CA 92093-090, USA; Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0628, USA.
| | - H Irene Su
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr. La Jolla, CA 92093-090, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, 9300 Campus Pointe Drive, MC 7433, La Jolla, CA 92037, USA.
| |
Collapse
|
41
|
Ruiz-Pérez I, Rodríguez-Gómez M, Pastor-Moreno G, Escribá-Agüir V, Petrova D. Effectiveness of interventions to improve cancer treatment and follow-up care in socially disadvantaged groups. Psychooncology 2019; 28:665-674. [PMID: 30695816 DOI: 10.1002/pon.5011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify and characterize the interventions that aimed to improve cancer treatment and follow-up care in socially disadvantaged groups. To summarize the state of the art for clinicians and researchers. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were randomized controlled trials and quasi-experimental studies with a control group (usual care or enhanced usual care) conducted in Organization for Economic Co-operation and Development (OECD) member countries and published until 2016. RESULTS Thirty-one interventions were identified, the majority of which were conducted in the United States in patients with breast cancer. Most interventions aimed to decrease social inequalities based on ethnicity/race and/or socioeconomic level, with fewer interventions targeting inequalities based on geographical area. The most frequently assessed outcomes were quality of life (n = 20) and psychosocial factors (n = 20), followed by treatment adherence or satisfaction (n = 12,), knowledge (n = 11), pain management (n = 10), and lifestyle habits (n = 3). CONCLUSIONS The impact of interventions designed to improve cancer treatment and follow-up care in socially disadvantages groups is multifactorial. Multicomponent-intervention approaches and cultural adaptations are common, and their effectiveness should be evaluated in the populations of interest. More interventions are needed from outside the Unite States and in patients with cancers other than breast cancer, targeting gender or geographical inequalities and addressing key outcomes such as treatment adherence or symptom management.
Collapse
Affiliation(s)
- Isabel Ruiz-Pérez
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain.,Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
| | | | - Guadalupe Pastor-Moreno
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain
| | - Vicenta Escribá-Agüir
- Department of Nursing, University of Valencia, Valencia, Spain.,Fundación para el fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Dafina Petrova
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain.,Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
| |
Collapse
|
42
|
Tevaarwerk AJ, Hocking WG, Buhr KA, Gribble M, Seaborne LA, Wisinski KB, Burkard ME, Yen T, Wiegmann DA, Sesto ME. A randomized trial of immediate versus delayed survivorship care plan receipt on patient satisfaction and knowledge of diagnosis and treatment. Cancer 2019; 125:1000-1007. [PMID: 30690714 DOI: 10.1002/cncr.31875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/07/2018] [Accepted: 10/08/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivorship care plans (SCPs) and care-planning sessions have been recommended for over a decade, yet evidence for their benefit remains mixed. In a randomized trial, changes in survivor knowledge and satisfaction before and after the receipt of an SCP were assessed. METHODS Patients with breast cancer who had completed curative-intent treatment were randomized to immediate versus delayed receipt of an individualized SCP. All participants completed the modified Wisconsin Survey of Cancer Diagnosis and Management in Breast Cancer and the Preparing for Life As a New Survivor survey to assess individual knowledge about cancer diagnosis, treatment, side effects, and follow-up as well as satisfaction with communication and care coordination. Surveys were completed at baseline, at 4 weeks (before delayed receipt), and again at 12 weeks (after all participants had received SCPs); the primary outcome was change in knowledge at 4 weeks. RESULTS In total, 127 eligible women were randomized. An improvement in individual knowledge was observed between baseline and week 12 for both arms combined (+1.6; 95% confidence interval, 0.9-2.3; P < .001). There was no statistically significant difference in the change in knowledge from baseline through week 4 between the arms. No significant change occurred for satisfaction scores over time. CONCLUSIONS This randomized trial of immediate versus delayed SCP receipt demonstrated a small improvement (4%) in survivor knowledge. However, this improvement did not appear to be related to SCP provision. The authors hypothesized that the improvement was because of repeated administration of the knowledge survey. If improved survivor knowledge is a goal, then strategies beyond the 1-time provision and review of an SCP should be explored.
Collapse
Affiliation(s)
- Amye J Tevaarwerk
- Division of Hematology/Oncology, Department of Medicine, The University of Wisconsin-Madison, Madison, Wisconsin.,The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin
| | | | - Kevin A Buhr
- Department of Biostatistics and Medical Informatics, The University of Wisconsin-Madison, Madison, Wisconsin
| | - Mindy Gribble
- Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Lori A Seaborne
- Department of Surgery, The University of Wisconsin-Madison, Madison, Wisconsin
| | - Kari B Wisinski
- The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin.,The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Mark E Burkard
- Division of Hematology/Oncology, Department of Medicine, The University of Wisconsin-Madison, Madison, Wisconsin.,The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin
| | - Thomas Yen
- The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Douglas A Wiegmann
- The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Mary E Sesto
- The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin.,Department of Medicine, The University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
43
|
Coughlin SS, Caplan L, Stewart JL, Young L. Do Breast Cancer Survivorship Care Plans Improve Health Outcomes? JOURNAL OF CANCER TREATMENT & DIAGNOSIS 2019; 3:28-33. [PMID: 31149659 PMCID: PMC6537902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although they have been widely studied, important questions remain about the impact of breast cancer survivorship care plans on improving health outcomes. The goal of this article was to review published studies on the impact of cancer survivorship care plans on health outcomes and health care delivery among breast cancer survivors. A total of 111 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, 7 studies met the eligibility criteria. All of the studies had a randomized controlled design. Early trials of the efficacy of breast cancer survivorship care plans generally showed little or no improvement in health outcomes. The positive findings of recent studies suggest that survivorship care interventions that empower and activate patients to self-manage their follow-up care and improve patient-provider communication may be especially promising.
Collapse
Affiliation(s)
- Steven S. Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA,Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, GA,Correspondence: Dr. Steven S. Coughlin, Professor, Division of Epidemiology, Department of Population Health Sciences, Medical College of Georgia, Augusta University, 1120 15th Street, AE-1042, Augusta, GA 30912, USA;
| | - Lee Caplan
- Morehouse College of Medicine, Department of Community Health and Preventive Medicine, Atlanta, GA
| | | | - Lufei Young
- College of Nursing, Augusta University, Augusta, GA
| |
Collapse
|
44
|
de Rooij BH, Ezendam NPM, Vos MC, Pijnenborg JMA, Boll D, Kruitwagen RFPM, van de Poll-Franse LV. Patients' information coping styles influence the benefit of a survivorship care plan in the ROGY Care Trial: New insights for tailored delivery. Cancer 2018; 125:788-797. [PMID: 30500067 PMCID: PMC6587821 DOI: 10.1002/cncr.31844] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/14/2018] [Accepted: 09/27/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND In efforts to improve the implementation of survivorship care plans (SCPs), the authors assessed whether the impact of SCPs on patient-reported outcomes differed between patients with an information-seeking coping style (monitoring) versus those with an information-avoiding coping style (blunting). METHODS In the Registration System Oncological Gynecology (ROGY) Care Trial, 12 hospitals in the Netherlands were randomized to deliver SCP care or usual care. All patients with newly diagnosed endometrial and ovarian cancer in the SCP care arm received an SCP that was generated automatically by their oncology provider through the web-based ROGY registration system. Outcomes (satisfaction with information provision and care, illness perceptions, and health care use) were measured directly after initial treatment and after 6, 12, and 24 months. Information coping style was measured at 12 months after initial treatment. RESULTS Among patients who had a monitoring coping style (N = 123), those in the SCP care arm reported higher satisfaction with information provision (mean score: 73.9 vs 63.9, respectively; P = .04) and care (mean score: 74.5 vs 69.2, respectively; P = .03) compared with those in the usual care arm. Among patients who had a blunting coping style (N = 102), those in the SCP care arm reported a higher impact of the disease on life (mean score: 5.0 vs 4.5, respectively; P = .02) and a higher emotional impact of the disease (mean score: 5.4 vs 4.2, respectively; P = .01) compared with those in the usual care arm. CONCLUSIONS SCPs may be beneficial for patients who desire information about their disease, whereas SCPs may be less beneficial for patients who avoid medical information, suggesting a need for tailored SCP delivery to improve survivorship care.
Collapse
Affiliation(s)
- Belle H de Rooij
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Nicole P M Ezendam
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - M Caroline Vos
- Gynecologic Cancer Center South, Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk, the Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dorry Boll
- Department of Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Roy F P M Kruitwagen
- Department of Gynecology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lonneke V van de Poll-Franse
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.,Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
45
|
Survivorship care visits in a high-risk population of breast cancer survivors. Breast Cancer Res Treat 2018; 173:701-708. [PMID: 30406364 DOI: 10.1007/s10549-018-5028-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Breast cancer survivors face numerous challenges after diagnosis and treatment. Several models have been developed to attempt to improve quality of care. Here, we describe characteristics and outcomes of patients who participated in survivorship visits (SV) at Johns Hopkins (JH). METHODS We retrospectively reviewed charts of breast cancer patients who participated in an optional SV 1-3 months after completing locoregional therapy and initial systemic therapy. We report patient demographics, comorbidities, tumor characteristics, treatments, and responses to symptom questionnaires. We compared the characteristics of SV participants to stage I-III analytical cases in the 2010-2015 JH Cancer Registry (JHCR). RESULTS We identified 87 women with stage I-III breast cancer who participated in SVs from 2010 to 2016. Compared to patients in the JHCR (n = 2942), SV participants were younger, more likely to be African American and more likely to have a higher TNM stage, hormone receptor-negative disease, and HER2-positive disease. They were more likely to have received chemotherapy and radiation therapy. They also have similar recurrence rates despite the SV cohort's shorter median follow-up time. Among SV participants, the prevalence of comorbidities including peripheral neuropathy, anemia, lymphedema, anxiety, deep vein thrombosis, and depression increased significantly from time of diagnosis to most recent follow-up. CONCLUSIONS Compared to the JHCR cohort, SV participants had higher risk cancers and a high frequency of comorbidities potentially associated with breast cancer and therapy. These high-risk patients may benefit most from specific interventions targeting survivorship care, and their experiences may help improve care delivery models.
Collapse
|
46
|
Parker PA, Banerjee SC, Matasar MJ, Bylund CL, Rogers M, Franco K, Schofield E, Li Y, Levin TT, Jacobsen PB, Astrow AB, Leventhal H, Horwitz S, Kissane D. Efficacy of a survivorship-focused consultation versus a time-controlled rehabilitation consultation in patients with lymphoma: A cluster randomized controlled trial. Cancer 2018; 124:4567-4576. [PMID: 30335188 DOI: 10.1002/cncr.31767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Survivors of cancer often describe a sense of abandonment after treatment along with heightened uncertainty and limited knowledge of what lies ahead. This study examined the efficacy of a survivorship care plan (SCP) intervention to help physicians to address survivorship issues through communication skills training plus a new consultation focused on the use of an SCP for patients with Hodgkin lymphoma and diffuse large B-cell lymphoma. METHODS This 4-site cluster randomized trial examined the efficacy of a survivorship planning consultation (SPC) in patients who achieved complete remission after the completion of first-line therapy (for the SPC, physicians received communication skills training and, using an SCP, applied those skills in a survivorship-focused office visit) versus a control arm in which physicians were trained in and subsequently provided a time-controlled, manualized wellness rehabilitation consultation (WRC) focused only on discussion of healthy nutrition and exercise as rehabilitation after chemotherapy. The primary outcomes for patients were changes in knowledge about lymphoma and adherence to physicians' recommendations for vaccinations and cancer screenings. RESULTS Forty-two physicians and 198 patients participated across the 4 sites. Patients whose physicians were in the SPC arm had greater knowledge about their lymphoma (P = .01) and showed greater adherence to physician recommendations for influenza vaccinations (P = .02) and colonoscopy (P = .02) than patients whose physicians were in the WRC arm. CONCLUSIONS A dedicated consultation using an SCP and supported by communication skills training may enhance patients' knowledge and adherence to some health promotion recommendations.
Collapse
Affiliation(s)
- Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
| | - Matthew J Matasar
- Department of Medicine, Weill Cornell Medical College, New York
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York
| | - Carma L Bylund
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- STEM Translational Communication Center, University of Florida, Gainesville
| | - Madeline Rogers
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
| | - Kara Franco
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
| | - Tomer T Levin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
| | - Paul B Jacobsen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Alan B Astrow
- Department of Medicine, New York Methodist Hospital, New York
- Hematology and Oncology, Weill Cornell Medical College, New York
| | - Howard Leventhal
- Department of Psychology, Rutgers University, New Brunswick, New Jersey
| | - Steven Horwitz
- Department of Medicine, Weill Cornell Medical College, New York
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York
| | - David Kissane
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York
- Department of Psychiatry, Weill Cornell Medical College, New York
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
47
|
Tevaarwerk AJ, Sesto ME. Continued Challenges to the Adoption and Implementation of Survivorship Care Plans. J Oncol Pract 2018; 14:573-576. [PMID: 30192692 PMCID: PMC6184078 DOI: 10.1200/jop.18.00378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amye J. Tevaarwerk
- University of Wisconsin; and University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Mary E. Sesto
- University of Wisconsin; and University of Wisconsin Carbone Cancer Center, Madison, WI
| |
Collapse
|
48
|
Tevaarwerk AJ, Klemp JR, van Londen GJ, Hesse BW, Sesto ME. Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors. Cancer 2018; 124:4292-4300. [PMID: 30277575 DOI: 10.1002/cncr.31546] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/13/2018] [Accepted: 03/19/2018] [Indexed: 01/22/2023]
Abstract
The American cancer survivor population is ever-growing, with necessary follow-up primarily accomplished in a high-touch fashion-adding to unsustainability and fragmentation of care. Given the complexities of the health care system processes needed to support survivorship, engineering approaches may best address performance deficits and facilitate the provision of patient-centered care. Such collaboration between health care and engineering is recommended for redesigning health care delivery systems. By using Systems Engineering Initiative for Patient Safety (SEIPS), a systems engineering model widely used to improve health care quality and delivery, the authors examine the work system to identify the barriers and facilitators to necessary care in the presence of a survivorship care plan and visit. Recommendations for future improvement include ensuring that care-planning processes are dynamic, clearly assigned, resilient, and integrated with electronic health record systems.
Collapse
Affiliation(s)
- Amye J Tevaarwerk
- Department of Medicine, University of Wisconsin, Madison and Carbone Cancer Center, Madison, Wisconsin
| | - Jennifer R Klemp
- Department of Medicine, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, Kansas
| | - Gijsberta J van Londen
- University of Pittsburgh Cancer Institute and School/Department of Medicine, Pittsburgh, Pennsylvania
| | - Bradford W Hesse
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Mary E Sesto
- Department of Medicine, University of Wisconsin, Madison and Carbone Cancer Center, Madison, Wisconsin
| |
Collapse
|
49
|
Birken SA, Clary AS, Bernstein S, Bolton J, Tardif-Douglin M, Mayer DK, Deal AM, Jacobs SR. Strategies for Successful Survivorship Care Plan Implementation: Results From a Qualitative Study. J Oncol Pract 2018; 14:e462-e483. [PMID: 30004824 PMCID: PMC6804914 DOI: 10.1200/jop.17.00054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Care for US cancer survivors is often fragmented, contributing to poor health outcomes. Care and outcomes may improve when survivors and follow-up care providers receive survivorship care plans (SCPs), written documents containing information regarding cancer diagnosis, treatment, surveillance plans, and health promotion. However, implementing SCPs is challenging. As such, we sought to identify strategies for successfully implementing SCPs. METHODS We measured SCP implementation using performance data from cancer programs participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative, an oncologist-led quality assessment and improvement program. We used semistructured interviews with cancer program employees (eg, physicians) to identify strategies for successfully implementing SCPs by comparing approaches in cancer programs that, according to Quality Oncology Practice Initiative performance indicators, developed and delivered SCPs to a relatively small proportion of eligible survivors and their follow-up care providers (ie, low performers; n = 6 participants in five programs) with approaches among programs with better performance (ie, moderate performers; n = 15 participants in nine programs). RESULTS Ten of 14 cancer programs developed SCPs for ≥ 50% of eligible survivors; two of 14 delivered SCPs to any survivors; and eight of 14 delivered SCPs to ≥ 25% of follow-up care providers. We found that moderate performers proactively addressed SCP requirements, leveraged requirements to improve survivorship care, set internal targets, automated implementation, had active leaders and champions, and tasked appropriate employees with SCP implementation. CONCLUSION SCP implementation remains challenging. We identified strategies for successfully implementing SCPs. Future research should examine how cancer programs have achieved these strategies; findings could contribute to an understanding of the changes needed to implement comprehensive survivorship care.
Collapse
Affiliation(s)
- Sarah A. Birken
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Alecia S. Clary
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Shampa Bernstein
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Jamiyla Bolton
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Miriam Tardif-Douglin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Deborah K. Mayer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Allison M. Deal
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Sara R. Jacobs
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| |
Collapse
|
50
|
Taylor K, Monterosso L, Bulsara C. Qualitative results from a phase II pilot randomised controlled trial of a lymphoma nurse-led model of survivorship care. Eur J Oncol Nurs 2018; 35:9-14. [DOI: 10.1016/j.ejon.2018.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 11/30/2022]
|