1
|
Salz T, Meza AM, Bradshaw PT, Jinna S, Moryl N, Kriplani A, R Tringale K, Flory J, Korenstein D, Lipitz-Snyderman A. Role of primary care in opioid prescribing for older head and neck cancer survivors. Cancer 2024. [PMID: 39072710 DOI: 10.1002/cncr.35478] [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: 02/28/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Older head and neck cancer (HNC) survivors have concerning rates of potentially unsafe opioid prescribing. Identifying the specialties of opioid prescribers for HNC survivors is critical for targeting the settings for opioid safety interventions. This study hypothesized that oncology and surgery providers are primarily responsible for opioid prescriptions in the year after treatment but that primary care providers (PCPs) are increasingly involved in prescribing over time. METHODS Using linked Surveillance, Epidemiology, and End Results-Medicare data, a retrospective analysis was conducted of adults aged >65 years diagnosed between 2014 and 2017 with stage I-III HNC and who had ≥6 months of treatment-free follow-up through 2019. Starting at treatment completion, opioid fills were assigned to a prescriber specialty: oncology, surgery, primary care, pain management, or other. Prescriber patterns were summarized for each year of follow-up. Multinomial logistic regression models captured the likelihood of opioids being prescribed by each specialty. RESULTS Among 5135 HNC survivors, 2547 (50%) had ≥1 opioid fill (median, 2.1-year follow-up). PCPs prescribed 47% of all fills (42%-55% each year). PCPs prescribed opioids to 45% of survivors with ≥1 opioid fill, which was a greater share than other specialties. PCPs prescribed longer supplies of opioids (median, 20 days/fill; median, 30 days/year) than oncologists or surgeons. The likelihood of an opioid being prescribed by an oncology provider was four times lower than that of it being prescribed by a PCP. CONCLUSIONS PCP involvement in opioid prescribing remains high throughout HNC survivorship. Interventions to improve the safety of opioid prescribing should target primary care, as is typical for opioid reduction efforts in the noncancer population.
Collapse
Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Sankeerth Jinna
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Natalie Moryl
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kathryn R Tringale
- University of California San Diego School of Medicine, San Diego, California, USA
| | - James Flory
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | |
Collapse
|
2
|
Tsai MH, Bevel MS, Andrzejak SE, Moore JX. Receipt of follow-up care plans on colorectal cancer screening among breast, prostate, and lung cancer survivors. J Cancer Surviv 2024; 18:781-790. [PMID: 36574189 PMCID: PMC10293471 DOI: 10.1007/s11764-022-01309-6] [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: 08/17/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Our study aimed to examine whether receipt of follow-up care plans is associated with greater guideline-concordant CRC screening stratified by breast, prostate, and lung cancer survivors. METHODS We used data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3339 eligible treatment-utilizing cancer survivors with complete treatment. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. RESULTS We observed that 83.9% of breast and 88.2% of prostate cancer survivors with follow-care plans received CRC screening (p-value < 0.001). The lowest CRC screening use was observed among lung cancer (70.8%). In multivariable analysis, receipt of follow-up care plans was strongly associated with greater odds of receiving CRC screening in breast (OR, 2.67; 95% CI: 1.71-4.16) and prostate (OR, 3.81; 95% CI: 2.30-6.31) cancer survivors. Regardless of provider type, 84 to 88% reduced likelihood of receipt of CRC screening when they received follow-up care plans among lung cancer survivors. Among those without follow-up care plans, breast (OR, 0.29; 95% CI: 0.09-0.92) and lung (OR, 0.05; 95% CI: 0.01-0.25) cancer survivors who received care from general practices were less likely to receive CRC screening compared to those who received care from non-general practices. CONCLUSIONS Receipt of follow-up care plans was associated with greater CRC screening use in breast and prostate cancers. Lung cancer survivors demonstrated lower screening use despite receipt of follow-up care plans. IMPLICATION FOR CANCER SURVIVORS Patient and provider communication regarding CRC screening recommendation should be included in their follow-up care plans.
Collapse
Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA.
- Georgia Prevention Institute, Augusta University, 1457 Walton Way, Augusta, GA, 30901, USA.
| | - Malcolm S Bevel
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Sydney E Andrzejak
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Justin X Moore
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
- Institute of Public and Preventive Health, Augusta University, 1120 15Th Street, Augusta, GA, 30912, USA
| |
Collapse
|
3
|
Filbert AL, Kremer L, Ladenstein R, Chronaki C, Degelsegger-Márquez A, van der Pal H, Bardi E, Uyttebroeck A, Langer T, Muraca M, Nieto AC, Rascon J, Bagnasco F, Beyer S, Te Dorsthorst J, Essiaf S, Galan AO, Kienesberger A, O'Brien K, Palau MC, Pluijm SMF, di Profio S, Saraceno D, Schneider C, Schreier G, Trinkūnas J, Zamberlan I, Grabow D, Haupt R. Scaling up and implementing the digital Survivorship Passport tool in routine clinical care - The European multidisciplinary PanCareSurPass project. Eur J Cancer 2024; 202:114029. [PMID: 38513384 DOI: 10.1016/j.ejca.2024.114029] [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: 12/21/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Childhood cancer survivors (CCS), of whom there are about 500,000 living in Europe, are at an increased risk of developing health problems [1-6] and require lifelong Survivorship Care. There are information and knowledge gaps among CCS and healthcare providers (HCPs) about requirements for Survivorship Care [7-9] that can be addressed by the Survivorship Passport (SurPass), a digital tool providing CCS and HCPs with a comprehensive summary of past treatment and tailored recommendations for Survivorship Care. The potential of the SurPass to improve person-centred Survivorship Care has been demonstrated previously [10,11]. METHODS The EU-funded PanCareSurPass project will develop an updated version (v2.0) of the SurPass allowing for semi-automated data entry and implement it in six European countries (Austria, Belgium, Germany, Italy, Lithuania and Spain), representative of three infrastructure healthcare scenarios typically found in Europe. The implementation study will investigate the impact on person-centred care, as well as costs and processes of scaling up the SurPass. Interoperability between electronic health record systems and SurPass v2.0 will be addressed using the Health Level Seven (HL7) International interoperability standards. RESULTS PanCareSurPass will deliver an interoperable digital SurPass with comprehensive evidence on person-centred outcomes, technical feasibility and health economics impacts. An Implementation Toolkit will be developed and freely shared to promote and support the future implementation of SurPass across Europe. CONCLUSIONS PanCareSurPass is a novel European collaboration that will improve person-centred Survivorship Care for CCS across Europe through a robust assessment of the implementation of SurPass v2.0 in different healthcare settings.
Collapse
Affiliation(s)
- Anna-Liesa Filbert
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ruth Ladenstein
- St. Anna Children's Cancer Research Institute, Vienna, Austria; St Anna Children's Hospital, Vienna, Austria
| | | | | | | | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria; Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | | | - Thorsten Langer
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Germany
| | | | | | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Clinics for Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | | | - Stefan Beyer
- AIT Austrian Institute of Technology, Graz, Austria
| | | | | | | | | | | | | | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Sonia di Profio
- Clinical Psychology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | | | - Justas Trinkūnas
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | | |
Collapse
|
4
|
Molinares D, Parke S, Yadav R, Liu D, Williams J, Bruera E. Knowledge, attitudes, and beliefs of oncology trainees on function and cancer rehabilitation medicine. PM R 2023; 15:982-989. [PMID: 36762725 DOI: 10.1002/pmrj.12881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Improved function is associated with reduced morbidity and mortality in patients with cancer. Cancer rehabilitation medicine (CRM) is a subspecialty of physical medicine and rehabilitation (PM&R) that focuses on improving function in patients with cancer. One of the barriers to patients accessing CRM services is the lack of referrals from oncology providers. Understanding the knowledge, attitudes and beliefs of oncology trainees regarding the importance of function and the role of CRM is essential to reducing educational gaps and improving patients' access to essential rehabilitation services. OBJECTIVE To determine oncology trainees' knowledge, attitude and beliefs about the importance of function and the role of CRM in the care of patients with cancer. SETTING The study was conducted at a comprehensive cancer center in the United States. INTERVENTION Descriptive survey study was administered to postgraduate oncology trainees who spent at least 1 day a week providing patient care. MAIN OUTCOME Participants' report of their knowledge, attitudes, and beliefs on the importance of function and CRM in the care of patients with cancer. RESULTS The survey was sent to 197 oncology trainees with a response rate of 67% (n = 132) and 126 were ultimately included. All participants believed that function is important in the care of patients with cancer. The majority believed that better function improves treatment tolerance (94%) and survival (84%). Most reported that having CRM physicians (80%) and an inpatient rehabilitation unit (88%) in the oncological setting is important; however, most participants reported that they refer fewer than 25% of their patients to CRM services. Participants with prior exposure to PM&R were significantly more likely to consult PM&R compared to those without exposure (p = .005). Most oncology trainees (81%) believed that education in CRM should be part of their oncology training. CONCLUSION This study demonstrates that oncology trainees believe that function is important. They also believe that access to CRM would improve treatment tolerance and survival, but most report that they rarely refer patients to CRM services. Most trainees desire increased exposure to CRM during oncology training.
Collapse
Affiliation(s)
- Diana Molinares
- Department of Physical Medicine and Rehabilitation, University of Miami Health System, Miami, Florida, USA
| | - Sara Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - Rajesh Yadav
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet Williams
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Duggan C, Cushing-Haugen KL, Cole AM, Allen J, Gilles R, Hornecker JR, Gutierrez AI, Warner J, Scott Baker K, Ceballos RM, Chow EJ. Feasibility of delivering survivorship care via lay health educators: A pilot randomized controlled trial among rural cancer survivors. J Rural Health 2023; 39:666-675. [PMID: 36593127 PMCID: PMC10650940 DOI: 10.1111/jrh.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE We tested the feasibility of survivorship care plan (SCP) delivery with/without a lay health educator (LHE) telephone-delivered information session among rural cancer survivors, and their effects on health-related self-efficacy and knowledge of cancer history. METHODS Randomized trial of cancer survivors from 3 rural oncology clinics featuring either SCP alone (control) or SCP plus LHE-delivered information session (intervention). Participants completed a questionnaire on health-related self-efficacy and knowledge of cancer-specific medical history. Responses were compared to medical records for accuracy. SCPs were then mailed to participants. Approximately 5 months later, participants completed a follow-up questionnaire. A subset of participants took part in subsequent qualitative interviews about their study experience. FINDINGS Of 301 survivors approached, 72 (23.9%) were randomized (mean age 66.4 years; 3.1 years from diagnosis; 62.5% female), and 65 (90.3%) completed the study. Global mental and physical health or self-efficacy scores did not change significantly from baseline to follow-up for either group. In exploratory analyses, self-efficacy increased in participants with inadequate/marginal health literacy in the intervention arm (+0.7, 95% CI = 0.1-1.2; P = .01). Accuracy of knowledge did not improve but was high at baseline (mean 76.0±14.5%). 60.1% and 48.4% of control and intervention participants, respectively, found SCPs definitely/somewhat useful. Qualitative data (n = 20) suggested that SCPs were helpful to patients when primary and oncology care were less integrated. CONCLUSIONS An LHE-delivered informational session was feasible but had limited benefit to rural cancer survivors versus delivery of SCP alone but may be of benefit to patients with low health literacy or with less integrated care.
Collapse
Affiliation(s)
- Catherine Duggan
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | | | - Allison M. Cole
- Institute of Translational Health Sciences, University of Washington, Seattle, WA 98105, USA
| | | | - Ryan Gilles
- Kootenai Health, Coeur d’Alene ID 83814, USA
| | - Jaime R. Hornecker
- University of Wyoming Family Medicine Residency Program, Caspar, WY 82071, USA
| | | | - Jude Warner
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - K. Scott Baker
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Rachel M. Ceballos
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Eric J. Chow
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
- University of Washington, Seattle, Washington, USA
| |
Collapse
|
7
|
Phothikul J, Seven M. Knowledge, Perception, and Skills, and Practices of Oncology Nurses in Cancer Survivorship Care: a Scoping Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023:10.1007/s13187-023-02311-x. [PMID: 37227591 DOI: 10.1007/s13187-023-02311-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 05/26/2023]
Abstract
Survivorship care focuses on the well-being and quality of life of people affected by cancer. Oncology nurses play an essential role in survivorship care and must be equipped with the knowledge, skills, and competencies to provide survivorship care. This scoping review explored the existing literature on nurses' knowledge, perception, skills, or practices in delivering cancer survivorship care for adult cancer survivors. A scoping review was conducted through databases including PubMed, CINAHL, Scopus, Web of Science, and PsycInfo in February 2022, following the Joanna Briggs Institute methodology. Fourteen original research studies were included. Most of the studies were conducted in the USA and targeted oncology registered nurses. The studies primarily focused on the knowledge (n = 2, 14.3%), perception of responsibility (n = 8, 57.1%), and practice (n = 9, 64.3%) regarding survivorship care among oncology nurses, reporting widely varied results. Nine studies reported perceived skills, practice, and perceived barriers as the most used outcome measurements, while two assessed nurses' cancer survivorship care knowledge. The main gaps were discrepancies between oncology nurses' perceptions of responsibility and practices in delivering survivorship care. Lack of time, knowledge, and skills were reported as significant factors impeding survivorship care provision among oncology nurses. Limited research shows a gap in integrating knowledge into survivorship care practices among oncology nurses. Further studies are needed to develop educational programs on survivorship care to support the integration of survivorship care into oncology nurses' practice.
Collapse
Affiliation(s)
- Jittrarath Phothikul
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, USA.
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, USA
| |
Collapse
|
8
|
McLoone JK, Chen W, Wakefield CE, Johnston K, Bell R, Thornton-Benko E, Cohn RJ, Signorelli C. Childhood cancer survivorship care: A qualitative study of healthcare providers’ professional preferences. Front Oncol 2022; 12:945911. [PMID: 36267959 PMCID: PMC9577072 DOI: 10.3389/fonc.2022.945911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/16/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Childhood cancer survivorship care is a complex specialty, though it is increasingly being integrated into the general practitioner’s (GP) remit. Establishing the essential components of tertiary- and primary-led care, to maximize the benefits and overcome the challenges inherent to each, is essential to inform the development of survivor-centered, sustainable care models. Methods We used the qualitative principles of semi-structured interviewing, verbatim transcription, coding (supported by NVivo12) and thematic analysis, to collect and evaluate the views and preferences of pediatric oncologists, survivorship nurse coordinators, and GPs currently caring for childhood cancer survivors. Results Seventy healthcare providers (19 oncology staff and 51 GPs) from 11 tertiary hospitals and 51 primary practices across Australia and New Zealand participated. Participants reported specialist expertise and holistic family-centered care as the key benefits of tertiary and primary care respectively. Participants reported that tertiary-led survivorship care was significantly challenged by a lack of dedicated funding and costs/travel burden incurred by the survivor, whereas primary-led survivorship care was challenged by insufficient GP training and GPs’ reliance on oncologist-developed action plans to deliver guideline-based care. GPs also reported a need for ongoing access to survivorship expertise/consultants to support care decisions at critical times. The discharge of survivors into primary care limited late-effects data collection and the rapid implementation of novel research findings. Conclusions Healthcare professionals report that while a risk-stratified, collaborative model of survivor-centered care is optimal, to be implemented successfully, greater provisions for the ongoing engagement of GPs and further access to GP education/training are needed.
Collapse
Affiliation(s)
- Jordana K. McLoone
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales (UNSW) Medicine & Health, Discipline of Paediatrics, UNSW Sydney, Sydney, NSW, Australia
- *Correspondence: Jordana K. McLoone,
| | - Weihan Chen
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales (UNSW) Medicine & Health, Discipline of Paediatrics, UNSW Sydney, Sydney, NSW, Australia
| | - Claire E. Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales (UNSW) Medicine & Health, Discipline of Paediatrics, UNSW Sydney, Sydney, NSW, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Rachael Bell
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Elysia Thornton-Benko
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Richard J. Cohn
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales (UNSW) Medicine & Health, Discipline of Paediatrics, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Christina Signorelli
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales (UNSW) Medicine & Health, Discipline of Paediatrics, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
9
|
Choi Y, Peairs KS, Sateia HF, Riddell R, Zhang C, McGuire MJ. High Value Care in Cancer Surveillance and Screening: Evaluating an e-Curriculum for Primary Care Providers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1472-1478. [PMID: 33723797 DOI: 10.1007/s13187-021-01986-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND With an expected shortage of oncologists, primary care providers (PCPs) may need to manage more cancer surveillance and screening, areas where educational resources for PCPs have been limited. The goal of this e-curriculum was for PCPs to learn surveillance and screening for several common cancers. METHODS The e-curriculum covered breast and colorectal cancer surveillance and lung cancer screening with (1) a pre-test assessing knowledge, attitudes, practice patterns, and confidence; (2) case vignette-based teaching; and (3) an immediate post-test (with knowledge and confidence items identical to the pre-test) providing feedback. A delayed post-test was administered several months later. The curriculum and test items were developed by content experts and evaluated in a primary care group practice. RESULTS Of 167 community PCPs, 152 completed the pre-test (91%), 145 completed the immediate post-test (87%), and 63 completed the delayed post-test (37%); 62 PCPs completed all three tests (37%). The median score on the pre-test was 43%, immediate post-test was 93%, and delayed post-test was 70%. For PCPs completing all three tests, the median scores were 50%, 90%, and 70%, respectively (p < 0.0001). The percentage of PCPs confident in their knowledge 4 to 6 months after module completion compared to the pre-test baseline was statistically significant for lung cancer screening but not for cancer surveillance. CONCLUSION This curriculum provided concise, effective education for PCPs on 3 common cancers. Limitations include content breadth and lack of data reflecting physician ordering patterns. Curricular strengths include its accessibility, immediate feedback, and effectiveness, with a significant improvement in immediate and delayed post-test knowledge. Given a lack of increased confidence to provide cancer surveillance, PCPs should rely on electronic medical record tools and other resources to guide appropriate surveillance care.
Collapse
Affiliation(s)
- Youngjee Choi
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | | | - Rebecca Riddell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Maura J McGuire
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
10
|
Kleckner AS, Magnuson A. The nutritional needs of older cancer survivors. J Geriatr Oncol 2022; 13:738-741. [PMID: 34906443 PMCID: PMC9187777 DOI: 10.1016/j.jgo.2021.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/29/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
Older adults comprise a large proportion of cancer survivors, and older cancer survivors have distinct nutritional needs. Herein, we summarize nutritional needs of older cancer survivors, describe approaches to identify nutritional impairments, and provide guidelines for clinicians to address nutritional needs.
Collapse
Affiliation(s)
- Amber S Kleckner
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland Baltimore, Baltimore, MD 21201, United States.
| | - Allison Magnuson
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14534, United States
| |
Collapse
|
11
|
Adherence to cardiovascular disease risk factor medications among patients with cancer: a systematic review. J Cancer Surviv 2022; 17:595-618. [PMID: 35578150 PMCID: PMC9923500 DOI: 10.1007/s11764-022-01212-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The most common cause of mortality for many cancer survivors is cardiovascular disease (CVD). This requires a shift in thinking where control of CVD risk factor-related comorbidity is paramount. Our objective was to provide an understanding of adherence to medications for the management of CVD risk factor-related comorbidities among cancer survivors. METHODS We systematically searched for articles indexed in MEDLINE (via PubMed), Embase, Cochrane (Wiley), PsycINFO, and Scopus (via Elsevier) for articles published from inception to October 31, 2019, and updated the search on June 7, 2021. English language, original research that assessed medication adherence to common CVD risk factor-related comorbidities among cancer survivors was included. We assessed risk of bias using the Mixed Methods Appraisal Tool. RESULTS Of the 21 studies included, 57% focused on multiple cancer types. Seventy-one percent used pharmacy-based adherence measures. Two were prospective. Adherence was variable across cancer types and CVD risk factor-related comorbidities. Among the studies that examined changes in comorbid medication adherence, most noted a decline in adherence following cancer diagnosis and throughout cancer treatment. There was a focus on breast cancer populations. CONCLUSIONS CVD risk factor-related medication adherence is low among cancer survivors and declines over time. Given the risk for CVD-mortality among cancer survivors, testing of interventions aimed at improving adherence to non-cancer medications is critically needed. IMPLICATIONS FOR CANCER SURVIVORS For many cancer survivors, regularly taking medications to manage CVD risk is important for longevity. Engaging with primary care throughout the cancer care trajectory may be important to support cardiovascular health.
Collapse
|
12
|
Duangchan C, Steffen A, Matthews AK. Thai oncology nurses' perspectives toward survivorship care plan components and implementation for colorectal cancer survivors. Support Care Cancer 2022; 30:4089-4098. [PMID: 35066665 DOI: 10.1007/s00520-021-06766-w] [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: 06/11/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe oncology nurses' perspectives regarding survivorship care plan (SCP) components and implementation for colorectal cancer (CRC) survivors in Thailand. METHODS A cross-sectional, descriptive online study was conducted between October and November 2020. Thai oncology nurses were recruited using Facebook and the Line application. Study participants (n = 160) rated the usefulness of four standard SCP components (treatment summaries, surveillance, late/long-term effects, and health promotion and psychosocial needs; n = 23 items) and gave input on the implementation of SCPs in clinical practice (n = 11 items). Data were analyzed using descriptive statistics. RESULTS Most oncology nurses supported providing CRC survivors with SCPs (93.2%) and felt that SCPs were an important part of their practice (93.7%). Nurses rated all four SCP components as "very useful," including treatment summaries (76.4%), surveillance (81.9%), late/long-term effects (85.7%), and health behavior and psychosocial concerns (80.2%). In terms of implementation, most nurses indicated that oncologists should prepare (84.4%) and provide SCPs (95%), but 61.9% and 69.4% of nurses, respectively, also believed that they should perform these tasks. In addition, most nurses indicated that they should play a significant role in the ongoing management of CRC survivors (95.7%) and that evidence-based surveillance guidelines are needed (96.2%). CONCLUSION Oncology nurses believed that the four SCP components were helpful to the long-term management of CRC survivors, supported SCP provision, and expressed their perceived responsibilities for preparing and delivering SCPs. The findings suggested opportunities for oncology nurses to play a significant role in developing and implementing SCPs. However, additional efforts are needed to expand nurses' roles in survivorship care and establish practice guidelines that will facilitate integration of SCPs into nursing practice.
Collapse
Affiliation(s)
- Cherdsak Duangchan
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA. .,Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Alana Steffen
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Alicia K Matthews
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| |
Collapse
|
13
|
Rocque GB, Dent DN, Caston NE, Salter T, DeMoss J, Bhatia S, Miller H, Pisu M. Building Sustainable Practice Transformation Through Payment Reform Initiatives. JCO Oncol Pract 2022; 18:e731-e739. [PMID: 34995081 DOI: 10.1200/op.21.00560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Novel value-based payment approaches provide an opportunity to deploy and sustain health care delivery interventions, such as treatment planning documentation. However, limited data are available on implementation costs. METHODS We described key factors affecting the cost of implementing care improvements under value-based payments, using treatment planning and Medicare's Oncology Care Model as examples. We estimated expected costs of implementing treatment plans for years 1 and 2-6 under (1) different staffing models, (2) use of technology, and (3) differences in the patients engaged. We compared costs to the payment amounts under the Oncology Care Model. RESULTS Team-based models where staffing is aligned with skills needed for key tasks (eg, a combination of lay navigator, nurse, and physician) are more financially feasible when compared with using physicians or nurses alone. When existing staff are at or near capacity, hiring new staff focused on practice transformation activities allows adequate time for new initiatives without negative impacts on existing services. Investments in information technology can enhance staff productivity, but initial costs may be high. Interventions may not be financially feasible if implemented for a small patient volume or only for patients insured by a particular payer. Finally, costs may be higher for disadvantaged populations, and equity in care delivery may require higher payments from payers. CONCLUSION Estimating the cost of implementing an intervention in different types of practice settings with various types of patients is essential to ensure that a value-based payment system will adequately support desired improvements in quality of care for all patients.
Collapse
Affiliation(s)
- Gabrielle B Rocque
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL.,University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL.,O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - D'Ambra N Dent
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Nicole E Caston
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Terri Salter
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | | | - Smita Bhatia
- University of Alabama at Birmingham Institute for Cancer Outcomes and Survivorship, Birmingham, AL
| | - Harold Miller
- Center for Healthcare Quality and Payment Reform, Pittsburgh, PA
| | - Maria Pisu
- O'Neal Comprehensive Cancer Center, Birmingham, AL.,University of Alabama at Birmingham, Department of Medicine, Division of Preventative Medicine, Birmingham, AL
| |
Collapse
|
14
|
Coschi CH, Bainbridge D, Sussman J. Understanding the Attitudes and Beliefs of Oncologists Regarding the Transitioning and Sharing of Survivorship Care. Curr Oncol 2021; 28:5452-5465. [PMID: 34940093 PMCID: PMC8700375 DOI: 10.3390/curroncol28060454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 01/23/2023] Open
Abstract
Transitioning survivorship care from oncologists to primary care physicians (PCPs) is a reasonable alternative to oncologist-led care. This study assessed oncologists’ attitudes and beliefs regarding sharing/transitioning survivorship care. A prospective survey of oncologists within a regional cancer program assessing self-reported barriers and facilitators to sharing/transitioning survivorship care was disseminated. In total, 63% (n = 39) of surveyed oncologists responded. Patient preference (89%) and anxiety (84%) are key to transition of care decisions; reduced remuneration (95%) and fewer longitudinal relationships (63%) do not contribute. Oncologists agreed that more patients could be shared/transitioned. Barriers include treatment-related toxicities (82% agree), tumor-specific factors (60–90% agree) and perception of PCP willingness to participate in survivorship care (47% agree). Oncologists appear willing to share/transition more survivors to PCPs, though barriers exist that warrant further study. Understanding these issues is critical to developing policies supporting comprehensive survivorship care models that address both cancer and non-cancer health needs. The demonstrated feasibility of this project warrants a larger-scale survey of oncologists with respect to the transition of survivorship care to PCPs, to further inform effective interventions to support high-quality survivorship care.
Collapse
Affiliation(s)
- Courtney H. Coschi
- Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada;
| | - Daryl Bainbridge
- Juravinski Hospital and Cancer Centre, Department of Oncology, McMaster University, 711 Concession Street, Hamilton, ON L8V 1C3, Canada;
| | - Jonathan Sussman
- Juravinski Hospital and Cancer Centre, Department of Oncology, McMaster University, 711 Concession Street, Hamilton, ON L8V 1C3, Canada;
- Hamilton Health Sciences Juravinski Cancer Centre, 699 Concession Street, Hamilton, ON L8V 5C2, Canada
- Correspondence:
| |
Collapse
|
15
|
Lyson HC, Haggstrom D, Bentz M, Obeng-Gyasi S, Dixit N, Sarkar U. Communicating Critical Information to Cancer Survivors: an Assessment of Survivorship Care Plans in Use in Diverse Healthcare Settings. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:981-989. [PMID: 32128714 PMCID: PMC7483188 DOI: 10.1007/s13187-020-01725-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Survivorship care plans (SCPs) serve to communicate critical information needed for cancer survivors' long-term follow-up care. The extent to which SCPs are tailored to meet the specific needs of underserved patient populations is understudied. To fill this gap, this study aimed to assess the content and communication appropriateness of SCPs collected from diverse healthcare settings. We analyzed collected SCPs (n = 16) for concordance with Institute of Medicine (IOM) recommendations for SCP content and for communication appropriateness using the Suitability Assessment of Materials (SAM) instrument. All plans failed to incorporate all IOM criteria, with the majority of plans (n = 11) incorporating less than 60% of recommended content. The average reading grade level of all the plans was 14, and only one plan received a superior rating for cultural appropriateness. There is significant variation in the format and content of SCPs used in diverse hospital settings and most plans are not written at an appropriate reading grade level nor tailored for underserved and/or minority patient populations. Co-designing SCPs with diverse patient populations is crucial to ensure that these documents are meeting the needs and preferences of all cancer survivors.
Collapse
Affiliation(s)
- Helena C Lyson
- University of California San Francisco, Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, UCSF Box 1364, San Francisco, CA, 94143, USA.
| | - David Haggstrom
- VA Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Health Services Research, Regenstrief Institute, Inc., 1481 West 10th Street, Indianapolis, IN, 46202, USA
| | - Michael Bentz
- University of California Berkeley, School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA
| | - Samilia Obeng-Gyasi
- Indiana University Simon Cancer Center, 535 Barnhill Drive RT 440, Indianapolis, IN, 46202, USA
| | - Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, 995 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Urmimala Sarkar
- University of California San Francisco, Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, UCSF Box 1364, San Francisco, CA, 94143, USA
| |
Collapse
|
16
|
Tremblay D, Touati N, Bilodeau K, Prady C, Usher S, Leblanc Y. Risk-Stratified Pathways for Cancer Survivorship Care: Insights from a Deliberative Multi-Stakeholder Consultation. Curr Oncol 2021; 28:3408-3419. [PMID: 34590587 PMCID: PMC8482148 DOI: 10.3390/curroncol28050295] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While the principle is supported by leading cancer institutions, translating knowledge to practice confronts a lack of clarity about the meaning of risk stratification, uncertainties around the expectations the model holds for different actors, and health system structures that impede communication and coordination across the care continuum. These barriers must be better understood and addressed to pave the way for future implementation. Recognizing that an innovation is more likely to be adopted when user experience is incorporated into the planning process, a deliberative consultation was held as a preliminary step to developing a pilot project of risk-stratified pathways for patients transitioning from specialized oncology teams to primary care providers. This article presents findings from the deliberative consultation that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: what does a risk stratified model of cancer survivorship care mean to care providers and users? What are the prerequisites for translating risk stratification into practice? What challenges are involved in establishing these prerequisites? The multi-stakeholder consultation provides empirical data to guide actions that support the development of risk-stratified pathways to coordinate survivorship care.
Collapse
Affiliation(s)
- Dominique Tremblay
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
- Correspondence: ; Tel.: +1-450-466-5000 (ext. 2885)
| | - Nassera Touati
- École Nationale d’Administration Publique, 4750 Henri-Julien Avenue, Montréal, QC H2T 3E5, Canada;
| | - Karine Bilodeau
- Faculté des Sciences Infirmières et Centre D’Innovation en Formation Infirmière, Université de Montréal, Montréal, QC H3T 1A8, Canada;
| | - Catherine Prady
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
- Centre Intégré de Cancérologie de la Montérégie, 3120 Boulevard Taschereau, Greenfield Park, QC J4V 2H1, Canada
| | - Susan Usher
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- École Nationale d’Administration Publique, 4750 Henri-Julien Avenue, Montréal, QC H2T 3E5, Canada;
| | - Yves Leblanc
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
| |
Collapse
|
17
|
Snyder C, Choi Y, Blackford AL, DeSanto J, Mayonado N, Rall S, White S, Bowie J, Cowall DE, Johnston F, Joyner RL, Mischtschuk J, Peairs KS, Thorner E, Tran PT, Wolff AC, Smith KC. Simplifying Survivorship Care Planning: A Randomized Controlled Trial Comparing 3 Care Plan Delivery Approaches. J Natl Cancer Inst 2021; 114:139-148. [PMID: 34302474 DOI: 10.1093/jnci/djab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Survivorship care plans seek to improve the transition to survivorship, but the required resources present implementation barriers. This randomized controlled trial aimed to identify the simplest, most effective approach for survivorship care planning. METHODS Stage 1-3 breast, colorectal, and prostate cancer patients aged 21+ completing treatment were recruited from an urban-academic and rural-community cancer center. Participants were randomized, stratified by recruitment site and cancer type, 1:1:1 to (a)mailed plan, (b)plan delivered during one-time transition visit, or (c)plan delivered during transition visit plus 6-month follow-up visit. Health service use data were collected from participants and medical records for 18 months. The primary outcome, receipt of all plan-recommended care, was compared across intervention arms using logistic regression adjusting for cancer type and recruitment site with p < 0.05 considered statistically significant. RESULTS Of 378 participants randomized, 159 (42.1%) were breast, 142 (37.6%) prostate, 77 (20.4%) colorectal cancer survivors; 207 (54.8%) from the academic site, 171 (45.2%) from the community site; 316 analyzable for the primary outcome. There was no difference across arms in the proportion of participants receiving all plan-recommended care: 45.2% mail, 50.5% one-visit, 42.7% two-visit (2-sided P = 0.60). Adherence by cancer type for mail, one-visit, and two-visit, respectively, was 52.2%, 53.3%, 40.0% for breast cancer; 48.6%, 64.1%, 57.1% for prostate cancer; and 23.8%, 19.0%, 26.1% for colorectal cancer. There were no statistically significant interactions by recruitment site or cancer type. CONCLUSIONS This study did not find differences in receipt of recommended follow-up care by plan delivery approach. Feasibility and other factors may determine the best approach for survivorship care planning.
Collapse
Affiliation(s)
- Claire Snyder
- Johns Hopkins University School of Medicine.,Johns Hopkins Bloomberg School of Public Health.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | | | | | | | - Susan Rall
- TidalHealth Richard A. Henson Research Institute
| | | | | | | | - Fabian Johnston
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | | | - Kimberly S Peairs
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | - Phuoc T Tran
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - Antonio C Wolff
- Johns Hopkins University School of Medicine.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - Katherine C Smith
- Johns Hopkins Bloomberg School of Public Health.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | |
Collapse
|
18
|
Salz T, Ostroff JS, Nightingale CL, Atkinson TM, Davidson EC, Jinna SR, Kriplani A, Lesser GJ, Lynch KA, Mayer DK, Oeffinger KC, Patil S, Salner AL, Weaver KE. The Head and Neck Survivorship Tool (HN-STAR) Trial (WF-1805CD): A protocol for a cluster-randomized, hybrid effectiveness-implementation, pragmatic trial to improve the follow-up care of head and neck cancer survivors. Contemp Clin Trials 2021; 107:106448. [PMID: 34023515 DOI: 10.1016/j.cct.2021.106448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
Survivors of head and neck cancer (HNC) can have multiple health concerns. To facilitate their care, we developed and pilot-tested a clinical informatics intervention, HN-STAR. HN-STAR elicits concerns online from HNC survivors prior to a routine oncology clinic visit. HN-STAR then presents tailored evidence-based clinical recommendations as a clinical decision support tool to be used during the visit where the oncology clinician and survivor select symptom management strategies and other actions. This generates a survivorship care plan (SCP). Online elicitation of health concerns occurs 3, 6, and 9 months after the clinic visit, generating an updated SCP each time. HN-STAR encompasses important methods of improving survivorship care (e.g., needs assessment, tailored interventions, dissemination of guidelines) and will be evaluated in a pragmatic trial to maximize external validity. This hybrid type 1 implementation-effectiveness trial tests HN-STAR effectiveness while studying barriers and facilitators to implementation in community oncology practices within the National Cancer Institute Community Oncology Research Program. Effectiveness will be measured as differences in key survivorship outcomes between HNC participants who do and do not use HN-STAR over one year after the clinic visit. The primary endpoint is HNC-specific quality of life; other outcomes include patient-centered measures and receipt of guideline-concordant care. Implementation outcomes will be assessed of survivors, providers, and clinic stakeholders. The hybrid design will provide insight into a dose-response relationship between the extent of implementation fidelity and effectiveness outcomes, as well as how to incorporate HN-STAR into standard practice outside the research setting.
Collapse
Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Chandylen L Nightingale
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Thomas M Atkinson
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Eleanor C Davidson
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Sankeerth R Jinna
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Glenn J Lesser
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Kathleen A Lynch
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Deborah K Mayer
- University of North Carolina Lineberger Comprehensive Cancer Center, 450 West Dr, Chapel Hill, NC 27599, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, 2424 Erwin Dr, Suite 601, Durham, NC 27705, USA
| | - Sujata Patil
- The Cleveland Clinic Foundation, 9500 Euclid Avenue, CA6-160, Cleveland, OH 44195, USA
| | - Andrew L Salner
- Hartford HealthCare Cancer Institute at Hartford Hospital, 79 Retreat Ave, Hartford, CT 06106, USA
| | - Kathryn E Weaver
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| |
Collapse
|
19
|
Peixoto NMDSM, Peixoto TADSM, Pinto CAS, Santos CSVDB. Nursing intervention focusing on health promotion behaviors in adult cancer patients: a scoping review. Rev Esc Enferm USP 2021; 55:e03673. [PMID: 33886904 DOI: 10.1590/s1980-220x2019039403673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 05/29/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This review aims to map and provide an overview of literature concerning nursing strategies and intervention programs that promote healthy behaviors in cancer patients. METHOD A scoping review was conducted using the methodological framework developed by Joanna Briggs Institute and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. Twelve databases were searched (2012-2019). Retrieved data included descriptive analyses exploring studies' methodological characteristics and results. RESULTS From 1589 studies, 12 were included. Most studies included patients on survivorship period (n=10) and selected intervention strategies focusing patient's knowledge and awareness (n=8). Educational sessions were supported by behavioral change reinforcements and motivational incentives. Only two of the considered studies analysed intervention cost effectiveness, but none disclosed intervention-related costs. CONCLUSION Nursing interventions are effective in promoting health behaviors when include health education and encouragement towards change. Survivorship is the perfect time for health promotion. Nurses can be considered health promoters, by encouraging health education and enhance survivor's motivation.
Collapse
|
20
|
King-Dowling S, Psihogios AM, Hill-Kayser C, Szalda D, O’Hagan B, Darabos K, Daniel LC, Barakat LP, Fleisher L, Maurer LA, Velázquez-Martin B, Jacobs LA, Hobbie W, Ginsberg JP, Vachani CC, Metz JM, Schwartz LA. Acceptability and feasibility of survivorship care plans and an accompanying mobile health intervention for adolescent and young adult survivors of childhood cancer. Pediatr Blood Cancer 2021; 68:e28884. [PMID: 33416214 PMCID: PMC9639403 DOI: 10.1002/pbc.28884] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-management interventions for adolescent and young adult (AYA) survivors of childhood cancer are needed. The present study reports on the acceptability and feasibility of delivering survivorship care plans (SCPs) and an accompanying app to AYA. PROCEDURE AYA (n = 224) ages 15-29 who completed treatment for cancer were randomized and received a digital SCP only or an SCP plus a mobile app intended to enhance self-management. For 16 weeks, the app delivered one to two daily messages complementing information in their SCP and tailored based on age, treatment, and health goal. Data are presented on feasibility, self-reported acceptability (including satisfaction and perceived benefits) and its relationship to app engagement (for those in app group), and feedback from qualitative interviews conducted with 10 AYA. RESULTS The SCP and app proved feasible as evidenced by high recruitment and retention, access to technology, time analysis, moderate app engagement, and minimal technical issues. However, 12% reported never reading the SCP and 8% never used the app. The app and SCP were acceptable to AYA, and SCP acceptability ratings did not differ between groups. For those with the app, acceptability was positively related to message engagement. AYA recommended enhanced individualization and design features of the SCP and app. CONCLUSIONS Results support the use of tailored SCPs and mobile health interventions for most AYA, as well as the need for further refinement and research. Delivery of SCPs and digital interventions are acceptable and feasible to AYA survivors, and may help promote health-related knowledge and survivorship self-management.
Collapse
Affiliation(s)
- Sara King-Dowling
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Alexandra M. Psihogios
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | - Christine Hill-Kayser
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA,University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Dava Szalda
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | - Bridget O’Hagan
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Katie Darabos
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | | | - Lamia P. Barakat
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Laurie A. Maurer
- Tennessee Department of Health, HIV/STD/Viral Hepatitis Section, Nashville, TN, USA
| | | | - Linda A. Jacobs
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA,University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Wendy Hobbie
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Jill P. Ginsberg
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | - Carolyn C Vachani
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - James M. Metz
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA,University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Lisa A. Schwartz
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
21
|
Developing a survivorship care plan (SCP) delivery process for patients and primary care providers serving poor, rural, and minority patients with cancer. Support Care Cancer 2021; 29:5021-5028. [PMID: 33587174 PMCID: PMC7883333 DOI: 10.1007/s00520-021-06043-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
Background Survivorship care plans (SCPs) summarize patients’ treatment and act as an education and communication tool between oncologists and primary care providers (PCPs). But creation and delivery of SCPs are challenging, labor intensive, and costly. The University of New Mexico Comprehensive Cancer Center (UNM CCC) treats a poor, rural, and minority patient population, and our purpose was to implement and evaluate a process to create and deliver SCPs to patients and PCPs. Methods Providers placed an electronic SCP order, basic information was imported, and staff compiled treatment details. Flagged SCPs were then ready for delivery, providers approved of and delivered the SCP at the next encounter, and the SCP was sent to the PCP. Results By April 2020, 283 SCPs were ordered, 241 (85.2%) were created by the designated staff, and 97 (34.2%) were given to patients after definitive therapy for breast cancer (59.1%), gynecological cancers (10.8%), prostate cancer (7.4%), colorectal cancer (5.1%), and lymphomas (4.8%). Of 97 SCPs eligible to be sent to PCPs, 75 (77.3%) were mailed or sent via EMR. Of the 41 (48.9%) SCPs sent via mail or fax, only 8 (8.3%) were received and 5 (5.2%) integrated. Conclusions This study shows that SCPs can be delivered to patients in a poor, rural, and minority patient population but that PCP receipt and integration of SCPs are poor. Future efforts need to ensure that an oncologist to PCP education and communication tool is able reach and be integrated by PCPs.
Collapse
|
22
|
Timsina LR, Zarzaur B, Haggstrom DA, Jenkins PC, Lustberg M, Obeng-Gyasi S. Dissemination of cancer survivorship care plans: who is being left out? Support Care Cancer 2021; 29:4295-4302. [PMID: 33415363 DOI: 10.1007/s00520-020-05915-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Institute of Medicine (IOM) and the American College of Surgeons Commission on Cancer (CoC) recommend a clear and effectively explained comprehensive survivorship care plan (SCP) be given to all cancer survivors. The objective of this study is to understand the relationship between social determinants of health (SDOH) and self-reported receipt of SCP by cancer survivors in the USA. METHODS We analyzed an adult population of cancer survivors in the 2016 Behavioral Risk Factor Surveillance System's (BRFSS) Survivorship modules. Weighted multivariable logistic regression was used to analyze the association of SDOH and reported receipt of SCP. RESULTS There were 7061 cancer patients eligible for an SCP. The probability of reporting receipt of SCP decreased with lower educational achievement (high school/some college: AOR = 0.82, 95% CI: 0.70-0.97, p = 0.02; < high school: AOR = 0.68, 95% CI: 0.47-0.97, p = 0.03) compared to those with at least one college degree. Additionally, being widowed/divorced/separated (widowed/divorced/separated: AOR = 0.72, 95% CI: 0.61-0.86, p < 0.01 vs. married/cohabiting) and uninsured (uninsured: AOR = 0.52, 95% CI: 0.0.34-0.80, p < 0.01 vs. insured) increased the odds of not receiving an SCP. Younger patients were more likely to receive an SCP than those over 65 (18-24 years: AOR = 6.62, 95% CI: 1.87-24.49, p < 0.01 vs. 65+ years). CONCLUSION Among cancer survivors, SDOH such as low educational achievement, widowed/divorced/separated marital status, and being uninsured were associated with a lower likelihood of receiving an SCP. Future studies should evaluate how omission of SCP in these patients influences the quality of care during the transition from oncologists to primary care.
Collapse
Affiliation(s)
- Lava R Timsina
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ben Zarzaur
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David A Haggstrom
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
| | - Peter C Jenkins
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maryam Lustberg
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
| |
Collapse
|
23
|
Kaur MN, Klassen AF, Xie F, Bordeleau L, Zhong T, Cano SJ, Tsangaris E, Breitkopf T, Kuspinar A, Pusic AL. An international mixed methods study to develop a new preference-based measure for women with breast cancer: the BREAST-Q Utility module. BMC Womens Health 2021; 21:8. [PMID: 33407389 PMCID: PMC7789506 DOI: 10.1186/s12905-020-01125-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Generic preference-based measures (PBM), though commonly used, may not be optimal for use in economic evaluations of breast cancer interventions. No breast cancer-specific PBM currently exists, and the generic PBMs fail to capture the unique concerns of women with breast cancer (e.g., body image, appearance, treatment-specific adverse effects). Hence, the objective of this study was to develop a breast cancer-specific PBM, the BREAST-Q Utility module. METHODS Women diagnosed with breast cancer (stage 0-4, any treatment) were recruited from two tertiary hospitals in Canada and one in the US. The study followed an exploratory sequential mixed methods approach, whereby semi-structured interviews were conducted and at the end of the interview, participants were asked to list their top five health-related quality of life (HRQOL) concerns and to rate the importance of each item on the BREAST-Q. Interviews were audio-recorded, transcribed verbatim, and coded. Constant comparison was used to refine the codes and develop a conceptual framework. Qualitative and quantitative data were triangulated to develop the content of the Utility module that was refined through 2 rounds of cognitive debriefing interviews with women diagnosed with breast cancer and feedback from experts. RESULTS Interviews were conducted with 57 women aged 55 ± 10 years. A conceptual framework was developed from 3948 unique codes specific to breasts, arms, abdomen, and cancer experience. Five top-level domains were HRQOL (i.e., physical, psychological, social, and sexual well-being) and appearance. Data from the interviews, top 5 HRQOL concerns, and BREAST-Q item ratings were used to inform dimensions for inclusion in the Utility module. Feedback from women with breast cancer (N = 9) and a multidisciplinary group of experts (N = 27) was used to refine the module. The field-test version of the HSCS consists of 10 unique dimensions. Each dimension is measured with 1 or 2 candidate items that have 4-5 response levels each. CONCLUSION The field-test version of the BREAST-Q Utility module was derived from extensive patient and expert input. This comprehensive approach ensured that the content of the Utility module is relevant, comprehensive, and includes concerns that matter the most to women with breast cancer.
Collapse
Affiliation(s)
- Manraj N Kaur
- McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, L8N 3Z5, Canada.
| | - Anne F Klassen
- McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, L8N 3Z5, Canada
| | - Feng Xie
- McMaster University, CRL-223, 1280 Main Street W, Hamilton, ON, L8N 3Z5, Canada
| | - Louise Bordeleau
- Juravinski Cancer Center, Room 3-17, 699 Concession Street, Hamilton, ON, L8V 5C2, Canada
| | - Toni Zhong
- Toronto General Hospital, Norman Urquhart Wing, Toronto, ON, 8N-871M5G 2C4, Canada
| | - Stefan J Cano
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City, SG6 4ET, UK
| | - Elena Tsangaris
- Brigham and Women's Hospital, 75 Francis S, Boston, MA, 02116, USA
| | - Trisia Breitkopf
- McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, L8N 3Z5, Canada
| | - Ayse Kuspinar
- McMaster University, Room 435, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Andrea L Pusic
- Brigham and Women's Hospital, 75 Francis S, Boston, MA, 02116, USA
| |
Collapse
|
24
|
Melnyk H, Djukic M, Merriman J, Vaughan Dickson V. An integrative review: Women's psychosocial vulnerability in relation to paid work after a breast cancer diagnosis. J Adv Nurs 2020; 77:2144-2154. [PMID: 33368563 DOI: 10.1111/jan.14730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022]
Abstract
AIM The aim of this integrative review was to explore psychosocial vulnerabilities in women after a breast cancer diagnosis that are related to their paid work. DESIGN The review methodology was guided by Whittemore and Knafl. The Mehnert Cancer Survivorship and Work Model provided a lens through which to view vulnerability in working women with a focus on facilitating interventions to improve both recovery and work outcomes. DATA SOURCES PUBMED, CINAHL, Web of Science, and PsycNET databases were searched for English language papers published between January 2014-June 2020. REVIEW METHODS Titles and abstracts were screened. Inclusion/exclusion criteria were then applied to full text screen of the remaining articles following PRISMA guidelines. Thirteen studies meeting the inclusion criteria were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist. A constant comparison approach was used to systematically distil findings into categories and assess their fit within the Mehnert Model subdomains. RESULTS Vulnerabilities coalesced predominantly within the following subdomains: (a) changes in identity and role functioning; (b) social reintegration; (c) coping strategies; and (d) social supports. Patterns and themes within these subdomains were related both positively and negatively to form the contours of a survivor's satisfaction/dissatisfaction with quality of life related to work and breast cancer recovery. CONCLUSION Overall, findings highlight the importance of employment and work environments in bolstering women's psychosocial health after a breast cancer diagnosis. IMPACT Findings from this review support adapting psychosocial distress screening to include vulnerabilities relating to work life. Nurses are ideally positioned to facilitate this screening and engage clinicians in a dialogue surrounding patient's support needs due to nursing's central role on the interdisciplinary team. Nurses may also foster collective accountability for implementing ongoing multidisciplinary survivorship care plans that include a return to work component.
Collapse
Affiliation(s)
- Halia Melnyk
- College of Nursing, New York University Rory Meyers, New York, NY, USA
| | - Maja Djukic
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, USA
| | - John Merriman
- College of Nursing, New York University Rory Meyers, New York, NY, USA
| | | |
Collapse
|
25
|
Hobden B, Turon H, Waller A, Carey M, Proietto A, Sanson-Fisher R. Gaps in patient-centered follow-up cancer care: a cross sectional study. J Psychosoc Oncol 2020; 39:161-172. [PMID: 32915113 DOI: 10.1080/07347332.2020.1815925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective There are published guidelines on the care that should be provided to cancer patients upon finishing treatment (i.e. follow-up care). Gaps in care may arise where patients' reported experiences of care do not align with guideline recommendations. The aim of this study was to explore whether oncology patients report gaps in patient-centered follow-up care. Methods This study was a cross-sectional survey of adult cancer patients receiving follow-up care within four outpatient oncology clinics. Patients were approached in clinic waiting rooms and asked to complete an electronic survey. The survey examined patients' self-report of receiving six aspects of follow-up care. Results A total of 239 participants completed the survey (study consent rate = 83%). Only 49% of participants received all six items of care. Patients reported high rates of being told who to contact if they have any questions or concerns (95%); who to contact if signs or symptoms occur (91%); and what to expect in their follow-up care (90%). A lower proportion of patients indicated they were informed about the role of their GP after treatment has finished (79%); what symptoms or signs might suggest the cancer had returned (74%); or were given a written care plan (71%). Conclusions: The study highlights that there is a gap between some aspects of optimal patient-centered care, and the actual care received by patients. Health care providers and researchers should consider how to improve follow-up care experiences to ensure best practice cancer care delivery during this important stage in cancer survivorship.
Collapse
Affiliation(s)
- Breanne Hobden
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Heidi Turon
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Amy Waller
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Mariko Carey
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Anthony Proietto
- Cancer Network, Hunter New England Local Health Network - HNELHN, New Lambton, Australia
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| |
Collapse
|
26
|
Lo AC, Samuel V, Chen B, Savage KJ, Freeman C, Goddard K. Evaluation of the discussion of late effects and screening recommendations in survivors of adolescent and young adult (AYA) lymphoma. J Cancer Surviv 2020; 15:179-189. [PMID: 32767044 DOI: 10.1007/s11764-020-00922-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/31/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The study objective was to assess the discussion of late effects (LEs) and screening recommendations (SRs) for adolescent and young adults (AYAs) treated for lymphoma. METHODS A retrospective study was conducted on AYA lymphoma survivors aged 15-24 years at diagnosis who received radiation therapy (RT) ± chemotherapy between 1984 and 2010 at any of the six British Columbia (BC) Cancer treatment centers across the province. Charts were reviewed to evaluate discussion of LEs and SRs. Susceptibility to specific LEs was determined by reviewing treatment details. RESULTS Of 305 patients, 212 (70%) had documented discussion of at least one specific LE, 39 (13%) had non-specific documentation only, and 54 (18%) had no documented discussion of LEs. Accounting only for patients susceptible to each LEs, the most frequently discussed LEs was radiation-induced (RI) neoplasm (42%), and the least frequently discussed LEs was carotid artery stenosis (0.4%). The most common SRs discussed in susceptible patients was for RI breast cancer (43%). Of patients discharged between 1985 and 1999 vs 2000 and 2014, LEs were discussed in 63 vs 93% (P < 0.0005), and SRs were discussed in 30 vs 65%, respectively (P < 0.0005). Older age at discharge, presence of a discharge note, and occurrence of a discharge appointment were associated with increased discussion of SRs. CONCLUSIONS Most survivors of AYA lymphoma received some discussion of LEs and SRs, but each relevant LEs and SRs was discussed in only a minority of susceptible patients. IMPLICATIONS FOR CANCER SURVIVORS Survivors of AYA lymphoma and their primary care professionals may not be appropriately informed of health risks and how to screen for them.
Collapse
Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Vanessa Samuel
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ben Chen
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry J Savage
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Ciara Freeman
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Karen Goddard
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
27
|
Qaderi SM, Swartjes H, Custers JAE, de Wilt JHW. Health care provider and patient preparedness for alternative colorectal cancer follow-up; a review. Eur J Surg Oncol 2020; 46:1779-1788. [PMID: 32571636 DOI: 10.1016/j.ejso.2020.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/06/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Follow-up after curative treatment for colorectal cancer (CRC) puts pressure on outpatient services due to the growing number of CRC survivors. The aim of this state-of-the-art review was to evaluate setting, manner and provider of follow-up. Moreover, perceptions of CRC survivors and health care providers regarding standard and alternative follow-up were examined. After a comprehensive literature search of the PubMed database, 69 articles were included reporting on CRC follow-up in the hospital, primary care and home setting. Hospital-based follow-up is most common and has been provided by surgeons, medical oncologists, and gastroenterologists, as well as nurses. Primary care-based follow-up has been provided by general practitioners or nurses. Even though most hospital- or primary care-based follow-up care requires patients to visit the clinic, telephone-based care has proven to be a feasible alternative. Most patients perceived follow-up as positive; valuing screening and detection for disease recurrence and appreciating support for physical and psychosocial symptoms. Hospital-based follow-up performed by the medical specialist or nurse is highly preferred by patients and health care providers. However, willingness of both patients and health care providers for alternative, primary care or remote follow-up exists. Nurse-led and GP-led follow-up have proven to be cost-effective alternatives compared to specialist-led follow-up. If proven safe and acceptable, remote follow-up can become a cost-effective alternative. To decrease the personal and financial burden of follow-up for a growing number of colorectal cancer survivors, a more acceptable, flexible and dynamic care follow-up mode consisting of enhanced communication and role definitions among clinicians is warranted.
Collapse
Affiliation(s)
- S M Qaderi
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - H Swartjes
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J A E Custers
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J H W de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
28
|
A structural equation modeling approach to understanding pathways linking survivorship care plans to survivor-level outcomes. J Cancer Surviv 2020; 14:834-846. [PMID: 32474862 DOI: 10.1007/s11764-020-00896-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/13/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Several high-profile organizations have mandated the delivery of survivorship care plans (SCPs) despite mixed evidence regarding the effectiveness of SCPs on key survivor-level outcomes. There is a need to understand the types of survivor-level outcomes the SCPs are likely to change. Informed by existing frameworks and the literature, the objective of this study was to understand the pathways linking the receipt of a SCP to key survivor-level outcomes including patient-centered communication (PCC), health self-efficacy, changes in health behaviors, and improvements in overall health. METHODS We used structural equation modeling to test the direct and indirect pathways linking the receipt of an SCP to patient-centered communication (PCC), health self-efficacy, and latent measures of health behaviors and physical health in a nationally representative sample of breast and colorectal cancer survivors from the Health Information National Trends Survey. RESULTS The receipt of an SCP did not have a significant effect on key survivor-level outcomes and was removed from the final structural model. The final structural model fit the data adequately well (Chi-square p value = 0.03, RMSEA = 0.07, CFI = .88, and WRMR = 0.73). PCC had a significant direct effect on physical health but not on health behaviors. Health self-efficacy had a significant direct effect on physical health and health behaviors. CONCLUSION The receipt of an SCP alone is unlikely to facilitate changes in PCC, health self-efficacy, health behaviors, or physical health. IMPLICATION FOR CANCER SURVIVORS A SCP is a single component of a larger model of survivorship care and should be accompanied by ongoing efforts that promote PCC, health self-efficacy, and changes in health behaviors resulting in improvements to physical health.
Collapse
|
29
|
Mann K, Wu YP, Pannier ST, Hacking C, Warner EL, Rosen S, Acharya A, Wright J, Gerdy C, Kirchhoff AC. Healthcare provider perspectives on pediatric cancer survivorship care plans: a single institution pilot study. Support Care Cancer 2020; 29:697-706. [PMID: 32435970 DOI: 10.1007/s00520-020-05522-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Survivorship care plans (SCPs) are used to facilitate communication between oncology and primary care providers (PCPs) after cancer treatment and to assist cancer survivors with healthcare decisions. We evaluated pediatric oncology providers' experiences creating and delivering SCPs. We also evaluated PCPs' opinions of SCPs. METHODS Together, oncology nurses and oncologists created individualized SCPs for leukemia patients treated at a children's hospital in Utah, with nurses in charge of inputting the majority of SCP content. We surveyed providers after each SCP was completed. We also mailed SCPs to PCPs with a survey on SCP content and their knowledge and comfort level caring for cancer survivors. Descriptive statistics were used to summarize survey content. RESULTS A total of 6 nurses and 8 oncologists created 21 SCPs. On average, nurses assisted with 3.5 SCPs and spent 209 min (range 100-600 min) on completing their sections of each SCP, whereas oncologists assisted with 2.6 SCPs and spent 47.4 min (range 15-120). For most SCPs, there was agreement that they should be shared with PCPs (nurse surveys 71.4%, oncologist surveys 100%). Of the 15 participating PCPs, only 28% felt prepared to manage long-term effects in pediatric cancer survivors. They agreed that the SCP would improve communication with their patient's oncologist (80%) and their knowledge for future care (100%). CONCLUSIONS SCPs require substantial clinician time to create, but are seen as useful by PCPs. PCPs require specific guidelines and resources concerning ongoing care for pediatric cancer survivors.
Collapse
Affiliation(s)
- Karely Mann
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA.
| | - Yelena P Wu
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA.,Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Samantha T Pannier
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA
| | - Claire Hacking
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA
| | - Echo L Warner
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA.,University of Utah, College of Nursing, Salt Lake City, UT, USA
| | - Stephanie Rosen
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA
| | - Akanksha Acharya
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA
| | | | - Cheryl Gerdy
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, Cancer Control and Population Sciences, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
30
|
Image of Your Own Body, Sense of Isolation and Quality of Life in Patients with Gynecological Cancers. ACTA BIOMEDICA SCIENTIFICA 2020. [DOI: 10.29413/abs.2020-5.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: to study mental state of gynecological oncological patients, their attitude to the existing disease and quality of life.Material and methods. The study was conducted on the basis of the City Clinical Hospital No. 1 of Novosibirsk. The main group (17women aged 29 to 60 years) included patients with ovarian cancer, cancer of the external female genital organs, and uterine cancer; the comparison group was comprised of 20 people aged 29 to 63 years without a history of cancer.Results. In gynecological oncological patients, dissatisfaction with their own bodies is more pronounced; they perceive their body distorted, which may be due to the characteristics of the disease and the specifics of treatment. Patients with gynecological cancers have a more pronounced subjective feeling of loneliness, but it is at the upper limit of the norm, which may mean the fact that these patients turn in upon themselves, in their experiences, as well as the feeling of something lost in their inner world. Patients with gynecological cancers showed an average level of quality of life and low indicators of the mental component of health, which indicates reduced functioning and a significant effect of the patient’s physical and emotional state on daily activities.Conclusion. The mental state of the cancer patient, his ability to withstand stress, his attitude to the existing disease affect the treatment process and further quality of life.
Collapse
|
31
|
Koczwara B, Doherty TN, Hislop CC, Cameron K, Bessen T, Christensen C, Corsini N, Fitzgerald MK, Loft N, Poprawski DM, Turpin KH, Eckert MC. Accuracy and acceptability of survivorship care plans: results of a pilot study. Intern Med J 2020; 50:363-366. [PMID: 32141202 DOI: 10.1111/imj.14754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 10/24/2022]
Abstract
Survivorship treatment summaries and care plans are increasingly incorporated into cancer care but there are limited data on their accuracy and acceptability. We have evaluated written care plans developed as part of a once-off, nurse-led survivorship consultations across four medical oncology clinics in South Australia as part of a state-wide pilot. While the accuracy of treatment summaries was high, level of detail in care plans was moderate to low, as was survivors' perception of plans' utility.
Collapse
Affiliation(s)
- Bogda Koczwara
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Adelaide, South Australia, Australia
| | - Tracey N Doherty
- South Australian Cancer Service, SA Health, Adelaide, South Australia, Australia
| | - Chantelle C Hislop
- South Australian Cancer Service, SA Health, Adelaide, South Australia, Australia
| | - Kate Cameron
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Taryn Bessen
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Michael K Fitzgerald
- Cancer Services, Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nicole Loft
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | | | - Kate H Turpin
- Paediatric Haematology/Oncology, Department of Clinical Haematology/Oncology, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Marion C Eckert
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
32
|
Impact of treatment summaries for cancer survivors: a systematic review. J Cancer Surviv 2020; 14:405-416. [PMID: 32030627 DOI: 10.1007/s11764-020-00859-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE As a treatment summary (TS) documents information for follow-up care, it is believed to be an important communication tool for the patient, their GP, and other health professionals. The aim of this systematic review (SR) was to evaluate the impact of receiving a TS for cancer survivors when compared to receiving standard care and to identify knowledge gaps to inform future research. METHODS A systematic search of electronic databases and grey literature was undertaken from August 2018 to October 2018. Studies were included if participants (cancer survivors) were over 18 years of age and had received a TS, and if outcomes for TS could be separated from other survivorship interventions. The McMaster Critical Appraisal Tool was used to evaluate the methodological quality of the included studies. A narrative synthesis of the study outcomes was then conducted. RESULTS Seven studies (one prospective cohort and six cross-sectional studies) met the inclusion criteria. The impact of TS was assessed using widely varied outcomes in these studies. Overall, receipt of a TS was related to greater patient understanding and perception of the quality of care provided. However, caution is required when interpreting these results due to methodological limitations. CONCLUSIONS This systematic review found that TS may have a positive impact on patient understandings about and perceptions of cancer care. However, more robust research including perspectives of cancer survivors is required. IMPLICATIONS FOR CANCER SURVIVORS TS could play an important role for cancer survivors especially in terms of knowledge of cancer care.
Collapse
|
33
|
Hill RE, Wakefield CE, Cohn RJ, Fardell JE, Brierley ME, Kothe E, Jacobsen PB, Hetherington K, Mercieca‐Bebber R. Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes. Oncologist 2020; 25:e351-e372. [PMID: 32043786 PMCID: PMC7011634 DOI: 10.1634/theoncologist.2019-0184] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision. METHODS We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome. RESULTS Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects. CONCLUSION SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies. IMPLICATIONS FOR PRACTICE Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.
Collapse
Affiliation(s)
- Rebecca E. Hill
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Claire E. Wakefield
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Richard J. Cohn
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Joanna E. Fardell
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Mary‐Ellen E. Brierley
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Emily Kothe
- School of Psychology, Deakin UniversityGeelongAustralia
| | | | - Kate Hetherington
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
| | - Rebecca Mercieca‐Bebber
- School of Women's and Children's Health, University of New South Wales (UNSW) SydneyRandwickAustralia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's HospitalRandwickAustralia
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of SydneyCamperdownAustralia
| |
Collapse
|
34
|
Benci JL, Vachani CC, Hampshire MK, Bach C, Arnold-Korzeniowski K, Metz JM, Hill-Kayser CE. Factors Influencing Delivery of Cancer Survivorship Care Plans: A National Patterns of Care Study. Front Oncol 2020; 9:1577. [PMID: 32083018 PMCID: PMC7005073 DOI: 10.3389/fonc.2019.01577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/31/2019] [Indexed: 11/15/2022] Open
Abstract
Nearly half of all Americans will develop cancer at least once in their lifetime. Through improved screening and treatments, the number of cancer survivors is reaching all-time highs. However, survivorship care plans (SCPs) are inconsistently used, denying many survivors access to critical information. This study used 46,408 SCPs generated from 2007 to 2016 and applied machine learning to identify predictors of SCP creation, including cancer type, type of physician, and healthcare center where they received care, as well as regional variations in care plan creation. Identifying these disparities in SCP use is a critical first step in efforts toward expanding access to survivorship care planning. Using a convenience sample of survivors, it is possible to model the factors that predict generation of SCPs either by the survivor or by a healthcare provider. This study identifies several important disparities both survivor intrinsic such as cancer type, as well as treatment associated and geographic differences in SCP generation. Identifying these disparities at the national level across cancer types will allow for more targeted recommendations to improve SCP creation and dissemination in underserved groups.
Collapse
Affiliation(s)
- Joseph L Benci
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Carolyn C Vachani
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Margaret K Hampshire
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina Bach
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Karen Arnold-Korzeniowski
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - James M Metz
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christine E Hill-Kayser
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
35
|
Abstract
OPINION STATEMENT As cancer care has evolved so has the awareness of the issues cancer patients, their caregivers and families face during and after treatment, giving rise to the cancer survivorship care initiative. The body of research pertaining to quality of life, health-related quality of life, and multidimensional symptom burden of neuro-oncology patients and their caregivers has grown significantly, yielding a wealth of data and information indicating interventions and actions targeting symptoms and needs are both warranted and desired. The provision of survivorship care aiming to deliver care in a patient-centered, whole-person model offers a means by which these interventions and actions can be actualized. The research specific to survivorship care models and survivorship care plans and their delivery remains a large opportunity, one worth the careful consideration and participation of neuro-oncology healthcare providers for the benefit of their highly deserving patients and their caregivers and families.
Collapse
|
36
|
Choi Y, Smith KC, Shukla A, Blackford AL, Wolff AC, Thorner E, Peairs KS, El Ayass W, Njoku P, Papathakis K, Riley CD, Zafman N, Asrari F, Camp M, Wright JL, Mayonado NJ, White SM, Snyder CF. Breast cancer survivorship care plans: what are they covering and how well do they align with national guidelines? Breast Cancer Res Treat 2019; 179:415-424. [DOI: 10.1007/s10549-019-05480-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
|
37
|
Salz T, Schnall RB, McCabe MS, Oeffinger KC, Corcoran S, Vickers AJ, Salner AL, Dornelas E, Raghunathan NJ, Fortier E, McKiernan J, Finitsis DJ, Chimonas S, Baxi S. Incorporating Multiple Perspectives Into the Development of an Electronic Survivorship Platform for Head and Neck Cancer. JCO Clin Cancer Inform 2019; 2:1-15. [PMID: 30652547 DOI: 10.1200/cci.17.00105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To improve the care of survivors of head and neck cancer, we developed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR). HN-STAR is an electronic platform that incorporates patient-reported outcomes into a clinical decision support tool for use at a survivorship visit. Selections in the clinical decision support tool automatically populate a survivorship care plan (SCP). We aimed to refine HN-STAR by eliciting and incorporating feedback on its ease of use and usefulness. METHODS Human-computer interaction (HCI) experts reviewed HN-STAR using think-aloud testing and the Nielsen Heuristic Checklist. Nurse practitioners (NPs) thought aloud while reviewing the clinical decision support tool and SCP and responded to an interview. Survivors used HN-STAR as part of a routine visit and were interviewed afterward. We analyzed themes from the feedback. We described how we addressed each theme to improve the usability of HN-STAR. RESULTS Five HCI experts, 10 NPs, and 10 cancer survivors provided complementary usability insight that we categorized into themes of improvements. For ease of use, themes included technical design considerations to enhance user interface, ease of completion of a self-assessment, streamlining text, disruption of the clinic visit, and threshold for symptoms to appear on the SCP. The theme addressing usefulness was efficiency and comprehensiveness of the clinic visit. For each theme, we report revisions to HN-STAR in response to the feedback. CONCLUSION HCI experts provided key technical design insights into HN-STAR, whereas NPs and survivors provided usability feedback and clinical perspectives. We incorporated the feedback into the preparation for additional testing of HN-STAR. This method can inform and improve the ease of use and usefulness of the survivorship applications.
Collapse
Affiliation(s)
- Talya Salz
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Rebecca B Schnall
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Mary S McCabe
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Kevin C Oeffinger
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Stacie Corcoran
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew J Vickers
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew L Salner
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Ellen Dornelas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Nirupa J Raghunathan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Elizabeth Fortier
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Janet McKiernan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - David J Finitsis
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Susan Chimonas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Shrujal Baxi
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| |
Collapse
|
38
|
Trogdon JG, Weir WH, Shai S, Mucha PJ, Kuo TM, Meyer AM, Stitzenberg KB. Comparing Shared Patient Networks Across Payers. J Gen Intern Med 2019; 34:2014-2020. [PMID: 30945065 PMCID: PMC6816773 DOI: 10.1007/s11606-019-04978-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/21/2018] [Accepted: 02/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Measuring care coordination in administrative data facilitates important research to improve care quality. OBJECTIVE To compare shared patient networks constructed from administrative claims data across multiple payers. DESIGN Social network analysis of pooled cross sections of physicians treating prevalent colorectal cancer patients between 2003 and 2013. PARTICIPANTS Surgeons, medical oncologists, and radiation oncologists identified from North Carolina Central Cancer Registry data linked to Medicare claims (N = 1735) and private insurance claims (N = 1321). MAIN MEASURES Provider-level measures included the number of patients treated, the number of providers with whom they share patients (by specialty), the extent of patient sharing with each specialty, and network centrality. Network-level measures included the number of providers and shared patients, the density of shared-patient relationships among providers, and the size and composition of clusters of providers with a high level of patient sharing. RESULTS For 24.5% of providers, total patient volume rank differed by at least one quintile group between payers. Medicare claims missed 14.6% of all shared patient relationships between providers, but captured a greater number of patient-sharing relationships per provider compared with the private insurance database, even after controlling for the total number of patients (27.242 vs 26.044, p < 0.001). Providers in the private network shared a higher fraction of patients with other providers (0.226 vs 0.127, p < 0.001) compared to the Medicare network. Clustering coefficients for providers, weighted betweenness, and eigenvector centrality varied greatly across payers. Network differences led to some clusters of providers that existed in the combined network not being detected in Medicare alone. CONCLUSION Many features of shared patient networks constructed from a single-payer database differed from similar networks constructed from other payers' data. Depending on a study's goals, shortcomings of single-payer networks should be considered when using claims data to draw conclusions about provider behavior.
Collapse
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, NC, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - W H Weir
- Carolina Center for Interdisciplinary Applied Mathematics, Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Curriculum in Bioinformatics and Computational Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Shai
- Department of Mathematics and Computer Science, Wesleyan University, Marion, IN, USA
| | - P J Mucha
- Carolina Center for Interdisciplinary Applied Mathematics, Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T M Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - K B Stitzenberg
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Surgical Oncology and Endocrinology Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
39
|
Utilization of an audit tool to evaluate accuracy of treatment summary and survivorship care plans. J Cancer Surviv 2019; 13:890-898. [DOI: 10.1007/s11764-019-00804-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
|
40
|
Implications for patient-provider communication and health self-efficacy among cancer survivors with multiple chronic conditions: results from the Health Information National Trends Survey. J Cancer Surviv 2019; 13:663-672. [PMID: 31309416 DOI: 10.1007/s11764-019-00785-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/03/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Cancer survivors with multiple chronic conditions experience significant challenges managing their health. The six core functions of patient-centered communication (PCC)-fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient self-management-represent a central component to facilitating a survivor's confidence to manage their health that has not been investigated in cancer survivors with multiple chronic conditions. METHOD Nationally representative data across two iterations of the Health Information National Trends Survey (HINTS) were merged with combined replicate weights using the jackknife replication method. Adjusted linear regression examined the association between PCC and health self-efficacy in a sample of breast, colorectal, and prostate cancer survivors and by multiple chronic conditions. RESULTS 53.9% reported that providers did not always respond to their emotions and 48.9% reported that they could not always rely on their providers to help them manage uncertainty. In the adjusted linear regression models, there was a significant positive association between PCC and health self-efficacy (β = 0.2, p = 0.01) for the entire sample. However, the association between PCC and health self-efficacy was attenuated in cancer survivors with multiple chronic conditions (β = 0.1, p = 0.53). CONCLUSION PCC alone is not enough to improve a cancer survivor's confidence in their ability to manage their health in the presence of multiple chronic conditions. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors with multiple chronic conditions need ongoing support, in addition to PCC, that render them prepared to manage their health after cancer.
Collapse
|
41
|
McGrath EB, Schaal A, Pace C. The Integration of Survivorship Care Planning at a Comprehensive Cancer Center. J Adv Pract Oncol 2019; 10:461-468. [PMID: 33457059 PMCID: PMC7779566 DOI: 10.6004/jadpro.2019.10.5.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Research has demonstrated that cancer survivors who receive a survivorship care plan (SCP) have better coordinated follow-up care, higher overall satisfaction, and report significantly fewer posttreatment emotional concerns. The Commission on Cancer, a program of the American College of Surgeons, has developed a standard of care in which 100% of eligible patients are to receive an SCP by the end of 2019. Nurse practitioners at a National Cancer Institute (NCI)-designated academic medical center worked to develop a standardized process to deliver SCPs to all eligible patients. The primary objective of the project was to standardize how SCPs were completed and embed them into the electronic medical record (EMR) using a templated note created for the EMR. Through an interdisciplinary steering committee, survivorship priorities were established and aligned with LIVESTRONG and American Society of Clinical Oncology guidelines. In addition, survivorship care planning was identified as an essential service to be provided by all cancer disease management groups (DMG) at the cancer center. A cancer SCP subcommittee was formed to explore methods to expand the delivery of SCPs and standardize the SCP process. Prior to this project, SCPs were being done by less than 10% of the providers and only for a few diagnoses, and no standardized method of documentation existed prior to this quality improvement initiative. The standardization of the SCP has increased both participation of other DMGs as well as increased the rate of completion to 34%. We believe that continuous reassessment and process improvement will help us reach the Commission on Cancer goal of providing SCPs to all eligible patients.
Collapse
Affiliation(s)
- Elizabeth B McGrath
- Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, New Hampshire
| | - Anna Schaal
- Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, New Hampshire
| | - Claire Pace
- Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, New Hampshire
| |
Collapse
|
42
|
Birken SA, Raskin S, Zhang Y, Lane G, Zizzi A, Pratt-Chapman M. Survivorship Care Plan Implementation in US Cancer Programs: a National Survey of Cancer Care Providers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:614-622. [PMID: 29948925 PMCID: PMC6294719 DOI: 10.1007/s13187-018-1374-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Survivorship care plans (SCPs)-documents intended to improve care for cancer survivors who have completed active treatment-are required, yet implementation is poor. We sought to understand SCP implementation in cancer programs in the USA with the objective of identifying opportunities for improvement. We recruited cancer care providers in the USA via several cancer care networks to participate in a survey regarding SCP implementation. We used descriptive statistics to analyze the data. Three hundred ninety-five providers from diverse cancer programs in 47 states and Washington, DC responded to the survey. The timing of SCP implementation varied across and within cancer programs, with approximately 40% of respondents reporting developing SCPs more than 3 months after primary treatment or adjuvant therapy completion. Nurse navigators were responsible for 48-58% of each stage of SCP implementation. Processes that could have been automated often occurred in-person or via phone and vice versa. Respondents reported spending more than 2 h per SCP to complete all stages of implementation, of which less than a third was reimbursed by third-party payers. We identified several opportunities for improving SCP implementation, including broadening the base of responsibility, optimizing modes of communication, decreasing the time required and increasing the funding available, and limiting variation in SCP implementation across and within cancer programs. Future work should assess the influence of approaches to SCP implementation on desired outcomes.
Collapse
Affiliation(s)
- Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | - Yuqing Zhang
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
| | - Gema Lane
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
| | - Alexandra Zizzi
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
| |
Collapse
|
43
|
Viscuse P, Yost KJ, Jenkins S, Lackore K, Habermann T, Thanarajasingam G, Thompson C. Impact of lymphoma survivorship clinic visit on patient-centered outcomes. J Cancer Surviv 2019; 13:344-352. [PMID: 31028525 DOI: 10.1007/s11764-019-00756-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Cancer survivors may experience physical, social, and emotional effects of cancer and its treatments. National Comprehensive Cancer Network (NCCN) guidelines recommend the development of a survivorship care plan (SCP) for cancer patients following completion of treatment with curative intent. Our institution developed a lymphoma survivorship clinic (SC) to assess patient needs, provide education, and create and deliver SCPs. This study analyzed the impact of a SC visit on patient-centered outcomes. METHODS Surveys were sent to lymphoma patients at Mayo Clinic Rochester within 4 weeks of their post-treatment visit to the SC that queried patient-reported outcomes, including experience of care, quality of life (QOL), and distress. We compared survey responses between those who attended the SC and those who were eligible but did not attend. RESULTS From November 2013 to May 2015, 236 lymphoma patients were surveyed, 96 of whom had a SC visit and 140 of who were eligible but did not attend. Those who attended the SC were more likely to "definitely" recall discussion on improving health, preventing illness, and making changes in habits/lifestyle, diet, and exercise. There were no differences in QOL or distress. Adjusted analyses revealed that SC attendance was associated with better self-reported overall health among younger patients and better physical well-being in Hodgkin lymphoma patients compared to those with other subtypes of lymphoma. CONCLUSIONS Participation in the lymphoma SC improved patient education on survivorship issues, particularly health behaviors. There may be a particular benefit in younger patients. However, there were no differences in QOL or distress. Further study is needed to determine if improved survivorship education and SCP delivery leads to long-term health benefits in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Our study evaluates the clinical impact of a SC in patients treated for lymphoma. We demonstrate that a SC visit improves patient education regarding health behaviors.
Collapse
Affiliation(s)
- Paul Viscuse
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Sarah Jenkins
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Kandace Lackore
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Thomas Habermann
- Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Gita Thanarajasingam
- Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Carrie Thompson
- Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
44
|
Abstract
PURPOSE OF REVIEW The transition from primary cancer treatment to posttreatment follow-up care is seen as critical to the long-term health of survivors. However, relatively little attention has been paid to understanding this pivotal period. This review will offer a brief outline of the significant work surrounding this pivotal time published in the past year. RECENT FINDINGS The growing number of cancer survivors has stimulated an emphasis on finding new models of care, whereby responsibility for survivorship follow-up is transitioned to primary care providers. A variety of models and tools have emerged for follow-up care. Survivorship care plans are heralded as a key component of survivorship care and a vehicle for supporting transition. Uptake of survivorship care plans and implementation of evidence-based models of survivorship care has been slow, hindered by a range of barriers. SUMMARY Evaluation is needed regarding survivorship models in terms of feasibility, survivor friendliness, cost effectiveness, and achievement of sustainable outcomes. How, and when, to introduce plans for transition to the patient and determine transition readiness are important considerations but need to be informed by evidence. Additional study is needed to identify best practice for the introduction and application of survivorship care plans.
Collapse
|
45
|
Donohue S, Haine JE, Li Z, Feldstein DA, Micek M, Trowbridge ER, Kamnetz SA, Sosman JM, Wilke LG, Sesto ME, Tevaarwerk AJ. Cancer Survivorship Care Plan Utilization and Impact on Clinical Decision-Making at Point-of-Care Visits with Primary Care: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:252-258. [PMID: 29098650 PMCID: PMC5932279 DOI: 10.1007/s13187-017-1295-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Every cancer survivor and his/her primary care provider should receive an individualized survivorship care plan (SCP) following curative treatment. Little is known regarding point-of-care utilization at primary care visits. We assessed SCP utilization in the clinical context of primary care visits. Primary care physicians and advanced practice providers (APPs) who had seen survivors following provision of an SCP were identified. Eligible primary care physicians and APPs were sent an online survey, evaluating SCP utilization and influence on decision-making at the point-of-care, accompanied by copies of the survivor's SCP and the clinic note. Eighty-eight primary care physicians and APPs were surveyed November 2016, with 40 (45%) responding. Most respondents (60%) reported discussing cancer or related issues during the visit. Information needed included treatment (66%) and follow-up visits, and the cancer team was responsible for (58%) vs primary care (58%). Respondents acquired this information by asking the patient (79%), checking oncology notes (75%), the SCP (17%), or online resources (8%). Barriers to SCP use included being unaware of the SCP (73%), difficulty locating it (30%), and finding needed information faster via another mechanism (15%). Despite largely not using the SCP for the visit (90%), most respondents (61%) believed one would be quite or very helpful for future visits. Most primary care visits included discussion of cancer or cancer-related issues. SCPs may provide the information necessary to deliver optimal survivor care but efforts are needed to reduce barriers and design SCPs for primary care use.
Collapse
Affiliation(s)
| | - James E Haine
- Department of Medicine, Division of Internal Medicine, University of Wisconsin, Madison, WI, USA
| | - Zhanhai Li
- Biostatistics, University of Wisconsin, Madison, WI, USA
| | - David A Feldstein
- Department of Medicine, Division of Internal Medicine, University of Wisconsin, Madison, WI, USA
| | - Mark Micek
- Department of Medicine, Division of Internal Medicine, University of Wisconsin, Madison, WI, USA
| | - Elizabeth R Trowbridge
- Department of Medicine, Division of Internal Medicine, University of Wisconsin, Madison, WI, USA
| | - Sandra A Kamnetz
- Department of Family and Community Health, University of Wisconsin, Madison, WI, USA
| | - James M Sosman
- Department of Medicine, Division of Internal Medicine, University of Wisconsin, Madison, WI, USA
| | - Lee G Wilke
- Department of Surgery, University of Wisconsin, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Mary E Sesto
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin, 1111 Highland Ave, WIMR 6037, Madison, WI, 53705, USA
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI, USA
| | - Amye J Tevaarwerk
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin, 1111 Highland Ave, WIMR 6037, Madison, WI, 53705, USA.
| |
Collapse
|
46
|
Coughlin SS, Caplan L, Stewart JL, Young L. Do Breast Cancer Survivorship Care Plans Improve Health Outcomes? JOURNAL OF CANCER TREATMENT & DIAGNOSIS 2019; 3:28-33. [PMID: 31149659 PMCID: PMC6537902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although they have been widely studied, important questions remain about the impact of breast cancer survivorship care plans on improving health outcomes. The goal of this article was to review published studies on the impact of cancer survivorship care plans on health outcomes and health care delivery among breast cancer survivors. A total of 111 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, 7 studies met the eligibility criteria. All of the studies had a randomized controlled design. Early trials of the efficacy of breast cancer survivorship care plans generally showed little or no improvement in health outcomes. The positive findings of recent studies suggest that survivorship care interventions that empower and activate patients to self-manage their follow-up care and improve patient-provider communication may be especially promising.
Collapse
Affiliation(s)
- Steven S. Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA,Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, GA,Correspondence: Dr. Steven S. Coughlin, Professor, Division of Epidemiology, Department of Population Health Sciences, Medical College of Georgia, Augusta University, 1120 15th Street, AE-1042, Augusta, GA 30912, USA;
| | - Lee Caplan
- Morehouse College of Medicine, Department of Community Health and Preventive Medicine, Atlanta, GA
| | | | - Lufei Young
- College of Nursing, Augusta University, Augusta, GA
| |
Collapse
|
47
|
Baxi SS, Sukhu R, Fortier E, Oeffinger K, Corcoran S, Salner A, Vickers AJ, McCabe MS, Salz T. Automating Treatment Summary Development Using Electronic Billing Information: A Pilot Study of Survivors of Head and Neck Cancer. J Oncol Pract 2018; 15:e84-e90. [PMID: 30523752 DOI: 10.1200/jop.18.00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although the provision of a treatment summary (TS) is a quality indicator in oncology, routine delivery of TSs remains challenging. Automatic TS generation could facilitate use, but data on accuracy are lacking in complex cancers such as head and neck cancer (HNC). We developed and evaluated an electronic platform to automate TS generation for HNC. METHODS The algorithms autopopulated TSs using data from billing records and an institutional cancer registry. A nurse practitioner used the medical record to verify the accuracy of the information and made corrections electronically. Inaccurate and missing data were considered errors. We described and investigated reasons for errors in the automatically generated TSs. RESULTS We enrolled a heterogeneous population of 43 survivors of HNC. Using billing data, the information on primary site, lymph node status, radiation, and chemotherapy use was accurate in 93%, 95%, 93%, and 95% of patients, respectively. Billing data captured surgery accurately in 77% of patients; once an omitted billing code was identified, accuracy increased to 98%. Chemotherapies were captured in 90% of patients. Using the cancer registry, month and year of diagnosis were accurate in 91% of cases; stage was accurate in 28% of cases. Reprogramming the algorithm to ascertain clinical stage when pathologic stage was unavailable resulted in 100% accuracy. The algorithms inconsistently identified radiation receipt and treating physicians from billing data. CONCLUSION It is feasible to automatically and accurately generate most components of TSs for HNC using billing and cancer registry data, although clinical review is necessary in some cases.
Collapse
Affiliation(s)
- Shrujal S Baxi
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Ranjit Sukhu
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Andrew Salner
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Mary S McCabe
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Talya Salz
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
48
|
Majhail NS, Murphy E, Laud P, Preussler JM, Denzen EM, Abetti B, Adams A, Besser R, Burns LJ, Cerny J, Drexler R, Hahn T, Idossa L, Jahagirdar B, Kamani N, Loren A, Mattila D, McGuirk J, Moore H, Reynolds J, Saber W, Salazar L, Schatz B, Stiff P, Wingard JR, Syrjala KL, Baker KS. Randomized controlled trial of individualized treatment summary and survivorship care plans for hematopoietic cell transplantation survivors. Haematologica 2018; 104:1084-1092. [PMID: 30514795 PMCID: PMC6518896 DOI: 10.3324/haematol.2018.203919] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/23/2018] [Indexed: 12/31/2022] Open
Abstract
Survivorship Care Plans (SCPs) may facilitate long-term care for cancer survivors, but their effectiveness has not been established in hematopoietic cell transplantation recipients. We evaluated the impact of individualized SCPs on patient-reported outcomes among transplant survivors. Adult (≥18 years at transplant) survivors who were 1-5 years post transplantation, proficient in English, and without relapse or secondary cancers were eligible for this multicenter randomized trial. SCPs were developed based on risk-factors and treatment exposures using patient data routinely submitted by transplant centers to the Center for International Blood and Marrow Transplant Research and published guidelines for long-term follow up of transplant survivors. Phone surveys assessing patient-reported outcomes were conducted at baseline and at 6 months. The primary end point was confidence in survivorship information, and secondary end points included cancer and treatment distress, knowledge of transplant exposures, health care utilization, and health-related quality of life. Of 495 patients enrolled, 458 completed a baseline survey and were randomized (care plan=231, standard care=227); 200 (87%) and 199 (88%) completed the 6-month assessments, respectively. Patients’ characteristics were similar in the two arms. Participants on the care plan arm reported significantly lower distress scores at 6 months and an increase in the Mental Component Summary quality of life score assessed by the Short Form 12 (SF-12) instrument. No effect was observed on the end point of confidence in survivorship information or other secondary outcomes. Provision of individualized SCPs generated using registry data was associated with reduced distress and improved mental domain of quality of life among 1-5 year hematopoietic cell transplantation survivors. Trial registered at clinicaltrials.gov 02200133.
Collapse
Affiliation(s)
| | | | | | - Jaime M Preussler
- National Marrow Donor Program/Be The Match, Minneapolis, MN.,Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, MN.,Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Alexia Adams
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - RaeAnne Besser
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, MN.,Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Jan Cerny
- UMass Memorial Medical Center, Worcester, MA
| | - Rebecca Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lensa Idossa
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | | | | | | | - Deborah Mattila
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Heather Moore
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | | | - Wael Saber
- Medical College of Wisconsin, Milwaukee, WI.,Center for International Blood and Marrow Transplant Research, Milwaukee, WI
| | | | | | | | | | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
49
|
Nekhlyudov L. Survivorship Care Plan: We’ve Got the Tool—It’s Time to Fix the Process. J Natl Cancer Inst 2018; 110:1285-1286. [DOI: 10.1093/jnci/djy077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 11/14/2022] Open
|
50
|
Choi Y, Huntley JH, Efron JE, Sato K, Marohn MR, Pollack CE. Survivorship care for early-stage colorectal cancer: a national survey of general surgeons and colorectal surgeons. Colorectal Dis 2018; 20:996-1003. [PMID: 29956455 DOI: 10.1111/codi.14321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/21/2018] [Indexed: 12/24/2022]
Abstract
AIM Few data are available on the optimal long-term care of early-stage colorectal cancer survivors, termed survivorship care. We aimed to investigate current practice in the management of patients following treatment for early-stage colorectal cancer. METHOD We performed an internet survey of members of the American Society for Colon and Rectal Surgeons about several aspects of long-term care, including allocation of clinician responsibility, challenges with transitions to primary care physicians (PCPs), long-term care plan provision and recommended surgical follow-up duration. RESULTS Overall, 251 surgeons responded. Surgeons reported taking primary responsibility for managing adverse surgical effects (93.2%) and surveillance testing (imaging and laboratories 68.6%, endoscopy 82.4%). Barriers to PCP handoffs included patient preference for surgical follow-up (endorsed by 76.6%) and inadequate communication with PCPs (endorsed by 36.9%). Approximately one-third of surgeons routinely provide survivorship care plans to PCPs; surgeons who received formal survivorship training were more likely to do so compared to those without such training (OR 3.29, 95% CI 1.57, 6.92). Although only 20.4% of surgeons follow their patients beyond 5 years, individuals in practice longer were more likely to continue long-term follow-up than those with ≤ 10 years of experience. CONCLUSIONS This is the largest survey of surgeons regarding long-term management for early-stage colorectal cancer and highlights the potential for improved coordination with PCPs and increased implementation of survivorship care plans.
Collapse
Affiliation(s)
- Y Choi
- Department of Medicine, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - J H Huntley
- Department of Medicine, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - J E Efron
- Department of Surgery, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - K Sato
- Department of Surgery, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - M R Marohn
- Department of Surgery, Johns Hopkins School of Medicine, Lutherville, MD, USA
| | - C E Pollack
- Department of Medicine, Johns Hopkins School of Medicine, Lutherville, MD, USA
| |
Collapse
|