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Berkman AM, Betts AC, Beauchemin M, Parsons SK, Freyer DR, Roth ME. Survivorship after adolescent and young adult cancer: models of care, disparities, and opportunities. J Natl Cancer Inst 2024; 116:1417-1428. [PMID: 38833671 DOI: 10.1093/jnci/djae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
Survivors of adolescent and young adult (AYA; age 15-39 years at diagnosis) cancer are a growing population with the potential to live for many decades after treatment completion. Survivors of AYA cancer are at risk for adverse long-term outcomes including chronic conditions, secondary cancers, impaired fertility, poor psychosocial health and health behaviors, and financial toxicity. Furthermore, survivors of AYA cancer from racially minoritized and low socioeconomic status populations experience disparities in these outcomes, including lower long-term survival. Despite these known risks, most survivors of AYA cancer do not receive routine survivorship follow-up care, and research on delivering high-quality, evidence-based survivorship care to these patients is lacking. The need for survivorship care was initially advanced in 2006 by the Institute of Medicine. In 2019, the Quality of Cancer Survivorship Care Framework (QCSCF) was developed to provide an evidence-based framework to define key components of optimal survivorship care. In this commentary focused on survivors of AYA cancer, we apply the QCSCF framework to describe models of care that can be adapted for their unique needs, multilevel factors limiting equitable access to care, and opportunities to address these factors to improve short- and long-term outcomes in this vulnerable population.
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Affiliation(s)
- Amy M Berkman
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
| | - Melissa Beauchemin
- School of Nursing, Columbia University Irving Medical Center, New York, NY, USA
| | - Susan K Parsons
- Department of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA, USA
- Institute for Clinical Research and Health Policy Studies and Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - David R Freyer
- Departments of Pediatrics, Medicine, and Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael E Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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McErlean G, Ashley C, Pradhan A, Yenson V, Paterson A, Farnham G, Owen F, Watson AM, Presgrave P, Kerridge I, Halcomb E. A qualitative study on blood and marrow transplant recipients' perceptions of health professional roles following BMT and preferences for ongoing care. J Cancer Surviv 2024:10.1007/s11764-024-01658-4. [PMID: 39153048 DOI: 10.1007/s11764-024-01658-4] [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: 07/09/2024] [Accepted: 07/30/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE Survivors of blood and marrow transplantation (BMT) require life-long follow-up involving both tertiary transplant and primary care services. This paper explores the attitudes and preferences of BMT survivors and their carers regarding the transition from BMT centre care to primary care. METHODS This qualitative study involved semi-structured interviews with BMT survivors and carers from New South Wales, Australia. Interviews were audio-recorded, transcribed verbatim and thematically analysed. RESULTS Twenty-two BMT survivors and six carers were interviewed. Two themes emerged: (1) 'Relationships with health professionals' and (2) 'Challenges of long-term care'. Participants, particularly rural/regional survivors, had diverse views on the availability of community BMT expertise and identified a range of strategies to optimise care for BMT survivors. CONCLUSIONS These results highlight the importance BMT survivors and carers place on their relationships with, and ongoing access to, specialised BMT teams for long-term care. While some are happy to receive community-based care, concerns exist about the capacity of primary care providers, particularly in rural and regional areas. Improved support, communication and coordination between BMT centres and primary care may help facilitate a person-centred, sustainable shared care model. Provider education, use of telehealth and clear delineation of roles and responsibilities may assist in this transition. IMPLICATIONS FOR CANCER SURVIVORS As BMT survivors live longer post-treatment, transitions of care and sustainable long-term care models are needed. A shared care approach, integrating specialised BMT teams and local primary care, may optimise outcomes but requires further development to balance accessibility, preferences, and specialised care needs.
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Affiliation(s)
- Gemma McErlean
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia.
- St George Hospital, Kogarah, NSW, Australia.
| | - Christine Ashley
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
| | - Anisha Pradhan
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
| | - Vanessa Yenson
- Consumer Advocate, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Gai Farnham
- Liverpool Hospital, Liverpool, NSW, Australia
| | - Fran Owen
- Wollongong Hospital, Wollongong, NSW, Australia
| | | | | | - Ian Kerridge
- Royal North Shore Hospital, St Leonards, NSW, Australia, Sydney
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
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Kabani A, Lenihan VF, Zhang C, Berger ZD, Pollack CE, Eaton CK, Liu Y, Dy SM, Peairs KS, Choi Y. Utilization of a primary care-based cancer survivorship clinic: patterns and patient characteristics. J Cancer Surviv 2024; 18:1347-1355. [PMID: 37093516 DOI: 10.1007/s11764-023-01378-1] [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: 11/30/2022] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The Johns Hopkins Primary Care for Cancer Survivors (PCCS) Clinic was established in 2015 to improve care delivery for the growing cancer survivor population. We aim to describe areas of care addressed by PCCS and factors associated with clinic utilization. METHODS We conducted a retrospective chart review of the first 301 patients' clinic visits. We used negative binomial regression models to identify factors associated with the rate of PCCS clinic visits overall and for cancer surveillance and treatment-related effects. RESULTS There were 1702 clinic visits across 301 patients during the study period (77% female, median age 61). The most common areas of care addressed were chronic medical problems (80%), preventive health care (62%), cancer surveillance (59%), treatment-related effects (50%), and new/acute problems (46%). Multivariate analyses found that age > 60 years (IRR = 1.9, 95% CI = 1.2-3.0, p = 0.007) and higher number of comorbidities (IRR = 1.2, 95% CI = 1.1 - 1.2, p < 0.001) were associated with more overall PCCS visits, while female gender was associated with fewer visits (IRR = 0.6, CI = 0.4 - 0.8, p = 0.001). Gastrointestinal cancer type, shorter length of survivorship, male gender, and higher number of comorbidities were associated with a higher rate of visits addressing both surveillance and treatment-related effects (p < 0.05). CONCLUSIONS The PCCS clinic addressed cancer and non-cancer related needs. Older patients and survivors with more comorbidities had significantly increased clinic utilization. IMPLICATIONS FOR CANCER SURVIVORS As the cancer survivor population grows, increasing access to survivorship clinics based in primary care may help meet these patients' diverse oncologic and general health needs.
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Affiliation(s)
- Aamna Kabani
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Christiana Zhang
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zackary D Berger
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Craig E Pollack
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Cyd K Eaton
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yisi Liu
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Sydney M Dy
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Kimberly S Peairs
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Youngjee Choi
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
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Sussman J, Cerasuolo JO, Pond GR, Bainbridge D, Seow H. Patterns of Survivorship Follow-Up Care Among Patients With Breast Cancer: A Retrospective Population-Based Cohort Study in Ontario, Canada, Between 2006 and 2016. JCO Oncol Pract 2024:OP2300813. [PMID: 39052954 DOI: 10.1200/op.23.00813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/06/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE Many cancer survivors have ongoing follow-up with their oncologist(s), despite evidence that this care can be competently managed by primary care and transitioning well survivors could relieve growing pressure on cancer care systems. We analyzed population-based administrative data from Ontario, Canada, to examine rates of transition to primary care-led follow-up care during the survivorship phase, including clinical and demographic predictors associated with being transitioned. METHODS We conducted a retrospective cohort study to describe the patterns of survivorship follow-up care among all patients with breast cancer in Ontario from 2006 to 2016. Data were derived from the Ontario Cancer Registry and other linked data sets. We defined the survivorship phase of care beginning at 2 years after initial diagnosis. Logistic regression was used to explore factors potentially prognostic of no oncology visits in each of the years after survivorship. RESULTS Our survivorship cohort was composed of 71,719 patients with breast cancer, 42% of whom were considered to have transitioned from oncology to primary care 2 years after diagnosis. Although the number of patients having oncology visits diminished over time, a quarter of the cohort continued being seen in year 5 of survivorship. Regression analysis found older age, early cancer stage, living farther from a cancer center, not receiving radiation or chemotherapy, and high well-being to be associated with transitioning to primary care. CONCLUSION Our findings contribute to the development of low-risk profiles among survivors to inform optimal transition from oncology to primary care. Further research examining qualitative perspectives from oncologists, cancer survivors, and primary care is also required to illuminate other sentinel factors to be considered when transitioning during follow-up.
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Affiliation(s)
- Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Joshua O Cerasuolo
- ICES McMaster, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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Pradhan P, Sharman AR, Palme CE, Elliott MS, Clark JR, Venchiarutti RL. Models of survivorship care in patients with head and neck cancer in regional, rural, and remote areas: a systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01643-x. [PMID: 39031309 DOI: 10.1007/s11764-024-01643-x] [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: 05/18/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Rural people with head and neck cancers (HNC) are likely to experience poorer health outcomes due to limited access to health services, so many benefit from models of care that account for rurality. The aim of this review was to synthesise literature on models of care in this population. METHODS Studies were identified using seven databases: PubMed, PsycINFO, Scopus, Embase, CINAHL, Medline, and Web of Science. Studies that tested or reported a model of care in rural HNC survivors were included. Data on characteristics and outcomes of the models were synthesised according to the domains in the Cancer Survivorship Care Quality Framework, and study quality was appraised. RESULTS Seventeen articles were included. Eight were randomised controlled trials (seven with a control group and one single-arm study). Three models were delivered online, nine via telehealth, and five in-person. Majority were led by nurses and allied health specialists and most addressed management of physical (n = 9) and psychosocial effects (n = 6), while only a few assessed implementation outcomes such as cost-effectiveness. None evaluated the management of chronic health conditions. CONCLUSION Positive outcomes were reported for domains of survivorship care that were measured; however, further evaluation of models of care for rural people with HNC is needed to assess effectiveness across all domains of care. IMPLICATIONS FOR CANCER SURVIVORS Rural cancer survivors are a diverse population with unique needs. Alternative models of care such as shared care, or models personalised to the individual, could be considered to reduce disparities in access to care and outcomes.
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Affiliation(s)
- Poorva Pradhan
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Ashleigh R Sharman
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Rebecca L Venchiarutti
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
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Gupta A, Chant ED, Mohile S, Vogel RI, Parsons HM, Blaes AH, Booth CM, Rocque GB, Dusetzina SB, Ganguli I. Health Care Contact Days Among Older Cancer Survivors. JCO Oncol Pract 2024; 20:943-952. [PMID: 38452315 PMCID: PMC11268556 DOI: 10.1200/op.23.00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/10/2023] [Accepted: 12/13/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Health care contact days-days spent receiving health care outside the home-represent an intuitive, practical, and person-centered measure of time consumed by health care. METHODS We linked 2019 Medicare Current Beneficiary Survey and traditional Medicare claims data for community-dwelling older adults with a history of cancer. We identified contact days (ie, spent in a hospital, emergency department, skilled nursing facility, or inpatient hospice or receiving ambulatory care including an office visit, procedure, treatment, imaging, or test) and described patterns of total and ambulatory contact days. Using weighted Poisson regression models, we identified factors associated with contact days. RESULTS We included 1,168 older adults representing 4.51 million cancer survivors (median age, 76.4 years, 52.8% women). The median (IQR) time from cancer diagnosis was 65 (27-126) months. In 2019, these adults had mean (standard deviation) total contact days of 28.4 (27.6) and ambulatory contact days of 24.2 (23.6). These included days for tests (8.0 [8.8]), imaging (3.6 [4.1]), visits with any clinicians (12.4 [11.5]), and visits with primary care clinicians (4.4 [4.7]), and nononcology specialists (7.1 [9.4]) specifically. Sixty-four percent of days with a nonvisit ambulatory service (eg, a test) were not on the same day as a clinician visit. Factors associated with more total contact days included younger age, lower income, more chronic conditions, poor self-rated health, and tendency to "go to doctor as soon as feel bad." CONCLUSION Older adult cancer survivors spent nearly 1 month of the year receiving health care outside the home. This care was largely ambulatory, often delivered by nononcologists, and varied by factors beyond clinical characteristics. These results highlight the need to recognize patient burdens and improve survivorship care delivery, including through care coordination.
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Affiliation(s)
| | - Emma D. Chant
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
| | - Supriya Mohile
- Department of Medicine, University of Rochester, Rochester, NY
| | | | | | | | | | | | - Stacie B. Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Ishani Ganguli
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
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Singhal S, Dickerson J, Glover MJ, Roy M, Chiu M, Ellis-Caleo T, Hui G, Tamayo C, Loecher N, Wong HN, Heathcote LC, Schapira L. Patient-reported outcome measurement implementation in cancer survivors: a systematic review. J Cancer Surviv 2024; 18:223-244. [PMID: 35599269 DOI: 10.1007/s11764-022-01216-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: 01/18/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Patient-reported outcome measurements (PROMs) are increasingly used for cancer patients receiving active treatment, but little is known about the implementation and usefulness of PROMs in cancer survivorship care. This systematic review evaluates how cancer survivors and healthcare providers (HCPs) perceive PROM implementation in survivorship care, and how PROM implementation impacts cancer survivors' health outcomes. METHODS We systematically searched PubMed/MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Database of Systematic Reviews from database inception to February 2022 to identify randomized and nonrandomized studies of PROM implementation in cancer survivors. RESULTS Based on prespecified eligibility criteria, we included 29 studies that reported on 26 unique PROMs. The studies were heterogeneous in study design, PROM instrument, patient demographics, and outcomes. Several studies found that cancer survivors and HCPs had favorable impressions of the utility of PROMs, and a few studies demonstrated that PROM implementation led to improvements in patient quality of life (QoL), with small to moderate effect sizes. CONCLUSIONS We found implementation of PROMs in cancer survivorship care improved health outcomes for select patient populations. Future research is needed to assess the real-world utility of PROM integration into clinical workflows and the impact of PROMs on measurable health outcomes. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors accepted PROMs. When successfully implemented, PROMs can improve health outcomes after completion of active treatment. We identify multiple avenues to strengthen PROM implementation to support cancer survivors.
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Affiliation(s)
- Surbhi Singhal
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA.
| | - James Dickerson
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
| | | | - Mohana Roy
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
| | - Michelle Chiu
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Gavin Hui
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Nele Loecher
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Lidia Schapira
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
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Been-Dahmen JMJ, van der Stege H, Oldenmenger WH, Braat C, van der Lans MCM, Scheper M, van Staa A, Ista E. What factors contribute to cancer survivors' self-management skills? A cross-sectional observational study. Eur J Oncol Nurs 2024; 69:102539. [PMID: 38460391 DOI: 10.1016/j.ejon.2024.102539] [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: 09/26/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE Many cancer survivors, facing the consequences of their disease and its treatment, have medical and supportive aftercare needs. However, limited knowledge exists regarding the relationship between support needs and survivors' self-management skills. The study aim is to explore factors contributing to cancer survivors' self-management skills. METHODS A cross-sectional study was conducted among cancer survivors (n = 277) of two outpatient oncology clinics at a university hospital in the Netherlands. Patients with head and neck cancer (n = 55) who had received radiotherapy and cisplatin or cetuximab were included, as well as patients who had undergone hematopoietic stem cell transplantation (n = 222). The primary outcome was self-management skills, assessed using the Partners in Health Scale (PIH), which comprises two subscales: knowledge and coping (PIH-KC), and recognition and management of symptoms, and adherence to treatment (PIH-MSA). Secondary outcomes were quality of life (EORTC QLQ-C30), self-efficacy (SECD6), patient-centered care (CAPHS), and social support (HEIQ). Machine learning-based Random Forest models were employed to construct associative models. Feature Importance (FI) was used to express the contribution to the model. RESULTS High emotional quality of life (FI = 33.1%), increased self-efficacy (FI = 22.2%), and greater social support (FI = 18.2%) were identified as key factors contributing to cancer survivors' self-management knowledge (PIH-KC). Furthermore, greater support from professionals (FI = 36.1%) and higher self-efficacy (FI = 18.2%) were found to benefit participants' recognition and management, and therapy adherence (PIH-MSA). CONCLUSIONS A patient-centered relationship between nurses and cancer survivors is essential for therapy adherence and the management of aftercare needs. Training to provide this holistic self-management support is required.
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Affiliation(s)
- Janet M J Been-Dahmen
- Rotterdam University of Applied Sciences, Research Center Innovations in Care, Rotterdam, P.O. Box 25035, 3001 HA, Rotterdam, the Netherlands.
| | - Heleen van der Stege
- Rotterdam University of Applied Sciences, Research Center Innovations in Care, Rotterdam, P.O. Box 25035, 3001 HA, Rotterdam, the Netherlands.
| | - Wendy H Oldenmenger
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology, Rotterdam, the Netherlands.
| | - Cora Braat
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands.
| | - Mariska C M van der Lans
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Mark Scheper
- Rotterdam University of Applied Sciences, Research Center Innovations in Care, Rotterdam, P.O. Box 25035, 3001 HA, Rotterdam, the Netherlands; Macquarie University, Faculty of Medicine and Science, Allied Health Professions, Sydney, Australia.
| | - AnneLoes van Staa
- Rotterdam University of Applied Sciences, Research Center Innovations in Care, Rotterdam, P.O. Box 25035, 3001 HA, Rotterdam, the Netherlands.
| | - Erwin Ista
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine - Section Nursing Science, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands; Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Garcia SF, O'Connor M, Kinahan K, Duffy M, Klein M, McCrum A, Didwania A, Kircher SM. Advancing survivorship at a comprehensive cancer center: integrating clinical care, education and research initiatives at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center. J Cancer Surviv 2024; 18:17-22. [PMID: 38294597 DOI: 10.1007/s11764-023-01518-7] [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: 11/14/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
The unprecedented and growing number of cancer survivors requires comprehensive quality care that includes cancer surveillance, symptom management, and health promotion to reduce morbidity and mortality and improve quality of life. However, coordinated and sustainable survivorship care has been challenged by barriers at multiple levels. We outline the survivorship programs at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center that have evolved over two decades. Our current survivorship clinics comprise STAR (Survivors Taking Action and Responsibility) for adult survivors of childhood cancers; Adult Specialty Survivorship for survivors of breast, colorectal and testicular cancers, lymphomas, and leukemias; and Gynecologic Oncology Survivorship. Care provision models align with general, disease/treatment-specific, and integrated survivorship models, respectively. Reimbursement for survivorship services has been bolstered by institutional budget allocations. We have standardized survivor education, counseling, and referrals through electronic health record (EHR)-integrated survivorship care plan (SCP) templates that incorporate partial auto-population. We developed EHR-integrated data collection tools (e.g., dashboards; SmartForm, and registry) to facilitate data analytics, personalized patient referrals, and reports to the Commission on Cancer (CoC). We report to the CoC on SCP delivery, dietitian encounters, and DEXA scans. For the last decade, our Cancer Survivorship Institute has aligned the efforts of clinicians, researchers, and educators. The institute promotes evidence-based care, high-impact research, and state-of-the-science educational programs for professionals, survivors, and the community. Future plans include expansion of clinical services and funding for applied research centered on the unique needs of post-treatment cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: The survivorship programs at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center underscore the imperative for comprehensive, coordinated, and sustainable survivorship care to address the needs of increasing numbers of cancer survivors, with a focus on evidence-based clinical practices, associated research, and educational initiatives.
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Affiliation(s)
- Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA.
- Northwestern Medicine, Chicago, IL, USA.
| | - Mary O'Connor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Aarati Didwania
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
- Northwestern Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sheetal M Kircher
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
- Northwestern Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kroenke K, Corrigan JD, Ralston RK, Zafonte R, Brunner RC, Giacino JT, Hoffman JM, Esterov D, Cifu DX, Mellick DC, Bell K, Scott SG, Sander AM, Hammond FM. Effectiveness of care models for chronic disease management: A scoping review of systematic reviews. PM R 2024; 16:174-189. [PMID: 37329557 DOI: 10.1002/pmrj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic brain injury (TBI). METHODS Information sources: Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January 2010 to May 2021. ELIGIBILITY CRITERIA Systematic reviews and meta-analyses reporting on the effectiveness of the Chronic Care Model (CCM), collaborative/integrated care, and other chronic disease management models. DATA Target diseases, model components used (n = 11), and six outcomes (disease-specific, generic health-related quality of life and functioning, adherence, health knowledge, patient satisfaction, and cost/health care use). SYNTHESIS Narrative synthesis, including proportion of reviews documenting outcome benefits. RESULTS More than half (55%) of the 186 eligible reviews focused on collaborative/integrated care models, with 25% focusing on CCM and 20% focusing on other chronic disease management models. The most common health conditions were diabetes (n = 22), depression (n = 16), heart disease (n = 12), aging (n = 11), and kidney disease (n = 8). Other single medical conditions were the focus of 22 reviews, multiple medical conditions of 59 reviews, and other or mixed mental health/behavioral conditions of 20 reviews. Some type of quality rating for individual studies was conducted in 126 (68%) of the reviews. Of reviews that assessed particular outcomes, 80% reported disease-specific benefits, and 57% to 72% reported benefits for the other five types of outcomes. Outcomes did not differ by the model category, number or type of components, or target disease. CONCLUSIONS Although there is a paucity of evidence for TBI per se, care model components proven effective for other chronic diseases may be adaptable for chronic TBI care.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Rick K Ralston
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Steven G Scott
- Center of Innovation on Disability & Rehab Research (CINDRR), James A Haley Veterans' Hospital, Tampa, Florida, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
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11
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Weaver KE, Dressler EV, Smith S, Nightingale CL, Klepin HD, Lee SC, Wells BJ, Hundley WG, DeMari JA, Price SN, Foraker RE. Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives. BMC Cancer 2024; 24:158. [PMID: 38297229 PMCID: PMC10829276 DOI: 10.1186/s12885-024-11912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Guidelines recommend cardiovascular risk assessment and counseling for cancer survivors. For effective implementation, it is critical to understand survivor cardiovascular health (CVH) profiles and perspectives in community settings. We aimed to (1) Assess survivor CVH profiles, (2) compare self-reported and EHR-based categorization of CVH factors, and (3) describe perceptions regarding addressing CVH during oncology encounters. METHODS This cross-sectional analysis utilized data from an ongoing NCI Community Oncology Research Program trial of an EHR heart health tool for cancer survivors (WF-1804CD). Survivors presenting for routine care after potentially curative treatment recruited from 8 oncology practices completed a pre-visit survey, including American Heart Association Simple 7 CVH factors (classified as ideal, intermediate, or poor). Medical record abstraction ascertained CVD risk factors and cancer characteristics. Likert-type questions assessed desired discussion during oncology care. RESULTS Of 502 enrolled survivors (95.6% female; mean time since diagnosis = 4.2 years), most had breast cancer (79.7%). Many survivors had common cardiovascular comorbidities, including high cholesterol (48.3%), hypertension or high BP (47.8%) obesity (33.1%), and diabetes (20.5%); 30.5% of survivors received high cardiotoxicity potential cancer treatment. Less than half had ideal/non-missing levels for physical activity (48.0%), BMI (18.9%), cholesterol (17.9%), blood pressure (14.1%), healthy diet (11.0%), and glucose/ HbA1c (6.0%). While > 50% of survivors had concordant EHR-self-report categorization for smoking, BMI, and blood pressure; cholesterol, glucose, and A1C were unknown by survivors and/or missing in the EHR for most. Most survivors agreed oncology providers should talk about heart health (78.9%). CONCLUSIONS Tools to promote CVH discussion can fill gaps in CVH knowledge and are likely to be well-received by survivors in community settings. TRIAL REGISTRATION NCT03935282, Registered 10/01/2020.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sydney Smith
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Heidi D Klepin
- Section on Hematology-Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Simon Craddock Lee
- Department of Population Health, University of Kansas Medical Center, Mail Stop 1008, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, 417 N 11th St 4th Floor, Richmond, VA, 23219, USA
| | - Joseph A DeMari
- Section on Gynecologic Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sarah N Price
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Randi E Foraker
- Department of Medicine, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., MSC 8066-22-6602, St. Louis, MO, 63110, USA
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12
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Zamudio-Sánchez A, Camarero-Gómez P, Rodríguez-Manjón E, Iglesias-Parra MR, Gómez-Salgado J, Romero A. Needs and Expectations of Long-Term Cancer Survivors: Multi-Centre Study Protocol. J Pers Med 2024; 14:64. [PMID: 38248765 PMCID: PMC10817242 DOI: 10.3390/jpm14010064] [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: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Cancer is a social issue as its outreach affects not only mortality (it is the second cause of death in our environment) but also the costs due to morbidity and the distress it causes, as well as the losses and consequences in personal, family, work, and even social areas. This study is trying to find out the health needs of long-term cancer survivors and their perceptions and expectations of the care they received during their survival stage. For this, a joint, cross-sectional descriptive study with a qualitative and quantitative approach has been designed. For the qualitative approach, we have used different focus groups representing different geographical areas of the Spanish territory. For the qualitative approach, we have used a validated questionnaire. This study will provide a better knowledge of the quality of life of these patients, as well as their level of unmet and even unexpressed needs, in order to develop effective strategies and interventions that allow for the implementation of adapted care plans that include such unexpressed needs. This study will also allow for the creation and development of assessment methods for health results from the patient's perspective and experience. These issues require a multidisciplinary, complex approach. These survivors may require not well-known health services, as the number of these patients has grown recently, and their survival time is also longer. This research explores a wider and more thorough perspective of long-term cancer survivors' needs, experiences, and expectations to be achieved.
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Affiliation(s)
- Antonio Zamudio-Sánchez
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, 29010 Malaga, Spain; (A.Z.-S.)
| | - Pilar Camarero-Gómez
- Malaga Guadalhorce Health District, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain
| | - Estefanía Rodríguez-Manjón
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, 29010 Malaga, Spain; (A.Z.-S.)
| | - María Rosa Iglesias-Parra
- Department of Nursing and Podiatry, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, 29010 Malaga, Spain (A.R.)
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work, and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Posgrade Program, Espíritu Santo University, Samborondón 09-01-952, Ecuador
| | - Adolfo Romero
- Department of Nursing and Podiatry, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, 29010 Malaga, Spain (A.R.)
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13
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Delemere E, Gitonga I, Maguire R. "A Really Really Almost Impossible Journey" Perceived Needs and Challenges of Families Impacted by Pediatric Cancer: A Qualitative Analysis. Compr Child Adolesc Nurs 2023; 46:277-294. [PMID: 37409984 DOI: 10.1080/24694193.2023.2229429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
Caring for a child with cancer can place a number of burdens on families, however it is unclear the extent to which health-care professionals (HCPs) and other personnel supporting families are aware of these burdens. This study sought to explore the needs and challenges encountered by families impacted by pediatric cancer in Ireland from the perspectives of both parents and the personnel who support them. Twenty-one participants, comprising seven parents (one male, six females), and 14 supportive personnel (nine hospital-based volunteers and five HCPs) took part in in-depth semi-structured interviews via Microsoft Teams (December 2020 to April 2021) to obtain a perspective of the needs, challenges, and currently available support for families. A reflexive thematic approach to analysis was employed. The need to navigate a new normal, a sense of riding the wave and reliance on others were perceived to be the primary challenges encountered by families. Participants reported a need for community service provision, connectivity across the health-care system and more accessible psychological support. High levels of overlap across themes were found for parents and supportive personnel, particularly HCPs. Results highlight the significant challenges encountered by families impacted by pediatric cancer. Themes voiced by parents were frequently echoed by HCPs, suggesting this group is attuned to broader family needs. As such, they may be capable of providing insight where parent perspectives are unavailable. While further analysis including children's voices is needed, findings highlight key areas toward which support for families should be directed.
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Affiliation(s)
- Emma Delemere
- Department of Psychology, Maynooth University Co., Kildare, Ireland
| | - Isaiah Gitonga
- Department of Psychology, Maynooth University Co., Kildare, Ireland
| | - Rebecca Maguire
- Department of Psychology, Maynooth University Co., Kildare, Ireland
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14
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Contiero P, Boffi R, Borgini A, Fabiano S, Tittarelli A, Mian M, Vittadello F, Epifani S, Ardizzone A, Cirilli C, Boschetti L, Marguati S, Cascone G, Tumino R, Fanetti AC, Giumelli P, Candela G, Scuderi T, Castelli M, Bongiorno S, Barigelletti G, Perotti V, Veronese C, Turazza F, Crivaro M, Tagliabue G. Causes of death in women with breast cancer: a risks and rates study on a population-based cohort. Front Oncol 2023; 13:1270877. [PMID: 38023134 PMCID: PMC10646497 DOI: 10.3389/fonc.2023.1270877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors. Materials and methods Using data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area. Results The study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age <50 years, 72.94% in women diagnosed at age 50-69 and 48.25% in women diagnosed at age ≥70. Greater CIF variations were observed according to stage: the contribution of causes other than breast cancer to CIF for all causes was 73.4% in women with stage I disease, 42.9% in stage II-III and only 13.2% in stage IV. CSH computation revealed temporal variations: in women diagnosed at age ≥70 the CSH for breast cancer was equaled by that for cardiovascular disease and "other diseases" in the sixth year following diagnosis, and an early peak for breast cancer was identified in the first year following diagnosis. Among women aged 50-69 we identified an early peak for breast cancer followed by a further peak near the second year of follow-up. Comparison by geographic area highlighted conspicuous variations: the highest CIF for cardiovascular disease was more than 70% higher than the lowest, while for breast cancer the highest CIF doubled the lowest. Conclusion The integrated interpretation of absolute risks and hazards suggests the need for multidisciplinary surveillance and prevention using community-based, holistic and well-coordinated survivorship care models.
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Affiliation(s)
- Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Boffi
- Respiratory Disease Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Borgini
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabrina Fabiano
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Tittarelli
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michael Mian
- Innovation, Research and Teaching Service, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Bozen, Italy
| | | | - Susi Epifani
- Statistics and Epidemiology Unit, ASL Brindisi, Brindisi, Italy
| | | | - Claudia Cirilli
- Servizio di Epidemiologia e Comunicazione del Rischio-Unità Funzionale di Modena, Registro Tumori Regione, Modena, Italy
| | | | - Stefano Marguati
- Pavia Cancer Registry, Public Health Agency of Pavia, Pavia, Italy
| | - Giuseppe Cascone
- Ragusa Cancer Registry Unit, Azienda Sanitaria Provinciale di Ragusa (ASP), Ragusa, Italy
| | - Rosario Tumino
- Ragusa Cancer Registry Unit, Azienda Sanitaria Provinciale di Ragusa (ASP), Ragusa, Italy
| | | | | | | | | | - Maurizio Castelli
- Dipartimento di Prevenzione Azienda USL Valle d’Aosta Loc, Quart, Italy
| | | | - Giulio Barigelletti
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Viviana Perotti
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Veronese
- Respiratory Disease Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fabio Turazza
- Cardiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Crivaro
- Cardiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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15
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Ehrhardt MJ, Krull KR, Bhakta N, Liu Q, Yasui Y, Robison LL, Hudson MM. Improving quality and quantity of life for childhood cancer survivors globally in the twenty-first century. Nat Rev Clin Oncol 2023; 20:678-696. [PMID: 37488230 DOI: 10.1038/s41571-023-00802-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
The contributions of cooperative groups to performing large-cohort clinical trials and long-term survivorship studies have facilitated advances in treatment, supportive care and, ultimately, survival for patients with paediatric cancers. As a result, the number of childhood cancer survivors in the USA alone is expected to reach almost 580,000 by 2040. Despite these substantial improvements, childhood cancer survivors continue to have an elevated burden of chronic disease and an excess risk of early death compared with the general population and therefore constitute a large, medically vulnerable population for which delivery of high-quality, personalized care is much needed. Data from large survivorship cohorts have enabled the identification of compelling associations between paediatric cancers, cancer therapy and long-term health conditions. Effectively translating these findings into clinical care that improves the quality and quantity of life for survivors remains an important focus of ongoing research. Continued development of well-designed clinical studies incorporating dissemination and implementation strategies with input from patient advocates and other key stakeholders is crucial to overcoming these gaps. This Review highlights the global progress made and future efforts that will be needed to further increase the quality and quantity of life-years gained for childhood cancer survivors.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Global Paediatric Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Qi Liu
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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16
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Morgan B, Kapadia V, Crawford L, Martin S, McCollom J. Bridging the gap: Palliative care integration into survivorship care. Curr Probl Cancer 2023; 47:101019. [PMID: 37866988 DOI: 10.1016/j.currproblcancer.2023.101019] [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: 07/21/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023]
Abstract
As the number of cancer survivors grows, there is an increasing need for comprehensive care to address the unique physical, psychological, and social needs of this population. Palliative care (PC) integration within survivorship care offers a promising model of care, however, there is no comprehensive review of literature to guide clinical practice. This manuscript presents a scoping review of the research literature on models of care that integrate PC with survivorship care, as well as a detailed description of an exemplar clinical model. We identified 20 articles that described various models of survivorship care with integrated PC, highlighting the diversity of approaches and the multidisciplinary nature of interventions. Few studies reported outcomes but those that did demonstrated improvements in pain, self-efficacy, depression, function, and documentation of advance care planning. The evidence base remains limited, indicating the need for further research in this area with a focus on exploring outcomes using prospective experimental designs. Future clinical practice and research should explore sustainable payment models and the implementation of integrated survivorship care in value-based payment systems.
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Affiliation(s)
- Brianna Morgan
- Department of Medicine, Division of Geriatrics and Palliative Care, New York University Grossman School of Medicine, New York City, NY
| | - Vishal Kapadia
- Landmark Health, Part of Optum Home and Community, Irving, TX
| | - Lesa Crawford
- Parkview Health, Parkview Packnett Family Cancer Institute, Fort Wayne, IN
| | - Samina Martin
- Department of Internal Medicine, Parkview Health, Fort Wayne, IN
| | - Joseph McCollom
- Parkview Health, Parkview Packnett Family Cancer Institute, Fort Wayne, IN.
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17
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Choi Y, Parrillo E, Wenzel J, Grabinski VF, Kabani A, Peairs KS. Optimizing cancer survivorship in primary care: patient experiences from the Johns Hopkins Primary Care for Cancer Survivors clinic. J Cancer Surviv 2023; 17:1286-1294. [PMID: 35025092 PMCID: PMC8756404 DOI: 10.1007/s11764-022-01166-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The optimal delivery of survivorship care, particularly within primary care, remains poorly understood. We established the Johns Hopkins Primary Care for Cancer Survivors (PCCS) clinic in 2015 to address care challenges unique to cancer survivors. To better understand the care from the PCCS clinic, we interviewed patients about their perception of care delivery, survivorship care, and care coordination. METHODS We conducted semi-structured interviews with adult survivors of any cancer type seen in the PCCS clinic. A priori and in vivo coding of verbatim transcripts was part of the thematic analysis. RESULTS Seventeen cancer survivors were interviewed (ages 37-78). Themes that emerged were (1) optimal care and (2) the PCCS experience. Subthemes respectively included the ideal role of the primary care provider (1), telehealth/COVID-19 challenges and opportunities (1), patient-derived value from the PCCS clinic (2), and improving the PCCS model (2). Overall, PCCS patients expected and experienced high-quality, comprehensive primary care by providers with cancer survivorship expertise. Patients reported telehealth benefits and challenges for survivorship care during the COVID-19 pandemic. CONCLUSIONS PCCS patients perceived receiving high-quality primary care and valued being seen in a primary care-based survivorship clinic. The PCCS clinic can serve as a model of primary care-based cancer survivorship. IMPLICATIONS FOR CANCER SURVIVORS Ideal primary care provider roles and care coordination are important factors for high-quality survivorship care and can be provided by a specialized cancer survivorship clinic in primary care.
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Affiliation(s)
- Youngjee Choi
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Elaina Parrillo
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jennifer Wenzel
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - Aamna Kabani
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kimberly S Peairs
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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18
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Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship. Nat Rev Clin Oncol 2023; 20:527-542. [PMID: 37231127 PMCID: PMC10211308 DOI: 10.1038/s41571-023-00776-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.
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Affiliation(s)
- Maryam B Lustberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Aakash Desai
- Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cristiane Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Brazil
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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19
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DeMari JA, Dressler EV, Foraker RE, Wells BJ, Smith S, Klepin H, Hundley WG, Lesser GJ, Shalowitz DI, Nightingale CL, Hernandez M, Weaver KE. Endometrial cancer survivors' perceptions of their cardiovascular disease risk (results from WF-1804CD AH-HA). Gynecol Oncol 2023; 174:208-212. [PMID: 37224793 PMCID: PMC10330616 DOI: 10.1016/j.ygyno.2023.05.009] [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: 01/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Despite considerable burden of cardiovascular disease (CVD), data on endometrial cancer survivors' CVD perceptions are lacking. We assessed survivors' perspectives on addressing CVD risk during oncology care. METHODS This cross-sectional analysis utilized data from an ongoing trial of an EHR heart health tool (R01CA226078 & UG1CA189824) conducted through the NCI Community Oncology Research Program (NCORP, WF-1804CD). Endometrial cancer survivors post-potentially curative treatment were recruited from community practices and completed a pre-visit baseline survey, including American Heart Association Simple 7 CVD factors. Likert-type questions assessed confidence in understanding CVD risk, CVD risk perception, and desired discussion during oncology care. Medical record abstraction ascertained data on CVD and cancer characteristics. RESULTS Survivors (N = 55, median age = 62; 62% 0-2 years post-diagnosis) were predominately white, non-Hispanic (87%). Most agreed/strongly agreed heart disease poses a risk to their health (87%) and oncology providers should talk to patients about heart health (76%). Few survivors reported smoking (12%) but many had poor/intermediate values for blood pressure (95%), body mass index (93%), fasting glucose/A1c (60%), diet (60%), exercise (47%) and total cholesterol (53%). 16% had not seen a PCP in the last year; these survivors were more likely to report financial hardship (22% vs 0%; p = 0.02). Most reported readiness to take steps to maintain or improve heart health (84%). CONCLUSIONS Discussions of CVD risk during routine oncology care are likely to be well received by endometrial cancer survivors. Strategies are needed to implement CVD risk assessment guidelines and to enhance communication and referrals with primary care. Clinical Trials #: NCT03935282.
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Affiliation(s)
- Joseph A DeMari
- Section on Gynecologic Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Randi E Foraker
- Department of Medicine, Washington University in St. Louis School of Medicine, St Louis, MO, United States of America
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Sydney Smith
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Heidi Klepin
- Section on Hematology-Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - William G Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Glenn J Lesser
- Section on Hematology-Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - David I Shalowitz
- Section on Gynecologic Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Marcia Hernandez
- Department of Women's Oncology, Mercy Hospital, Springfield, MO, United States of America
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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Schlairet MC, Heddon MA, Randolph J. Predicting Survivorship Appointment Nonattendance in a Community Cancer Center: A Machine-Learning Approach. West J Nurs Res 2023; 45:607-617. [PMID: 37085980 DOI: 10.1177/01939459231165749] [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] [Indexed: 04/23/2023]
Abstract
Understanding and predicting cancer survivors' health care utilization is critical to promote quality care. The consultative system of survivorship care uses a onetime consultative appointment to transition patients from active treatment into survivorship follow-up care. Knowledge of attributes associated with nonattendance at this essential appointment is needed. An ability to predict patients with a likelihood of nonattendance would be of value to practitioners. Unfortunately, traditional data modeling techniques may not be useful in working with large numbers of variables from electronic medical record platforms. A variety of machine-learning algorithms were used to develop a model for predicting 843 survivors' nonattendance at a comprehensive community cancer center in the southeastern United States. A parsimonious model resulted in a k-fold classification accuracy of 67.3% and included three variables. Practitioners may be able to increase utilization of follow-up care among survivors by knowing which patient groups are more likely to be survivorship appointment nonattenders.
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Affiliation(s)
- Maura C Schlairet
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, USA
| | - Mary Ann Heddon
- Clinical Trials Program, Pearlman Cancer Center of South Georgia Medical Center, Valdosta, GA, USA
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, USA
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Bateman J, Egan R, Maclennan K. 'Survivorship care is one big gap': a qualitative study of post-treatment supportive care in Aotearoa New Zealand. BMC Health Serv Res 2023; 23:594. [PMID: 37291526 DOI: 10.1186/s12913-023-09580-8] [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: 11/14/2022] [Accepted: 05/18/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND This study focuses on the provision of supportive care services and programmes for cancer survivors post-treatment in Aotearoa New Zealand (NZ). It aims to aid our understanding of an often challenging and fragmented phase of cancer survivorship, and lay the groundwork for future research into the development of survivorship care in NZ. METHODS This study employed a qualitative design using semi-structured interviews with a range of healthcare providers (n = 47) involved in service provision for cancer survivors post active treatment, including supportive care providers; clinical and allied health providers; primary health providers; and Māori health providers. Data were analysed using thematic analysis. RESULTS We found that cancer survivors in NZ face a range of psycho-social and physical issues post-treatment. The provision of supportive care to meet these needs is currently fragmented and inequitable. The key barriers to improved supportive care provision for cancer survivors post-treatment include a lack of capacity and resources within the existing cancer care framework; divergent attitudes to survivorship care within the cancer care workforce; and a lack of clarity around whose responsibility post-treatment survivorship care is. CONCLUSIONS Post-treatment cancer survivorship should be established as a distinct phase of cancer care. Measures could include greater leadership in the survivorship space; the implementation of a survivorship model(s) of care; and the use of survivorship care plans; all of which could help improve referral pathways, and clarify clinical responsibility for post-treatment survivorship care.
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Affiliation(s)
- Jerram Bateman
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Richard Egan
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Karyn Maclennan
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Seibel K, Sauer B, Wagner B, Becker G. "Scanxiety" and a sense of control: the perspective of lung cancer survivors and their caregivers on follow-up - a qualitative study. BMC Psychol 2023; 11:119. [PMID: 37069692 PMCID: PMC10111662 DOI: 10.1186/s40359-023-01151-0] [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: 12/07/2022] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES Lung cancer survivors often suffer from physical, emotional and social long-term effects of disease and treatment. Caregivers are also affected by the cancer diagnosis throughout the course of the disease and are frequently burdened by high levels of psychosocial stress. However, little is known about how follow-up care after the completed treatment phase can help to improve long-term quality of life. In the context of patient-centred cancer care, considering the survivors' and caregivers' perspectives is an important step toward improving care structures. We therefore explored how lung cancer survivors and their caregivers experience follow-up examinations and their possible psychosocial effects on everyday life in order to shed light on what support is helpful for improving their quality of life. MATERIAL AND METHODS 25 survivors after curative lung cancer treatment and 17 caregivers underwent a face-to-face semi-structured, audio-recorded interview that was analysed using qualitative content analysis. RESULTS Especially burdened cancer survivors and caregivers described recurring anxiety before a follow-up appointment influencing their everyday life. At the same time, follow-up care also provided reassurance of still being healthy and helped regain a sense of security and control until the following scan. Despite possible long-term consequences in everyday life, the interviewees reported that the survivors´ psychosocial needs were not explicitly assessed or discussed. Nevertheless, the interviewees indicated that conversations with the physician were important for the success of "good" follow-up care. CONCLUSION Anxiety surrounding follow-up scans, also known as "scanxiety", is a common problem. In this study, we expanded on previous findings and found a positive aspect of scans, namely regaining a sense of security and control, which can strengthen the psychological well-being of the survivors and their families. To optimize follow-up care and improve the quality of life of lung cancer survivors and caregivers, strategies to integrate psychosocial care, like the introduction of survivorship care plans or increased use of patient-reported outcomes, should be explored in the future.
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Affiliation(s)
- Katharina Seibel
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
| | - Barbara Sauer
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
| | - Bernd Wagner
- Department of Palliative Care, Marienhaus Hospital, An der Goldgrube 11, 55131, Mainz, Germany
| | - Gerhild Becker
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
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Provision and delivery of survivorship care for adult patients with haematological malignancies: A scoping review protocol. PLoS One 2023; 18:e0282458. [PMID: 36862719 PMCID: PMC9980752 DOI: 10.1371/journal.pone.0282458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Haematological malignancies are a heterogenous group of blood and lymphatic cancers. Survivorship care is a similarly diverse term concerning patients' health and wellbeing from diagnosis to end of life. Survivorship care for patients with haematological malignancies has traditionally been consultant-led and secondary care-based, although shifts away from this model have been occurring, largely via nurse-led clinics and interventions with some remote monitoring. However, there remains a lack of evidence regarding which model is most appropriate. Although previous reviews exist, patient populations, methodologies, and conclusions are varied, and further high-quality research and evaluation has been recommended. AIMS The aim of the scoping review this protocol describes is to summarise current evidence on the provision and delivery of survivorship care for adult patients diagnosed with a haematological malignancy, and to identify existing gaps to inform future research. METHODOLOGY A scoping review will be carried out utilising Arksey and O'Malley's guidelines as its methodological framework. Studies published in the English language from December 2007 to the present will be searched on bibliographic databases, including Medline, CINAHL, PsycInfo, Web of Science, and Scopus. Papers' titles, abstracts, and full text will predominantly be screened by one reviewer with a second reviewer blind screening a proportion. Data will be extracted using a customised table developed in collaboration with the review team, and presented in tabular and narrative format, arranged thematically. Studies included will contain data regarding adult (25+) patients diagnosed with any haematological malignancy in combination with aspects related to survivorship care. The survivorship care elements could be delivered by any provider within any setting, but should be delivered pre- or post-treatment, or to patients on a watchful waiting pathway. REGISTRATION The scoping review protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/rtfvq; DOI: 10.17605/OSF.IO/RTFVQ).
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25
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Mukherjee SD, Bainbridge D, Hillis C, Sussman J. Optimizing Cancer Survivorship Care: Examination of Factors Associated with Transition to Primary Care. Curr Oncol 2023; 30:2743-2750. [PMID: 36975420 PMCID: PMC10047055 DOI: 10.3390/curroncol30030207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
Healthcare systems in Canada and elsewhere have identified the need to develop methods to effectively and safely transition appropriate cancer survivors to primary care. It is generally accepted that survivors with a low risk of adverse events, including recurrence and toxicity, should be more systematically identified and offered transition. There remains a lack of clarity about what constitutes an appropriate profile that would assist greater application in practice. To address this gap, we examined the clinical profiles of patients that were transitioned from a large regional cancer centre to the community. The factors examined included disease site, clinical stage, time since diagnosis/first consult, cancer treatments, and Edmonton Symptom Assessment System (ESAS) scores. In total, 2604 patients were identified as transitioned between 2013 and 2020. These patients tended to have common cancers (e.g., breast, endometrium, colorectal) that were generally of lower stage. Half of the patients had received chemotherapy and/or radiation treatment. Nearly one-third of survivors were transitioned within a year of first consult and a third after five years. Most patients reported minimal symptoms based on ESAS scores prior to being transitioned. This study represents one of the first to analyze the types of cancer patients that are being selected for transition to primary care.
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Affiliation(s)
- Som D Mukherjee
- Juravinski Cancer Center, Hamilton Health Sciences, Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Daryl Bainbridge
- Juravinski Cancer Center, Hamilton Health Sciences, Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Christopher Hillis
- Juravinski Cancer Center, Hamilton Health Sciences, Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Jonathan Sussman
- Juravinski Cancer Center, Hamilton Health Sciences, Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
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26
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Neuman HB, Schumacher JR. Follow-up and Cancer Survivorship. Surg Clin North Am 2023; 103:169-185. [DOI: 10.1016/j.suc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Turner K, Brownstein NC, Whiting J, Arevalo M, Islam JY, Vadaparampil ST, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 Pandemic on Women's Health Care Access: A Cross-Sectional Study. J Womens Health (Larchmt) 2022; 31:1690-1702. [PMID: 36318766 PMCID: PMC9805885 DOI: 10.1089/jwh.2022.0128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: There has been limited study of how the COVID-19 pandemic has affected women's health care access. Our study aims to examine the prevalence and correlates of COVID-19-related disruptions to (1) primary care; (2) gynecologic care; and (3) preventive health care among women. Materials and Methods: We recruited 4,000 participants from a probability-based online panel. We conducted four multinomial logistic regression models, one for each of the study outcomes: (1) primary care access; (2) gynecologic care access; (3) patient-initiated disruptions to preventive visits; and (4) provider-initiated disruptions to preventive visits. Results: The sample included 1,285 women. One in four women (28.5%) reported that the pandemic affected their primary care access. Sexual minority women (SMW) (odds ratios [OR]: 1.67; 95% confidence intervals [CI]: 1.19-2.33) had higher odds of reporting pandemic-related effects on primary care access compared to women identifying as heterosexual. Cancer survivors (OR: 2.07; 95% CI: 1.25-3.42) had higher odds of reporting pandemic-related effects on primary care access compared to women without a cancer history. About 16% of women reported that the pandemic affected their gynecologic care access. Women with a cancer history (OR: 2.34; 95% CI: 1.35-4.08) had higher odds of reporting pandemic-related effects on gynecologic care compared to women without a cancer history. SMW were more likely to report patient- and provider-initiated delays in preventive health care. Other factors that affected health care access included income, insurance status, and having a usual source of care. Conclusions: The COVID-19 pandemic disrupted women's health care access and disproportionately affected access among SMW and women with a cancer history, suggesting that targeted interventions may be needed to ensure adequate health care access during the COVID-19 pandemic.
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Affiliation(s)
- Kea Turner
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Susan T. Vadaparampil
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Cathy D. Meade
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Clement K. Gwede
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Shannon M. Christy
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
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Cull Weatherer AL, Krebsbach JK, Tevaarwerk AJ, Kerch SC, LoConte NK. The current status of survivorship care provision at the state level: a Wisconsin-based assessment. J Cancer Surviv 2022; 16:1355-1365. [PMID: 34609701 PMCID: PMC8490831 DOI: 10.1007/s11764-021-01117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE As the number of cancer survivors grows, the responsibility for addressing their unique physical and emotional needs also increases. Survivorship care services vary by geography, health system, and insurance coverage. We aimed to understand the state of survivorship care services in Wisconsin's cancer facilities. METHODS The selection of cancer treatment facilities sought to provide a geographically representative sample. An adapted Patient-Centered Survivorship Care Index was comprised of questions regarding different aspects of survivorship practices. Areas of interest included disciplines incorporated, services provided, standards of care, and discussion of late-term effects, among others. RESULTS Out of 90 sites invited, 40 responded (44.4%). Oncologists, physician assistants, and nurse practitioners were the most common follow-up care disciplines. Risk reduction services, dietary services, access to physical activity, and behavioral health specialist referral were described as standards of care in less than half of sites. All sites reported working with community partners, 92.5% of which worked with YMCA-related programs. Discussion of long-term effects was a standard of care for all sites. Effects such as emotional distress and health practice changes were frequently discussed with almost all patients, while sexual functioning and fertility were not. CONCLUSIONS Services and specialties related to behavioral health, fertility/sexual health, and rehabilitation and physical activity varied between sites. Such services may be offered less often due to variable insurance coverage. IMPLICATIONS FOR CANCER SURVIVORS Policy solutions should be explored to increase insurance coverage and provision rates of necessary survivorship services to keep up with the projected increase in demand. Given imperfect and evolving measurement tools to assess needs for cancer survivorship care services, cancer survivors should feel empowered to voice when they have unmet needs and request referrals.
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Affiliation(s)
| | - John K Krebsbach
- University of Wisconsin Carbone Cancer Center, 610 N Walnut St., Room 370 WARF, Madison, WI, 53726, USA
| | - Amye J Tevaarwerk
- University of Wisconsin Carbone Cancer Center, 610 N Walnut St., Room 370 WARF, Madison, WI, 53726, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sarah C Kerch
- University of Wisconsin Carbone Cancer Center, 610 N Walnut St., Room 370 WARF, Madison, WI, 53726, USA
| | - Noelle K LoConte
- University of Wisconsin Carbone Cancer Center, 610 N Walnut St., Room 370 WARF, Madison, WI, 53726, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Implementing a community-based shared care breast cancer survivorship model in Singapore: a qualitative study among primary care practitioners. BMC PRIMARY CARE 2022; 23:73. [PMID: 35395732 PMCID: PMC8991467 DOI: 10.1186/s12875-022-01673-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
Background The adaptability of existing recommendations on shared care implementation to Asian settings is unknown. This qualitative study aims to elicit public- and private-sectors primary care practitioners’ (PCPs) perspectives on the sustainable implementation of a shared care model among breast cancer survivors in Singapore. Methods Purposive sampling was employed to engage 70 PCPs from SingHealth Polyclinics, National University Polyclinics, National Healthcare Group Polyclinics, and private practice. Eleven focus groups and six in-depth interviews were conducted between June to November 2018. All sessions were audio-recorded and transcribed verbatim. Guided by the RE-AIM framework, we performed deductive thematic analysis in QSR NVivo 12. Results PCPs identified low-risk breast cancer survivors who demonstrated clear acceptability of PCPs’ involvement in follow-up as suitable candidates for shared care. Engagement with institution stakeholders as early adopters is crucial with adequate support through PCP training, return pathways to oncologists, and survivorship care plans as communication tools. Implementation considerations differed across practices. Selection of participating PCPs could consider seniority and interest for public and private practice, respectively. Proposed adoption incentives included increased renumeration for private PCPs and work recognition for public PCPs. Public PCPs further proposed integrating shared care elements to their existing family medicine clinics. Conclusions PCPs perceived shared care favorably as it echoed principles of primary care to provide holistic and well-coordinated care. Contextual factors should be considered when adapting implementation recommendations to Asian settings like Singapore. With limited competitive pressure, the government is then pivotal in empowering primary care participation in survivorship shared care delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01673-3.
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Moraitis AM, Seven M, Sirard J, Walker RR. Clinical Relevance and Implementation Considerations of Physical Activity in Young Adult Cancer Survivorship: An Expert Consensus Study. J Adolesc Young Adult Oncol 2022. [PMID: 36269579 DOI: 10.1089/jayao.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Elevated survival rates in young adult cancer survivors (YACS) are accompanied by high morbidity levels resulting in an array of unmet needs limiting full life potential. Physical activity (PA) improves physical, psychological, and social aspects of health after a cancer diagnosis. There are no standardized PA guidelines tailored to YACS. Therefore, there is a critical need to understand areas of clinical relevance/agreement on PA use and implementation in young adult (YA) survivorship care. Aim: To identify expert consensus areas on the assessment, prescription, and implementation of PA in YA survivorship care; identify areas of clinical relevance and endorsement of PA as a health optimization strategy in YA survivorship care. Methods: A four-round modified Delphi study of international multidisciplinary experts (Round I/II n = 18; Round III n = 57, Round IV n = 45) in exercise oncology, symptom management, survivorship care, youth cancer care was conducted. Qualitative content analysis, descriptive statistics (% agreement, standard deviation, mean), and inter-rater reliability (Kappa) were calculated. Results: Experts reached a consensus on clinical providers needed to assess, refer, and provide PA interventions, the need for guidelines, and essential care delivery system components to foster the integration of PA integration in YA survivorship care as a health optimization activity. Conclusions/Implications: Cancer care integration models should optimize the unique preferences, strengths, and developmental stage of YA affected by cancer. The study adds to the existing literature on multidisciplinary teams needed to provide clinical expertise and organizational support to foster PA integration into YA survivorship care.
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Affiliation(s)
| | - Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - John Sirard
- Department of Kinesiology and Commonwealth Honors College, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - Rachel Rae Walker
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
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Palo SK, Panda M, Sahoo KC, Mahapatra P, Pati S. Impediments of Cancer Survivorship and Palliative Care: A Mixed-Methods Study in a Tertiary Healthcare Facility in Odisha, India. Indian J Palliat Care 2022; 28:398-405. [DOI: 10.25259/ijpc_74_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/29/2022] [Indexed: 11/12/2022] Open
Abstract
Objective:
Measure the satisfaction level of patients visiting a tertiary level cancer institute in Odisha, identify the factors associated with the satisfaction level and assess the health system challenges related to quality service provision for cancer survival.
Methodology:
Analytical cross-sectional study was carried out using a mixed-methods approach in a tertiary cancer care unit in Odisha among 538 cancer patients using the Patient Satisfaction 32 questionnaire and the Patient Health Questionnaire (PHQ)-9 questionnaire.
Results:
There were 41% and 43% of outdoor and indoor patients who were below poverty line. Hindu was the predominant religion (>90%), 10% were illiterates and 90% were married in each category. Breast cancer (16%) was predominant among outdoor patients, whereas, it was stomach cancer (15%) among indoor patients. The PHQ median score for females was 1.5 and 1 each for indoor and outdoor patients, respectively. Nearly, 72% and 57% of males and females had mild depression to adjustment disorders statistically significant at P < 0.05. 90% of outdoor and 68% of indoor patients with a greater frequency of visits were significantly more depressed than their counterparts. All those accompanied by people other than their family members also showed higher values of adjustment and mild depressive features (69%) at P < 0.05. About 81% were satisfied with both general services and staff and nearly 40% with treatment and diagnosis.
Conclusion:
It gave us demographic details of cancer morbidity and its associates besides validating the survivorship framework in the Indian setting. Self-help anonymous and rehabilitation centres for a holistic integrative approach at the primary level of care need to be done.
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Affiliation(s)
- Subrata Kumar Palo
- Department of Health Research, DHR, RMRC, ICMR, Bhubaneswar, Odisha, India,
| | - Meely Panda
- Department of Community Medicine, AIIMS, Bibinagar, Hyderabad, India,
| | | | - Pranab Mahapatra
- Department of Psychiatry, KIMS, KIIT University, Bhubaneswar, Odisha, India,
| | - Sanghamitra Pati
- Department of Health Research, DHR, RMRC, ICMR, Bhubaneswar, Odisha, India,
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Fox J, Thamm C, Mitchell G, Emery J, Rhee J, Hart NH, Yates P, Jefford M, Koczwara B, Halcomb E, Steinhardt R, O'Reilly R, Chan RJ. Cancer survivorship care and general practice: A qualitative study of roles of general practice team members in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1415-e1426. [PMID: 34423502 DOI: 10.1111/hsc.13549] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/30/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Primary care providers, including general practice teams (GPTs), are well positioned within the community to integrate cancer survivorship care into ongoing health management. However, roles of GPT members in delivery of cancer survivorship care have not been explored. The purpose of this study is to explore these roles from the perspectives of General Practitioners (GPs), Practice Nurses (PNs) and Practice Managers (PMs). An interpretive qualitative study using semi-structured in-depth telephone interviews with ten GPs, nine PNs and five PMs was conducted. Interviews were recorded, transcribed and analysed using grounded theory methods. Perspectives of roles in delivery of cancer survivorship care were highly variable. Variation was evident among perceptions of needs of cancer survivors, individual team members' scopes of practice, and individual professional knowledge and skills. A lack of clarity in roles and responsibilities of GPT members was thought to contribute to a lack of consistency in survivorship care. Reducing variations in perceptions of survivorship care in the primary care setting should be a priority. Such efforts may include development of practical guidance to support GPT members to clarify scopes of practice within the team. In addition to accessible comprehensive education programs, other innovative, tailored individualised education approaches may be helpful. System-level support in clarifying and supporting the roles of the primary care team is needed to facilitate a survivorship delivery system at general practice level where those within GPT can ensure that individual patients' needs are met in a timely and effective manner.
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Affiliation(s)
- Jennifer Fox
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Carla Thamm
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Geoff Mitchell
- Limestone Medical Centre, Ipswich, Qld, Australia
- Primary Care Clinical Unit, University of Queensland, Herston, Qld, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, The University of Melbourne, Melbourne, Vic., Australia
| | - Joel Rhee
- General Practice Academic Unit, School of Medicine, The University of Wollongong, Wollongong, NSW, Australia
| | - Nicolas H Hart
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia
- East Brunswick Medical Centre, Brunswick, Vic., Australia
| | - Patsy Yates
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Elizabeth Halcomb
- School of Nursing, Midwifery and Indigenous Health, The University of Wollongong, Wollongong, NSW, Australia
| | | | - Roslyn O'Reilly
- School of Nursing, Midwifery and Indigenous Health, The University of Wollongong, Wollongong, NSW, Australia
| | - Raymond J Chan
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia
- East Brunswick Medical Centre, Brunswick, Vic., Australia
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Tan JY(B, Zhai J, Wang T, Zhou HJ, Zhao I, Liu XL. Self-Managed Non-Pharmacological Interventions for Breast Cancer Survivors: Systematic Quality Appraisal and Content Analysis of Clinical Practice Guidelines. Front Oncol 2022; 12:866284. [PMID: 35712474 PMCID: PMC9195587 DOI: 10.3389/fonc.2022.866284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/21/2022] [Indexed: 01/31/2023] Open
Abstract
Background A growing number of clinical practice guidelines (CPGs) regarding non-pharmacological interventions for breast cancer survivors are available. However, given the limitations in guideline development methodologies and inconsistent recommendations, it remains uncertain how best to design and implement non-pharmacological strategies to tailor interventions for breast cancer survivors with varied health conditions, healthcare needs, and preferences. Aim To critically appraise and summarise available non-pharmacological interventions for symptom management and health promotion that can be self-managed by breast cancer survivors based on the recommendations of the CPGs. Methods CPGs, which were published between January 2016 and September 2021 and described non-pharmacological interventions for breast cancer survivors, were systematically searched in six electronic databases, nine relevant guideline databases, and five cancer care society websites. The quality of the included CPGs was assessed by four evaluators using The Appraisal of Guidelines for Research and Evaluation, second edition tool. Content analysis was conducted to synthesise the characteristics of the non-pharmacological interventions recommended by the included CPGs, such as the intervention’s form, duration and frequency, level of evidence, grade of recommendation, and source of evidence. Results A total of 14 CPGs were included. Among which, only five were appraised as high quality. The “range and purpose” domain had the highest standardized percentage (84.61%), while the domain of “applicability” had the lowest (51.04%). Five CPGs were rated “recommended”, seven were “recommended with modifications”, and the other two were rated “not recommended”. The content analysis findings summarised some commonly recommended self-managed non-pharmacological interventions in the 14 guidelines, including physical activity/exercise, meditation, hypnosis, yoga, music therapy, stress management, relaxation, massage and acupressure. Physical activity/exercise was the most frequently recommended approach to managing psychological and physical symptoms by the included guidelines. However, significant variations in the level of evidence and grade of recommendation were identified among the included CPGs. Conclusion Recommendations for the self-managed non-pharmacological interventions were varied and limited among the 14 CPGs, and some were based on medium- and low-quality evidence. More rigorous methods are required to develop high-quality CPGs to guide clinicians in offering high-quality and tailored breast cancer survivorship care.
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Affiliation(s)
| | - Jianxia Zhai
- Charles Darwin University, College of Nursing and Midwifery, Melbourne Hub, Melbourne, VIC, Australia
| | - Tao Wang
- Charles Darwin University, College of Nursing and Midwifery, Brisbane Centre, Brisbane, QLD, Australia
- *Correspondence: Tao Wang,
| | - Hong-Juan Zhou
- Fujian University of Traditional Chinese Medicine, School of Nursing, Minhou, China
| | - Isabella Zhao
- Charles Darwin University, College of Nursing and Midwifery, Brisbane Centre, Brisbane, QLD, Australia
- Queensland University of Technology, Cancer and Palliative Care Outcomes Centre, Brisbane, QLD, Australia
| | - Xian-Liang Liu
- Charles Darwin University, College of Nursing and Midwifery, Brisbane Centre, Brisbane, QLD, Australia
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[Long-term survival in cancer: definitions, concepts, and design principles of survivorship programs]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:406-411. [PMID: 35301545 PMCID: PMC8979857 DOI: 10.1007/s00103-022-03518-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/02/2022] [Indexed: 11/23/2022]
Abstract
Aufgrund von diagnostischen und therapeutischen Fortschritten in der Hämatologie und Onkologie und entsprechend steigenden Überlebensaussichten ist ein stetiger Zuwachs der Gruppe von Langzeitüberlebenden mit und nach Krebs (Cancer Survivor) in Deutschland zu verzeichnen. Obwohl das bereits vorhandene deutsche Gesundheitswesen vielfältige Versorgungsangebote vorhält, die auch für Langzeitüberlebende verfügbar sind, ist die Versorgungssituation dieser Gruppe nicht zufriedenstellend. So bedarf es zum einen der Entwicklung von Orientierungshilfen für Langzeitüberlebende, zum anderen sollten neue und innovative Versorgungsprogramme für Überlebende (Survivorship-Programme) entwickelt werden. Der Beitrag gibt einen Überblick über die Problematik, definiert relevante Begrifflichkeiten und formuliert Kernaspekte für die Ausgestaltung von Survivorship-Programmen für Langzeitüberlebende nach Krebserkrankung.
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Jain U, Jain B, Dee EC, Jain P, Palakodeti S. Integrated practice units present an opportunity over siloed survivorship care settings. Support Care Cancer 2022; 30:6375-6379. [PMID: 35290514 DOI: 10.1007/s00520-022-06964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Given the rapidly rising cancer burden in the USA, the need to innovate survivorship care for oncology patients is rising rapidly. The current body of empirical evidence in survivorship care has focused on care provided by general practitioners (GP) and specialists/surgeons (SS). In particular, current evaluations address cost of care, cancer recurrence, quality of life, and overall survival of patients, with results indicating no statistically significant differences in GP- and SS-led care models and little emphasis on the broader characteristics of care settings. We fill this gap in survivorship care by introducing a perspective on the potential for holistic care delivery with a multidisciplinary team approach at integrated practice units (IPUs). Additionally, we propose a comprehensive examination of survivorship care across GP-, SS-, and IPU-led settings to provide researchers and practitioners with solid ground to determine the optimal survivorship care model, considering four key characteristics: (1) operating mode and skills, (2) cost and accountability of care, (3) health outcome measurement, and (4) workflow and scheduling.
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Affiliation(s)
- Urvish Jain
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pankaj Jain
- Indiana University of Pennsylvania, Indiana, PA, USA.,Highmark Health, Pittsburgh, PA, USA
| | - Sandeep Palakodeti
- Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USA.
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Crabtree-Ide C, Sevdalis N, Bellohusen P, Constine LS, Fleming F, Holub D, Rizvi I, Rodriguez J, Shayne M, Termer N, Tomaszewski K, Noyes K. Strategies for Improving Access to Cancer Services in Rural Communities: A Pre-implementation Study. FRONTIERS IN HEALTH SERVICES 2022; 2:818519. [PMID: 36925773 PMCID: PMC10012790 DOI: 10.3389/frhs.2022.818519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/28/2022] [Indexed: 12/18/2022]
Abstract
Background Implementation science is defined as the scientific study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners. Failure of implementation is more common in resource-limited settings and may contribute to health disparities between rural and urban communities. In this pre-implementation study, we aimed to (1) evaluate barriers and facilitators for implementation of guideline-concordant healthcare services for cancer patients in rural communities in Upstate New York and (2) identify key strategies for successful implementation of cancer services and supportive programs in resource-poor settings. Methods The mixed methods study was guided by the Consolidated Framework for Implementation Research (CFIR). Using engagement approaches from Community-Based Participatory Research, we collected qualitative and quantitative data to assess barriers and facilitators to implementation of rural cancer survivorship services (three focus groups, n = 43, survey n = 120). Information was collected using both in-person and web-based approaches and assessed attitude and preferences for various models of cancer care organization and delivery in rural communities. Stakeholders included cancer survivors, their families and caregivers, local public services administrators, health providers, and allied health-care professionals from rural and remote communities in Upstate New York. Data was analyzed using grounded theory. Results Responders reported preferences for cross-region team-based cancer care delivery and emphasized the importance of connecting local providers with cancer care networks and multidisciplinary teams at large urban cancer centers. The main reported barriers to rural cancer program implementation included regional variation in infrastructure and services delivery practices, inadequate number of providers/specialists, lack of integration among oncology, primary care and supportive services within the regions, and misalignment between clinical guideline recommendations and current reimbursement policies. Conclusions Our findings revealed a unique combination of community, socio-economic, financial, and workforce barriers to implementation of guideline-concordant healthcare services for cancer patients in rural communities. One strategy to overcome these barriers is to improve provider cross-region collaboration and care coordination by means of teamwork and facilitation. Augmenting implementation framework with provider team-building strategies across and within regions could improve rural provider confidence and performance, minimize chances of implementation failure, and improve continuity of care for cancer patients living in rural areas.
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Affiliation(s)
- Christina Crabtree-Ide
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Nick Sevdalis
- Center for Implementation Science, King's College London, London, United Kingdom
| | - Patricia Bellohusen
- Judy DiMarzo Cancer Survivorship Program, University of Rochester, Rochester, NY, United States
| | - Louis S. Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, Rochester, NY, United States
| | - Fergal Fleming
- Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY, United States
| | - David Holub
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Irfan Rizvi
- Mid-Atlantic Permanente Medical Group, McLean, VA, United States
| | - Jennifer Rodriguez
- Livingston County Public Health Department, Mt. Morris, NY, United States
| | - Michelle Shayne
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Nancy Termer
- Flatiron Healthcare Inc., New York, NY, United States
| | | | - Katia Noyes
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, United States
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Hwang S, Bozkurt B, Huson T, Asad S, Richardson L, Ogbansiegbe JA, Viera L, Buse C, James TA, Mayer DK, Shulman LN, Birken SA. Identifying Strategies for Robust Survivorship Program Implementation: A Qualitative Analysis of Cancer Programs. JCO Oncol Pract 2022; 18:e304-e312. [PMID: 34606296 PMCID: PMC8932497 DOI: 10.1200/op.21.00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The Commission on Cancer seeks to promote robust survivorship programs among accredited cancer programs. In practice, cancer programs' survivorship programs range from cursory (eg, developing care plans without robust services) to robust (eg, facilitating follow-up care). To inform cancer programs' future efforts, in this study, we identified the implementation strategies that cancer programs used to achieve robust survivorship programs, distinguishing them from cursory programs. METHODS We sampled 39 cancer programs across the United States with approaches to survivorship program implementation ranging from cursory to robust on the basis of LIVESTRONG survivorship care consensus elements. Within sampled cancer programs, we conducted in-depth semistructured interviews with a total of 42 health care professionals. We used template analysis to distinguish implementation strategies used in cancer programs with robust survivorship programs from strategies that yielded cursory survivorship programs. RESULTS Cancer programs with robust survivorship programs established clear systems survivorship care and formal committees to improve the survivorship care processes. They sought buy-in from multiple stakeholders to leverage cancer program resources and defined clear roles with shared accountability among multidisciplinary groups. By contrast, cancer programs with cursory survivorship programs reported less consistency in survivorship care processes and lacked buy-in from key stakeholders. They had limited resources, faced persistent structural concerns, and had insufficient clarity in roles among team members. CONCLUSION Accrediting bodies may consider incorporating the implementation strategies that robust survivorship programs have used as guidance for supporting cancer programs in operationalizing survivorship care and evaluating the use of these strategies during the accreditation and review process.
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Affiliation(s)
- Soohyun Hwang
- Health Policy and Management, University of North Carolina Chapel Hill, Chapel Hill, NC,Soohyun Hwang, MPH, Health Policy and Management, University of North Carolina Chapel Hill, 135 Dauer Drive, Chapel Hill, NC;
| | - Burcu Bozkurt
- Health Policy and Management, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Tamara Huson
- Health Policy and Management, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Sarah Asad
- Health Policy and Management, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Lauren Richardson
- Health Policy and Management/Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Laura Viera
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Buse
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ted A. James
- Breast Center/Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Deborah K. Mayer
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Sarah A. Birken
- Wake Forest University School of Medicine, Winston-Salem, NC
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Vos JAM, de Best R, Duineveld LAM, van Weert HCPM, van Asselt KM. Delivering colon cancer survivorship care in primary care; a qualitative study on the experiences of general practitioners. BMC PRIMARY CARE 2022; 23:13. [PMID: 35172743 PMCID: PMC8761520 DOI: 10.1186/s12875-021-01610-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/13/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas). METHODS Semi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs' experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework. RESULTS Overall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs' work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs' commitment to the intervention and whether it felt right for them to be involved. Patients' initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs' lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients' use of eHealth. CONCLUSIONS GPs' opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation. TRIAL REGISTRATION Netherlands Trial Register; NTR4860 . Registered on the 2nd of October 2014.
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Affiliation(s)
- Julien A M Vos
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Postbox 22660, Amsterdam, 1100 DD, the Netherlands.
- Program of Personalized Medicine & Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Robin de Best
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Postbox 22660, Amsterdam, 1100 DD, the Netherlands
- Program of Personalized Medicine & Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Laura A M Duineveld
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Postbox 22660, Amsterdam, 1100 DD, the Netherlands
- Program of Personalized Medicine & Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Postbox 22660, Amsterdam, 1100 DD, the Netherlands
- Program of Personalized Medicine & Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Kristel M van Asselt
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Postbox 22660, Amsterdam, 1100 DD, the Netherlands
- Program of Personalized Medicine & Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Dal Maso L, Santoro A, Iannelli E, De Paoli P, Minoia C, Pinto M, Bertuzzi AF, Serraino D, De Angelis R, Trama A, Haupt R, Pravettoni G, Perrone M, De Lorenzo F, Tralongo P. Cancer Cure and Consequences on Survivorship Care: Position Paper from the Italian Alliance Against Cancer (ACC) Survivorship Care Working Group. Cancer Manag Res 2022; 14:3105-3118. [PMID: 36340999 PMCID: PMC9635309 DOI: 10.2147/cmar.s380390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023] Open
Abstract
A multidisciplinary panel of experts and cancer patients developed a position paper to highlight recent evidence on "cancer cure" (ie, the possibility of achieving the same life expectancy as the general population) and discuss the consequences of this concept on follow-up and rehabilitation strategies. The aim is to inform clinicians, patients, and health-care policy makers about strategies of survivorship care for cured cancer patients and consequences impacting patient lives, spurring public health authorities and research organizations to implement resources to the purpose. Two identifiable, measurable, and reproducible indicators of cancer cure are presented. Cure fraction (CF) is >60% for breast and prostate cancer patients, >50% for colorectal cancer patients, and >70% for patients with melanoma, Hodgkin lymphoma, and cancers of corpus uteri, testis (>90%), and thyroid. CF was >65% for patients diagnosed at ages 15-44 years and 30% for those aged 65-74 years. Time-to-cure was consistently <1 year for thyroid and testicular cancer patients and <10 years for patients with colorectal and cervical cancers, melanoma, and Hodgkin lymphoma. The working group agrees that the evidence allows risk stratification of cancer patients and implementation of personalized care models for timely diagnosis, as well as treatment of possible cancer relapses or related long-term complications, and preventive measures aimed at maintaining health status of cured patients. These aspects should be integrated to produce an appropriate follow-up program and survivorship care plan(s), avoiding stigma and supporting return to work, to a reproductive life, and full rehabilitation. The "right to be forgotten" law, adopted to date only in a few European countries, may contribute to these efforts for cured patients.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
- Correspondence: Luigino Dal Maso, Epidemiologia Oncologica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy, Tel +39 0434 659354, Email
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Elisabetta Iannelli
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | | | - Carla Minoia
- SC Haematology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale, Naples, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Riccardo Haupt
- DOPO Clinic, Department of Pediatric Haematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Perrone
- Psychology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy
| | - Francesco De Lorenzo
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Siracusa, Italy
- Paolo Tralongo, Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Via Giuseppe Testaferrata 1, Siracusa, 96100, Italy, Tel +39 0931 724 464, Email
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Trogdon JG, Amin K, Gupta P, Urick BY, Reeder-Hayes KE, Farley JF, Wheeler SB, Spees L, Lund JL. Providers' mediating role for medication adherence among cancer survivors. PLoS One 2021; 16:e0260358. [PMID: 34843550 PMCID: PMC8629272 DOI: 10.1371/journal.pone.0260358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background We conducted a mediation analysis of the provider team’s role in changes to chronic condition medication adherence among cancer survivors. Methods We used a retrospective, longitudinal cohort design following Medicare beneficiaries from 18-months before through 24-months following cancer diagnosis. We included beneficiaries aged ≥66 years newly diagnosed with breast, colorectal, lung or prostate cancer and using medication for non-insulin anti-diabetics, statins, and/or anti-hypertensives and similar individuals without cancer from Surveillance, Epidemiology, and End Results-Medicare data, 2008–2014. Chronic condition medication adherence was defined as a proportion of days covered ≥ 80%. Provider team structure was measured using two factors capturing the number of providers seen and the historical amount of patient sharing among providers. Linear regressions relying on within-survivor variation were run separately for each cancer site, chronic condition, and follow-up period. Results The number of providers and patient sharing among providers increased after cancer diagnosis relative to the non-cancer control group. Changes in provider team complexity explained only small changes in medication adherence. Provider team effects were statistically insignificant in 13 of 17 analytic samples with significant changes in adherence. Statistically significant provider team effects were small in magnitude (<0.5 percentage points). Conclusions Increased complexity in the provider team associated with cancer diagnosis did not lead to meaningful reductions in medication adherence. Interventions aimed at improving chronic condition medication adherence should be targeted based on the type of cancer and chronic condition and focus on other provider, systemic, or patient factors.
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Affiliation(s)
- Justin G. Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Krutika Amin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Parul Gupta
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Benjamin Y. Urick
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Katherine E. Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joel F. Farley
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lisa Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jennifer L. Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Austin JD, Allicock M, Fernandez ME, Balasubramanian BA, Lee SC. Understanding the Delivery of Patient-Centered Survivorship Care Planning: An Exploratory Interview Study With Complex Cancer Survivors. Cancer Control 2021; 28:10732748211011957. [PMID: 34689577 PMCID: PMC8718161 DOI: 10.1177/10732748211011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Understanding key elements of the survivorship care planning process, such as patient-centered communication (PCC) and health self-efficacy, are critical for delivering patient-centered survivorship care to cancer survivors with multiple chronic conditions (“complex cancer survivors”). Building upon our team’s recent research efforts to examine the survivorship care planning process from a patient-centered lens, this exploratory study leveraged an ongoing quasi-experimental trial to elucidate the experience of complex cancer survivors with survivorship care planning and post-treatment management. Methods: We conducted a hypothesis-generating thematic content analysis on 8 interview transcripts. Results: Survivors reported positive experiences communicating with their oncology care team but the presence of multiple chronic conditions in addition to cancer creates additional barriers to patient-centered survivorship care. Conclusion: These findings support the need for further in-depth research aimed at improving PCC across all care teams and enabling self-management by delivering more personalized survivorship care planning that aligns with survivor’s needs, values, and preferences.
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Affiliation(s)
- Jessica D Austin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
| | - Simon Craddock Lee
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Hernandez-Garcia E, Chrysikou E, Kalea AZ. The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10891. [PMID: 34682637 PMCID: PMC8536084 DOI: 10.3390/ijerph182010891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 12/11/2022]
Abstract
Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with the central role in low-grade systemic inflammation-are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.
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Affiliation(s)
- Eva Hernandez-Garcia
- The Bartlett Real Estate Institute, The Bartlett School of Sustainable Construction, University College London, London WC1E 6BT, UK;
| | - Evangelia Chrysikou
- The Bartlett Real Estate Institute, The Bartlett School of Sustainable Construction, University College London, London WC1E 6BT, UK;
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, 700 13 Heraklion, Greece
| | - Anastasia Z. Kalea
- Division of Medicine, University College London, London WC1E 6JF, UK;
- Institute of Cardiovascular Science, University College London, London WC1E 6HX, UK
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43
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Kano M, Chen L, Boyce T, Gomez R, Gundelach AC, Jaffe SA, Sussman AL, Dayao ZR, Lobo J, Pestak CR, Rutledge TL. Characterizing Low-Risk Breast and Gynecological Cancer Patients for Transition into an Oncology/Primary Care Coordinated Care Model: Findings from a Survey of Diverse Survivors in a Rural U.S. State. Cancers (Basel) 2021; 13:cancers13174428. [PMID: 34503237 PMCID: PMC8431122 DOI: 10.3390/cancers13174428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 02/01/2023] Open
Abstract
We conducted a survey to characterize the key attributes of racial/ethnic and geographically diverse low-risk breast and gynecologic cancer patients. We collected data regarding patients' access to primary care (PC); compliance with screening recommendations; treatment for comorbidities; logistical barriers to clinic visits; and receipt of survivorship care documentation (SCD). Survey findings informed the development of an oncology/Primary Care Provider (PCP) care coordination intervention to improve care. We distributed a cross-sectional survey among a convenience sample of 150 cancer survivors. Responses were calculated using descriptive statistics and compared based on the distance participants traveled to their appointments at the cancer center (≤30 vs. >30 miles). Of the 150 respondents, 35% traveled >30 miles for follow-up care and 78% reported having one or more comorbid condition(s). PC utilization was high: 88% reported having a PCP, and 91% indicated ≤1 yearly follow-up visit. Participants traveling >30 miles reported higher rates of logistical challenges associated with cancer center visits compared to those traveling ≤30 miles. Nearly half of respondents (46%) had not received SCD. In conclusion, survey studies such as these allow for the systematic assessment of survivor behaviors and care utilization patterns to inform the development of care coordination interventions for diverse, low-risk cancer patients.
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Affiliation(s)
- Miria Kano
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Correspondence: ; Tel.: +1-(505)-925-1115
| | - Lu Chen
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch; Albuquerque, NM 77555, USA;
| | - Tawny Boyce
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Ricardo Gomez
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Amy C. Gundelach
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Shoshana Adler Jaffe
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Andrew L. Sussman
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Zoneddy R. Dayao
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Jolene Lobo
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Claire R. Pestak
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Teresa L. Rutledge
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA
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Luoh RP, Tevaarwerk AJ, Chandereng T, Smith EM, Carroll CB, Emamekhoo H, Sesto ME. Patterns and predictors of cancer-specific patient health portal usage among patients with cancer: results from the UWCCC Survivorship Program. Cancer Med 2021; 10:7373-7382. [PMID: 34453403 PMCID: PMC8525111 DOI: 10.1002/cam4.4234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/22/2023] Open
Abstract
Background Portals can assist patients in managing their healthcare. Understanding how patients with cancer use portals can facilitate improvements in patient engagement in cancer care. This study sought to determine if patients with cancer used portals differently for cancer versus noncancer purposes. The effects of geographic residence (rural vs. urban residence) and cancer stage on portal usage were also investigated. Methods We conducted a retrospective analysis of portal usage by patients seen at an NCI‐designated cancer center between 2015 and 2019. Demographics, cancer characteristics, and portal usage (number of successful logins, messages sent, and results viewed) were extracted. Messages sent and results viewed in the portal were deemed oncologist‐specific and cancer specific if sent to or ordered in medical oncology departments, respectively. Results The analysis included a total of 5950 patients with cancer. Patients were less likely to send and view oncologist‐specific messages compared to non‐oncologist‐specific messages. They were also less likely to view cancer results compared to noncancer results. Compared to urban counterparts, patients residing in rural areas had lower odds of having any logins and logged in less frequently during the year of diagnosis. Compared to patients with non‐metastatic disease, individuals with metastatic disease were more likely to become frequent portal users. Conclusions Patients may use portals differently for cancer versus noncancer purposes; urban residence and metastatic cancer were associated with more frequent usage. Further investigation can inform interventions to increase accessibility for groups at a disadvantage related to the use of this technology and to help patients better leverage portals to manage their cancer.
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Affiliation(s)
- Rebecca P Luoh
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Amye J Tevaarwerk
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Thevaa Chandereng
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | | | - Cibele B Carroll
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Hamid Emamekhoo
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Mary E Sesto
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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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.
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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
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Lesser I, Fritz JA, Belanger L. The Evaluation of a Health-Based Education and Behavioral Change Retreat on Quality of Life, Physical Activity and Psychosocial Health in Adult Cancer Survivors: An Exploratory Analysis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:755-762. [PMID: 32020519 PMCID: PMC7222053 DOI: 10.1007/s13187-020-01700-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Knights Cabin Cancer retreats may represent an ideal opportunity and environment to fill the gap in health education and behavioral change. It is unknown, however, whether the program improves quality of life, physical activity, and psychosocial health. Cancer survivors who enrolled in a retreat completed online questionnaires prior to and 3 months post to assess health-related quality of life, physical activity, and psychosocial variables; perceived stress, depression, and self-esteem. Paired t tests were utilized to compare changes pre and 3 months post the retreat. The majority of the 51 cancer survivors were female with a mean age of 53. The mental component summary of health-related quality of life (p < 0.016) and physical activity score (p = 0.048) was significantly improved at follow-up, while the physical component summary of health-related quality of life was not (p = 0.139). In addition, participants showed an improvement in psychosocial variables of self-esteem (p = 0.016) and depression (p = 0.016) after 3 months but did not show a significant improvement in perceived stress (p = 0.054). Improvements were seen following a Knights Cabin Cancer retreat in mental health-related quality of life and physical activity as well as some psychosocial variables. Further research is needed to evaluate the individual program components and the sustainability of the program in the community.
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Affiliation(s)
- Iris Lesser
- Department of Kinesiology, University of the Fraser Valley, 45190 Caen Avenue, Chilliwack, BC, V2R 0N3, Canada.
| | - Julie-Anne Fritz
- Department of Science, Mount Royal University, Calgary, AB, Canada
| | - Lisa Belanger
- Haskayne School of Business, University of Calgary, Calgary, Alberta, Canada
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Jayasekera J, Yeh J, Graves K, Mandelblatt J. Profits, public health, and patient care: caring for childhood cancer survivors. Transl Behav Med 2021; 11:772-774. [PMID: 33595065 DOI: 10.1093/tbm/ibaa006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jinani Jayasekera
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Jennifer Yeh
- Harvard Medical School and Division of General Pediatrics at Boston Children's Hospital, Boston, MA, USA
| | - Kristi Graves
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Jeanne Mandelblatt
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
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Mollica MA, Mayer DK, Oeffinger KC, Kim Y, Buckenmaier SS, Sivaram S, Muha C, Taib NA, Andritsch E, Asuzu CC, Bochis OV, Diaz S, Trill MD, Garcia PJ, Grassi L, Uchitomi Y, Shaikh AJ, Jefford M, Lee HJ, Johansen C, Luyirika E, Maher EJ, Mallillin MMB, Maniragaba T, Mehnert-Theuerkauf A, Pramesh CS, Siesling S, Spira O, Sussman J, Tang L, Hai NV, Yalcin S, Jacobsen PB. Follow-Up Care for Breast and Colorectal Cancer Across the Globe: Survey Findings From 27 Countries. JCO Glob Oncol 2021; 6:1394-1411. [PMID: 32955943 PMCID: PMC7529533 DOI: 10.1200/go.20.00180] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The purpose of this study was to describe follow-up care for breast and colorectal cancer survivors in countries with varying levels of resources and highlight challenges regarding posttreatment survivorship care. METHODS We surveyed one key stakeholder from each of 27 countries with expertise in survivorship care on questions including the components/structure of follow-up care, delivery of treatment summaries and survivorship care plans, and involvement of primary care in survivorship. Descriptive analyses were performed to characterize results across countries and variations between the WHO income categories (low, middle, high). We also performed a qualitative content analysis of narratives related to survivorship care challenges to identify major themes. RESULTS Seven low- or /lower-middle-income countries (LIC/LMIC), seven upper-middle-income countries (UMIC), and 13 high-income countries (HICs) were included in this study. Results indicate that 44.4% of countries with a National Cancer Control Plan currently address survivorship care. Additional findings indicate that HICs use guidelines more often than those in LICs/LMICs and UMICs. There was great variation among countries regardless of income level. Common challenges include issues with workforce, communication and care coordination, distance/transportation issues, psychosocial support, and lack of focus on follow-up care. CONCLUSION This information can guide researchers, providers, and policy makers in efforts to improve the quality of survivorship care on a national and global basis. As the number of cancer survivors increases globally, countries will need to prioritize their long-term needs. Future efforts should focus on efforts to bridge oncology and primary care, building international partnerships, and implementation of guidelines.
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Affiliation(s)
| | - Deborah K Mayer
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | - Nur Aishah Taib
- Graddip Genet Counsell, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Ovidiu V Bochis
- Universitatea de Medicina si Farmacie Iuliu Hatieganu Facultatea de Medicina, Cluj-Napoca, Romania
| | - Sheila Diaz
- Universidad Autonoma de Santo Domingo Facultad Ciencias de la Salud, Santo Domingo, Dominican Republic
| | - Maria Die Trill
- Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | | | | | | | - Michael Jefford
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | | | | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation and University of Twente, Enschede, the Netherlands
| | - Orit Spira
- Israel Cancer Association, Givatayim, Israel
| | | | - Lili Tang
- Peking University Cancer Hospital, Beijing, People's Republic of China
| | - Nguyen V Hai
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Suayib Yalcin
- Hacettepe University Institute of Cancer, Ankara, Turkey
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Puschel K, León A, Arancibia V, Aubel P, Velásquez Eng C, Sáez Ps S, Vinés E, León A, Thompson B, Are C. The interdisciplinary and psychosocial gap in cancer survivorship: A longitudinal study in a Latin American Cancer Center. J Surg Oncol 2021; 124:876-885. [PMID: 34133760 DOI: 10.1002/jso.26574] [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: 03/21/2021] [Revised: 05/02/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES There is lack of information on the quality of care provided to the rapidly increasing population of cancer survivors in Latin America. Our study attempts to address this gap and to identify areas needed to be improved. METHODS A random sample of 210 breast and colorectal cancer survivors were selected from a hospital-based registry in Chile. Cancer registry information, electronic chart review, and personal interviews were used to assess medical and nonmedical care over a 5-year period. Survivorship care practices were compared to a standardized reference based on the US Institute of Medicine domains and the American Cancer Association guidelines. RESULTS Over 80% of breast and colorectal cancer survivors received appropriate medical care, ongoing testing surveillance and risk factors assessment. Only a third of survivors were assessed for psychosocial disorders and 25% of them received interdisciplinary care. Overall, 66.1% of breast and 58.6% of colorectal cancer survivors reached the expected quality level of cancer survivorship care according to the reference standard (p < .001). CONCLUSION Medical care practices reached a high standard in a leading cancer center in Latin America. However, a much stronger psychosocial assessment and interdisciplinary care is needed to improve survivorship cancer quality care.
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Affiliation(s)
- Klaus Puschel
- Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Augusto León
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victor Arancibia
- Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Aubel
- Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristián Velásquez Eng
- Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Sáez Ps
- Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eugenio Vinés
- Department of Radiation Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Augusto León
- Resident in Radiation Oncology, School of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Beti Thompson
- Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Chandrakanth Are
- Department of Surgery, College of Medicine, University of Nebraska, Omaha, Nebraska, USA
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Gerardi C, Allocati E, Minoia C, Guarini A, Banzi R. Long-Term Follow-Up of Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma Survivors: Aims and Methodological Approach for Fondazione Italiana Linfomi Systematic Reviews. Cancers (Basel) 2021; 13:cancers13122976. [PMID: 34198635 PMCID: PMC8232245 DOI: 10.3390/cancers13122976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary In 2019, the Fondazione Italiana Linfomi research team proposed a new project to summarize the evidence on late sequelae after treatment of classical Hodgkin lymphoma and diffuse large B cell lymphoma in long-term survivors (>5 years free of disease). Six systematic reviews were conducted. Clinical research questions focused on the incidence of late toxicities, comparison of toxicities with different chemotherapies, radiotherapies and autologous stem-cell transplantation, and evidence on early detection and long-term follow-up of late sequelae. The six reviews investigated the late impact of treatment on cardiological diseases, secondary neoplasms, metabolic and endocrine, neurological and psychological disorders, preservation of fertility and reproductive status, and the effect of lifestyle and nutrition. The literature search was conducted on Pubmed, Embase, and Cochrane Library databases up to 2020. This project summarized current evidence in order to see which course of action was best applicable for the clinical management of long-term survivors after Hodgkin lymphoma and diffuse large B cell lymphoma, and highlighted the gaps in the field. Abstract Advances in diagnosis and treatment of hematological malignancies has boosted attention on optimal follow-up care of survivors after cancer. To collect evidence that could inform the development of an optimal model for Italian hematology centers and the scientific community, Fondazione Italiana Linfomi (FIL) commissioned an analysis of the international follow-up approaches for long-term survivors after classical Hodgkin lymphoma (cHL) or diffuse large B-cell lymphoma (DLBCL). FIL set up multidisciplinary teams, representing all different skills relevant for cancer survivors. They conducted a series of systematic reviews focused on three main aspects: incidence of long-term toxicity; comparison of old or standard therapies and more recent ones; and evidence on specific follow-up approaches. The teams applied this framework to cardiological, endocrine-metabolic, neurological/cognitive, and psychological disorders, secondary cancers, fertility preservation, and lifestyles. Each team conducted comprehensive literature searches on PubMed, Embase and Cochrane Library databases up to 2020. Screening followed the PRISMA statement for reporting systematic reviews. The reviews report the results of this wide project covering the main areas of late toxicity and conditions in the long-term survival of cHL and DLBCL patients and their follow-up. From a clinical point of view, the series confirmed that the evidence on follow-up tended to focus on solid tumors with scant evidence on hematological malignancies.
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Affiliation(s)
- Chiara Gerardi
- Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, 20156 Milano, Italy; (E.A.); (R.B.)
- Correspondence:
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, 20156 Milano, Italy; (E.A.); (R.B.)
| | - Carla Minoia
- Hematology Unit-IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (C.M.); (A.G.)
| | - Attilio Guarini
- Hematology Unit-IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (C.M.); (A.G.)
| | - Rita Banzi
- Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, 20156 Milano, Italy; (E.A.); (R.B.)
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