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Mollica MA, McWhirter G, Tonorezos E, Fenderson J, Freyer DR, Jefford M, Luevano CJ, Mullett T, Nasso SF, Schilling E, Passero VA. Developing national cancer survivorship standards to inform quality of care in the United States using a consensus approach. J Cancer Surviv 2024:10.1007/s11764-024-01602-6. [PMID: 38739299 DOI: 10.1007/s11764-024-01602-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To develop United States (US) standards for survivorship care that informs (1) essential health system policy and process components and (2) evaluation of the quality of survivorship care. METHODS The National Cancer Institute and the Department of Veterans Affairs led a review to identify indicators of quality cancer survivorship care in the domains of health system policy, process, and evaluation/assessment. A series of three virtual consensus meetings with survivorship care and research experts and advocates was conducted to rate the importance of the indicators and refine the top indicators. The final set of standards was developed, including ten indicators in each domain. RESULTS Prioritized items were survivor-focused, including processes to both assess and manage physical, psychological, and social issues, and evaluation of patient outcomes and experiences. Specific indicators focused on developing a business model for sustaining survivorship care and collecting relevant business metrics (e.g., healthcare utilization, downstream revenue) to show value of survivorship care to health systems. CONCLUSIONS The National Standards for Cancer Survivorship Care can be used by health systems to guide development of new survivorship care programs or services or to assess alignment and enhance services in existing survivorship programs. Given the variety of settings providing care to survivors, it is necessary for health systems to adapt these standards based on factors including age-specific needs, cancer types, treatments received, and health system resources. IMPLICATIONS FOR CANCER SURVIVORS With over 18 million cancer survivors in the United States, many of whom experience varied symptoms and unmet needs, it is essential for health systems to have a comprehensive strategy to provide ongoing care. The US National Standards for Survivorship Care should serve as a blueprint for what survivors and their families can anticipate after a cancer diagnosis to address their needs.
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Affiliation(s)
- Michelle A Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E440, Bethesda, MD, 20892-9762, USA.
| | - Gina McWhirter
- Department of Veterans Affairs, National Oncology Program, Washington, DC, USA
| | - Emily Tonorezos
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E440, Bethesda, MD, 20892-9762, USA
| | - Joshua Fenderson
- Hematology/Oncology Service, Brooke Army Medical Center, Defense Health Agency, San Antonio, TX, USA
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - David R Freyer
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles and USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher J Luevano
- Office of The Assistant Secretary of Defense for Health Affairs, Department of Defense, Washington, DC, USA
| | - Timothy Mullett
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Ethan Schilling
- Cancer Survivorship Advocate, Carolina Pediatric Therapy, Asheville, NC, USA
| | - Vida Almario Passero
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Section of Hematology/Oncology, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- VA National TeleOncology, Durham, NC, USA
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van Leeuwen M, Kieffer JM, Young TE, Annunziata MA, Arndt V, Arraras JI, Autran D, Hani HB, Chakrabarti M, Chinot O, Cho J, da Costa Vieira RA, Darlington AS, Debruyne PR, Dirven L, Doege D, Eller Y, Eichler M, Fridriksdottir N, Gioulbasanis I, Hammerlid E, van Hemelrijck M, Hermann S, Husson O, Jefford M, Johansen C, Kjaer TK, Kontogianni M, Lagergren P, Lidington E, Lisy K, Morag O, Nordin A, Al Omari ASH, Pace A, De Padova S, Petranovia D, Pinto M, Ramage J, Rammant E, Reijneveld J, Serpentini S, Sodergren S, Vassiliou V, Leeuw IVD, Vistad I, Young T, Aaronson NK, van de Poll-Franse LV. Phase III study of the European Organisation for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire. J Cancer Surviv 2023; 17:1111-1130. [PMID: 35088246 DOI: 10.1007/s11764-021-01160-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to develop a European Organisation for Research and Treatment of Cancer Quality of Life Group (EORTC QLG) questionnaire that captures the full range of physical, mental, and social health-related quality of life (HRQOL) issues relevant to disease-free cancer survivors. In this phase III study, we pretested the provisional core questionnaire (QLQ-SURV111) and aimed to identify essential and optional scales. METHODS We pretested the QLQ-SURV111 in 492 cancer survivors from 17 countries with one of 11 cancer diagnoses. We applied the EORTC QLG decision rules and employed factor analysis and item response theory (IRT) analysis to assess and, where necessary, modify the hypothesized questionnaire scales. We calculated correlations between the survivorship scales and the QLQ-C30 summary score and carried out a Delphi survey among healthcare professionals, patient representatives, and cancer researchers to distinguish between essential and optional scales. RESULTS Fifty-four percent of the sample was male, mean age was 60 years, and, on average, time since completion of treatment was 3.8 years. Eleven items were excluded, resulting in the QLQ-SURV100, with 12 functional and 9 symptom scales, a symptom checklist, 4 single items, and 10 conditional items. The essential survivorship scales consist of 73 items. CONCLUSIONS The QLQ-SURV100 has been developed to assess comprehensively the HRQOL of disease-free cancer survivors. It includes essential and optional scales and will be validated further in an international phase IV study. IMPLICATIONS FOR CANCER SURVIVORS The availability of this questionnaire will facilitate a standardized and robust assessment of the HRQOL of disease-free cancer survivors.
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Affiliation(s)
- Marieke van Leeuwen
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Jacobien M Kieffer
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Teresa E Young
- Lynda Jackson Macmillan Centre, North Hertfordshire NHS Trust Including Mount Vernon Cancer Centre, East &, Northwood, UK
| | | | - Volker Arndt
- Unit of Cancer Survivorship Research, Division of Clinical Epidemiology and Aging Research & Epidemiological Cancer Registry Baden-Wurttemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Didier Autran
- Pole Neurosciences Cliniques, Service de Neuro-Oncologie, Aix-Marseille Universite, Marseille, France
| | | | | | - Olivier Chinot
- Pole Neurosciences Cliniques, Service de Neuro-Oncologie, Aix-Marseille Universite, Marseille, France
| | - Juhee Cho
- Center for Clinical Epidemiology and Cancer Education Center, Samsung Medical Center, School of Medicine Sungkyunkwan University, Seoul, Korea
| | | | | | - Philip R Debruyne
- Kortrijk Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniela Doege
- Unit of Cancer Survivorship Research, Division of Clinical Epidemiology and Aging Research & Epidemiological Cancer Registry Baden-Wurttemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yannick Eller
- Centre for Medical Education, University of Dundee, Dundee, UK
| | - Martin Eichler
- National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Nanna Fridriksdottir
- National University Hospital of Iceland, Ugo De Giorgi, Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, 47014, Italy
| | | | - Eva Hammerlid
- Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Mieke van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Silke Hermann
- Epidemiological Cancer Registry Baden-Wurttemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Christoffer Johansen
- Oncology Clinic, Finsen Center, Copenhagen Colin Johnson, University Surgical Unit, University Hospitals Southampton, Southampton, UK
| | - Trille Kristina Kjaer
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Meropi Kontogianni
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ofir Morag
- Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, Margate, UK
| | | | - Andrea Pace
- Neuroncology Unit, National Cancer Institute Regina Elena, Rome, Italy
| | - Silvia De Padova
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, 47014, Italy
| | - Duska Petranovia
- Hematology Department, University Clinical Hospital Center Rijeka, Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Monica Pinto
- Rehabilitation Medicine Unit, Department of Strategic Health Services, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - John Ramage
- Department of Gastroenterology and Hepatology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Elke Rammant
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jaap Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Samantha Serpentini
- Unit of Psychoncology-Breast Unit, Istituto Oncologico Veneto (IOV)-IRCCS, Padua, Italy
| | - Sam Sodergren
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Irma Verdonck-de Leeuw
- Department of Otolaryngology / Head & Neck Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ingvild Vistad
- Department of Gynecology and Obstetrics, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Teresa Young
- Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Neil K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Chan RJ, Crawford-Williams F, Crichton M, Joseph R, Hart NH, Milley K, Druce P, Zhang J, Jefford M, Lisy K, Emery J, Nekhlyudov L. Effectiveness and implementation of models of cancer survivorship care: an overview of systematic reviews. J Cancer Surviv 2023; 17:197-221. [PMID: 34786652 PMCID: PMC8594645 DOI: 10.1007/s11764-021-01128-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To critically assess the effectiveness and implementation of different models of post-treatment cancer survivorship care compared to specialist-led models of survivorship care assessed in published systematic reviews. METHODS MEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were searched from January 2005 to May 2021. Systematic reviews that compared at least two models of cancer survivorship care were included. Article selection, data extraction, and critical appraisal were conducted independently by two authors. The models were evaluated according to cancer survivorship care domains, patient and caregiver experience, communication and decision-making, care coordination, quality of life, healthcare utilization, costs, and mortality. Barriers and facilitators to implementation were also synthesized. RESULTS Twelve systematic reviews were included, capturing 53 primary studies. Effectiveness for managing survivors' physical and psychosocial outcomes was found to be no different across models. Nurse-led and primary care provider-led models may produce cost savings to cancer survivors and healthcare systems. Barriers to the implementation of different models of care included limited resources, communication, and care coordination, while facilitators included survivor engagement, planning, and flexible services. CONCLUSIONS Despite evidence regarding the equivalent effectiveness of nurse-led, primary care-led, or shared care models, these models are not widely adopted, and evidence-based recommendations to guide implementation are required. Further research is needed to address effectiveness in understudied domains of care and outcomes and across different population groups. IMPLICATIONS FOR CANCER SURVIVORS Rather than aiming for an optimal "one-size fits all" model of survivorship care, applying the most appropriate model in distinct contexts can improve outcomes and healthcare efficiency.
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Affiliation(s)
- Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South, Australia.
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Megan Crichton
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science & Medicine, Bond University, Robina, QLD, Australia
| | - Ria Joseph
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Kristi Milley
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Paige Druce
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Jianrong Zhang
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Jefford
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karolina Lisy
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jon Emery
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Larissa Nekhlyudov
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Toohey K, Hunter M, McKinnon K, Casey T, Turner M, Taylor S, Paterson C. A systematic review of multimodal prehabilitation in breast cancer. Breast Cancer Res Treat 2023; 197:1-37. [PMID: 36269525 PMCID: PMC9823038 DOI: 10.1007/s10549-022-06759-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/02/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Breast cancer is the most prevalent malignancy in women. Prehabilitation may offer improvements in physical and psychological wellbeing among participants prior to treatment. This systematic review aimed to determine the efficacy of prehabilitation in participants diagnosed with breast cancer. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the impact of prehabilitation in participants with breast cancer were included. Studies were assessed independently according to pre-eligibility criteria, with data extraction and methodological quality assessed in parallel. RESULTS 3184 records were identified according to our search criteria, and 14 articles were included. Articles comprised of quantitative randomised controlled trials (n = 7), quantitative non-randomised studies (n = 5), a qualitative study (n = 1), and a mixed-method study (n = 1). The majority of selected studies completed exercise programs (n = 4) or had exercise components (n = 2), with two focusing on upper-limb exercise. Five articles reported complementary and alternative therapies (n = 5). Two articles reported smoking cessation (n = 2), with a single study reporting multi-modal prehabilitation (n = 1). Mostly, prehabilitation improved outcomes including physical function, quality of life, and psychosocial variables (P < 0.05). The qualitative data identified preferences for multimodal prehabilitation, compared to unimodal with an interest in receiving support for longer. CONCLUSIONS Prehabilitation for patients with breast cancer is an emerging research area that appears to improve outcomes, however, ensuring that adequate intervention timeframes, follow-up, and population groups should be considered for future investigations. IMPLICATIONS FOR CANCER SURVIVORS The implementation of prehabilitation interventions for individuals diagnosed with breast cancer should be utilised by multidisciplinary teams to provide holistic care to patients as it has the potential to improve outcomes across the cancer care trajectory.
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Affiliation(s)
- Kellie Toohey
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia.
| | - Maddison Hunter
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
| | - Karen McKinnon
- Australian Capital Territory Breast Care, Calvary Public Hospital, Bruce ACT, Australia
| | - Tamara Casey
- Australian Capital Territory Breast Care, Calvary Public Hospital, Bruce ACT, Australia
| | - Murray Turner
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia
| | - Suzanne Taylor
- Australian Capital Territory Breast Care, Calvary Public Hospital, Bruce ACT, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
- Robert Gordon University, Aberdeen, AB10 7QB, Scotland
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Jefford M, Howell D, Li Q, Lisy K, Maher J, Alfano CM, Rynderman M, Emery J. Improved models of care for cancer survivors. Lancet 2022; 399:1551-1560. [PMID: 35430022 PMCID: PMC9009839 DOI: 10.1016/s0140-6736(22)00306-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 12/24/2022]
Abstract
The number of survivors of cancer is increasing substantially. Current models of care are unsustainable and fail to address the many unmet needs of survivors of cancer. Numerous trials have investigated alternate models of care, including models led by primary-care providers, care shared between oncology specialists and primary-care providers, and care led by oncology nurses. These alternate models appear to be at least as effective as specialist-led care and are applicable to many survivors of cancer. Choosing the most appropriate care model for each patient depends on patient-level factors (such as risk of longer-term effects, late effects, individual desire, and capacity to self-manage), local services, and health-care policy. Wider implementation of alternative models requires appropriate support for non-oncologist care providers and endorsement of these models by cancer teams with their patients. The COVID-19 pandemic has driven some changes in practice that are more patient-centred and should continue. Improved models should shift from a predominant focus on detection of cancer recurrence and seek to improve the quality of life, functional outcomes, experience, and survival of survivors of cancer, reduce the risk of recurrence and new cancers, improve the management of comorbidities, and reduce costs to patients and payers. This Series paper focuses primarily on high-income countries, where most data have been derived. However, future research should consider the applicability of these models in a wider range of health-care settings and for a wider range of cancers.
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Affiliation(s)
- Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Doris Howell
- Princess Margaret Cancer Research Institute, Toronto, ON, Canada
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Catherine M Alfano
- Northwell Health Cancer Institute, Lake Success, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Meg Rynderman
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jon Emery
- Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Mazariego C, Jefford M, Chan RJ, Roberts N, Millar L, Anazodo A, Hayes S, Brown B, Saunders C, Webber K, Vardy J, Girgis A, Koczwara B. Priority recommendations for the implementation of patient-reported outcomes in clinical cancer care: a Delphi study. J Cancer Surviv 2022; 16:33-43. [PMID: 35107792 PMCID: PMC8881271 DOI: 10.1007/s11764-021-01135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/06/2021] [Indexed: 12/13/2022]
Abstract
Purpose The aim of this study was to develop priority recommendations for the service level implementation of patient-reported outcomes (PROs) into clinical cancer care. Methods Development of draft guidance statements was informed by a literature review, the Knowledge to Action (KTA) implementation framework, and discussion with PRO experts and cancer survivors. A two-round modified Delphi survey with key stakeholders including cancer survivors, clinical and research experts, and Information Technology specialists was undertaken. Round 1 rated the importance of the statements and round 2 ranked statements in order of priority. Results Round 1 was completed by 70 participants with round 2 completed by 45 participants. Forty-seven statements were rated in round 2. In round 1, the highest agreement items (>90% agreement) included those that focused on the formation of strong stakeholder partnerships, ensuring ongoing communication within these partnerships, and the use of PROs for improvement and guidance in clinical care. Items ranked as the highest priorities in round 2 included assessment of current staff capabilities and service requirements, mapping of workflows and processes to enable collection, and using collected PROs to guide improved health outcomes. Conclusions This stakeholder consultation process has identified key priorities in PRO implementation into clinical cancer care that include clinical relevance, stakeholder engagement, communication, and integration within the existing processes and capabilities. Implication for Cancer Survivors Routine adoption of PRO collection by clinical cancer services requires multiple implementation steps; of highest priority is strong engagement and communication with key stakeholders including cancer survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01135-2.
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Affiliation(s)
- C Mazariego
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling street, Woolloomooloo, NSW, 2011, Australia.
| | - M Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - R J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - N Roberts
- Metro North Health Service, Herston, QLD, Australia.,University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - L Millar
- Medical School, University of Western Australia, Perth, WA, Australia
| | - A Anazodo
- School of Women's and Children's Health, University of New South Wales, Randwick, Sydney, Australia.,Kids Cancer Centre, Sydney, Sydney Children's Hospital, Randwick, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - S Hayes
- Consumer representative, Patients First: The Continuous Improvement in Care-Cancer Project, Perth, Australia
| | - B Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - C Saunders
- Medical School, University of Western Australia, Perth, WA, Australia
| | - K Webber
- School of Medical Sciences, Monash University, Clayton, Vic, Australia.,Oncology Department, Monash Health, Clayton, Vic, Australia
| | - J Vardy
- Sydney Medical School, University of Sydney, Camperdown, Australia.,Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia
| | - A Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - B Koczwara
- Department of Clinical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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7
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Mead KH, Wang Y, Cleary S, Arem H, Pratt-Chapman ML. Defining a patient-centered approach to cancer survivorship care: development of the patient centered survivorship care index (PC-SCI). BMC Health Serv Res 2021; 21:1353. [PMID: 34922530 PMCID: PMC8684610 DOI: 10.1186/s12913-021-07356-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/25/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose This study presents the validation of an index that defines and measures a patient-centered approach to quality survivorship care. Methods We conducted a national survey of 1,278 survivors of breast, prostate, and colorectal cancers to identify their priorities for cancer survivorship care. We identified 42 items that were “very important or absolutely essential” to study participants. We then conducted exploratory and confirmatory factor analyses (EFA/CFA) to develop and validate the Patient-Centered Survivorship Care Index (PC-SCI). Results A seven-factor structure was identified based on EFA on a randomly split half sample and then validated by CFA based on the other half sample. The seven factors include: (1) information and support in survivorship (7 items), (2) having a medical home (10 items) (3) patient engagement in care (3 items), (4) care coordination (5 items), (5) insurance navigation (3 items), (6) care transitions from oncologist to primary care (3 items), and (7) prevention and wellness services (5 items). All factors have excellent composite reliabilities (Cronbach’s alpha 0.84-0.94, Coefficient of Omega: 0.81-0.94). Conclusions Providing quality post-treatment care is critical for the long-term health and well-being of survivors. The PC-SCI defines a patient-centered approach to survivorship care to complement clinical practice guidelines. The PC-SCI has acceptable composite reliability, providing the field with a valid instrument of patient-centered survivorship care. The PC-SCI provides cancer centers with a means to guide, measure and monitor the development of their survivorship care to align with patient priorities of care. Trial registration ClinicalTrials.gov ID: NCT02362750, 13 February 2015 Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07356-6.
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Affiliation(s)
- K Holly Mead
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, Washington, DC, 20052, USA
| | - Yan Wang
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, Washington, DC, 20052, USA
| | - Sean Cleary
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, Washington, DC, 20052, USA
| | - Hannah Arem
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, DC, 20008, USA.,Department of Oncology, Georgetown Medical School, Washington, DC, 20007, USA
| | - Mandi L Pratt-Chapman
- George Washington University Cancer Center, George Washington University, 2600 Virginia Ave, NW, #300, Washington, DC, 20037, USA.
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Cancer Survivorship Issues: Dissemination and Translation of Evidence-Based Knowledge. Cancers (Basel) 2021; 13:cancers13225794. [PMID: 34830944 PMCID: PMC8616426 DOI: 10.3390/cancers13225794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
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