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Paltrinieri S, Cavuto S, Contri A, Bassi MC, Bravi F, Schiavi M, Fugazzaro S, Guberti M, Costi S. Needs of breast cancer survivors: a systematic review of quantitative data. Crit Rev Oncol Hematol 2024; 201:104432. [PMID: 38955309 DOI: 10.1016/j.critrevonc.2024.104432] [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: 04/19/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
This systematic review aimed to update the perceived needs of individuals with breast cancer (BC). Databases were searched for studies reporting quantitative data collected through validated assessment tools. Needs of adults with BC were reported by survivorship phase. The post-diagnosis and the post-surgery phases revealed the most needs; health system and information needs represented the greatest concern, with average Supportive Care Needs Survey-Short Form (SCNS-SF34) scores ranging from 62.0 to 75.8 post-diagnosis and from 45.0 to 67.8 post-surgery. Needs then seemed to decrease or remain stable up to within one year from diagnosis, when needs in all domains increased again; health system and information needs remained a priority. Younger age, side effects, type of treatment, and advanced stage were associated with the occurrence of unmet needs. The needs of BC survivors vary over the course of their cancer experience. This knowledge can assist the planning of appropriate assessments.
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Affiliation(s)
- S Paltrinieri
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Public Health Sciences PhD Program, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - S Cavuto
- Statistics Unit, Clinical Trial Center, SOC Infrastructure, Research and Statistics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Contri
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - M C Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Bravi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Schiavi
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - S Fugazzaro
- Physical Medicine and Rehabilitation Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Costi
- Physical Medicine and Rehabilitation Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
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2
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Bender JL, Scruton S, Wong G, Abdelmutti N, Berlin A, Easley J, Liu ZA, McGee S, Rodin D, Sussman J, Urquhart R. Virtual follow-up care among breast and prostate cancer patients during and beyond the COVID-19 pandemic: Association with distress. Cancer Med 2024; 13:e6948. [PMID: 38466233 PMCID: PMC10926960 DOI: 10.1002/cam4.6948] [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: 08/04/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The purpose of this study was to investigate associations between self-reported distress (anxiety/depression) and satisfaction with and desire for virtual follow-up (VFU) care among cancer patients during and beyond the COVID-19 pandemic. METHODS Breast and prostate cancer patients receiving VFU at an urban cancer centre in Toronto, Canada completed an online survey on their sociodemographic, clinical, and technology, characteristics and experience with and views on VFU. EQ5D-5 L was used to assess distress. Statistical models adjusted for age, gender, education, income and Internet confidence. RESULTS Of 352 participants, average age was 65 years, 48% were women,79% were within 5 years of treatment completion, 84% had college/university education and 74% were confident Internet users. Nearly, all (98%) had a virtual visit via phone and 22% had a virtual visit via video. The majority of patients (86%) were satisfied with VFU and 70% agreed that they would like VFU options after the COVID-19 pandemic. Participants who reported distress and who were not confident using the Internet for health purposes were significantly less likely to be satisfied with VFU (OR = 0.4; 95% CI: 0.2-0.8 and OR = 0.19; 95% CI: 0.09-0.38, respectively) and were less likely to desire VFU option after the COVID-19 pandemic (OR = 0.49; 95% CI: 0.30-0.82 and OR = 0.41; 95% CI: 0.23-0.70, respectively). CONCLUSIONS The majority of respondents were satisfied with VFU and would like VFU options after the COVID-19 pandemic. Future research should determine how to optimize VFU options for cancer patients who are distressed and who are less confident using virtual care technology.
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Affiliation(s)
- Jacqueline L. Bender
- Cancer Rehabilitation and Survivorship, Department of Supportive CarePrincess Margaret Cancer CentreTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Sarah Scruton
- Cancer Rehabilitation and Survivorship, Department of Supportive CarePrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Geoff Wong
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Nazek Abdelmutti
- Cancer Quality Lab (CQual)Princess Margaret Cancer CentreTorontoOntarioCanada
- Cancer Digital IntelligencePrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Alejandro Berlin
- Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Julie Easley
- Department of Medical EducationHorizon Health NetworkFrederictonNew BrunswickCanada
| | - Zhihui Amy Liu
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Biostatistics DepartmentUniversity Health NetworkTorontoOntarioCanada
| | - Sharon McGee
- Division of Medical Oncology, Department of MedicineThe Ottawa Hospital and the University of OttawaOttawaOntarioCanada
| | - Danielle Rodin
- Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | | | - Robin Urquhart
- Department of Community Health and EpidemiologyDalhousie UniversityHalifaxNova ScotiaCanada
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Halpern M, Mollica MA, Han PK, Tonorezos ES. Myths and Presumptions About Cancer Survivorship. J Clin Oncol 2024; 42:134-139. [PMID: 37972343 PMCID: PMC10824378 DOI: 10.1200/jco.23.00631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
Identifying cancer survivorship myths and presumptions perpetuated in survivorship circles.
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Affiliation(s)
- Michael Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Michelle A. Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Paul K.J. Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Emily S. Tonorezos
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
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4
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Ankersmid JW, Drossaert CHC, van Riet YEA, Strobbe LJA, Siesling S. Needs and preferences of breast cancer survivors regarding outcome-based shared decision-making about personalised post-treatment surveillance. J Cancer Surviv 2023; 17:1471-1479. [PMID: 35122224 PMCID: PMC10442247 DOI: 10.1007/s11764-022-01178-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE In this study, we explored how patients experience current information provision and decision-making about post-treatment surveillance after breast cancer. Furthermore, we assessed patients' perspectives regarding less intensive surveillance in case of a low risk of recurrence. METHODS We conducted semi-structured interviews with 22 women in the post-treatment surveillance trajectory in seven Dutch teaching hospitals. RESULTS Although the majority of participants indicated a desire for shared decision-making (SDM) about post-treatment surveillance, participants experienced no SDM. Information provision was often suboptimal and unstructured. Participants were open for using risk information in decision-making, but hesitant towards less intensive surveillance. Perceived advantages of less intensive surveillance were: less distressing moments, leaving the patient role behind, and lower burden. Disadvantages were: fewer moments for reassurance, fear of missing recurrences, and a higher threshold for aftercare for side effects. CONCLUSIONS SDM about post-treatment surveillance is desirable. Although women are hesitant about less intensive surveillance, they are open to the use of personalised risk assessment for recurrences in decision-making about surveillance. IMPLICATIONS FOR CANCER SURVIVORS To facilitate SDM about post-treatment surveillance, the timing and content of information provision should be improved. Risk information should be provided in an accessible and understandable way. Moreover, fear of cancer recurrence and other personal considerations should be addressed in the process of SDM.
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Affiliation(s)
- Jet W Ankersmid
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands.
- Santeon Hospital Group, Utrecht, The Netherlands.
| | - Constance H C Drossaert
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | | | - Luc J A Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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5
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Byng D, Thomas SM, Rushing CN, Lynch T, McCarthy A, Francescatti AB, Frank ES, Partridge AH, Thompson AM, Retèl VP, van Harten WH, Grimm LJ, Hyslop T, Hwang ES, Ryser MD. Surveillance Imaging after Primary Diagnosis of Ductal Carcinoma in Situ. Radiology 2023; 307:e221210. [PMID: 36625746 PMCID: PMC10068891 DOI: 10.1148/radiol.221210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 01/11/2023]
Abstract
Background Guidelines recommend annual surveillance imaging after diagnosis of ductal carcinoma in situ (DCIS). Guideline adherence has not been characterized in a contemporary cohort. Purpose To identify uptake and determinants of surveillance imaging in women who underwent treatment for DCIS. Materials and Methods A stratified random sample of women who underwent breast-conserving surgery for primary DCIS between 2008 and 2014 was retrospectively selected from 1330 facilities in the United States. Imaging examinations were recorded from date of diagnosis until first distant recurrence, death, loss to follow-up, or end of study (November 2018). Imaging after treatment was categorized into 10 12-month periods starting 6 months after diagnosis. Primary outcome was per-period receipt of asymptomatic surveillance imaging (mammography, MRI, or US). Secondary outcome was diagnosis of ipsilateral invasive breast cancer. Multivariable logistic regression with repeated measures and generalized estimating equations was used to model receipt of imaging. Rates of diagnosis with ipsilateral invasive breast cancer were compared between women who did and those who did not undergo imaging in the 6-18-month period after diagnosis using inverse probability-weighted Kaplan-Meier estimators. Results A total of 12 559 women (median age, 60 years; IQR, 52-69 years) were evaluated. Uptake of surveillance imaging was 75% in the first period and decreased over time (P < .001). Across the first 5 years after treatment, 52% of women participated in consistent annual surveillance. Surveillance was lower in Black (adjusted odds ratio [OR], 0.80; 95% CI: 0.74, 0.88; P < .001) and Hispanic (OR, 0.82; 95% CI: 0.72, 0.94; P = .004) women than in White women. Women who underwent surveillance in the first period had a higher 6-year rate of diagnosis of invasive cancer (1.6%; 95% CI: 1.3, 1.9) than those who did not (1.1%; 95% CI: 0.7, 1.4; difference: 0.5%; 95% CI: 0.1, 1.0; P = .03). Conclusion Half of women did not consistently adhere to imaging surveillance guidelines across the first 5 years after treatment, with racial disparities in adherence rates. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Rahbar and Dontchos in this issue.
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Affiliation(s)
- Danalyn Byng
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Samantha M. Thomas
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Christel N. Rushing
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Thomas Lynch
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Anne McCarthy
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Amanda B. Francescatti
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Elizabeth S. Frank
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Ann H. Partridge
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Alastair M. Thompson
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Valesca P. Retèl
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Wim H. van Harten
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Lars J. Grimm
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Terry Hyslop
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - E. Shelley Hwang
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Marc D. Ryser
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
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6
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Sandell T, Schütze H, Miller A, Ivers R. Patients' acceptance of a shared cancer follow-up model of care between general practitioners and radiation oncologists: A population-based survey using the theoretical Framework of Acceptability. BMC PRIMARY CARE 2023; 24:86. [PMID: 36973691 PMCID: PMC10044765 DOI: 10.1186/s12875-023-02032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION International and national guidelines highlight the need for general practitioner involvement during and after active cancer treatment and throughout long-term follow-up care. This paper aimed to evaluate patients' acceptance of radiation oncology shared follow-up care using the Theoretical Framework of Acceptability (TFA). METHODS This cross-sectional study was conducted at two cancer care centres in the Illawarra Shoalhaven region of Australia. A sample of patients scheduled for a radiation oncology follow-up consultation in 2021 were sent a 32-point self-complete paper-based survey. Data were analysed using descriptive, parametric and non-parametric statistical analysis. This paper followed the Checklist for Reporting of Survey Studies (CROSS). RESULTS Of the 414 surveys returned (45% response rate), the acceptance for radiation oncology shared cancer follow-up care was high (80%). Patients treated with only radiotherapy were 1.7 times more likely to accept shared follow-up care than those treated with multiple modalities. Patients who preferred follow-up care for fewer than three years were 7.5 times more likely to accept shared care than those who preferred follow-up care for five years. Patients who travelled more than 20 minutes to their radiation oncologist or to the rural cancer centre were slightly more likely to accept shared care than those who travelled less than twenty minutes to the regional cancer centre. A high understanding of shared care (Intervention Coherence) and a positive feeling towards shared care (Affective Attitude) were significant predictive factors in accepting shared radiation oncology follow-up care. CONCLUSION Health services need to ensure patient preferences are considered to provide patient-centred cancer follow-up care. Shared cancer follow-up care implementation should start with patients who prefer a shorter follow-up period and understand the benefits of shared care. However, patients' involvement needs to be considered alongside other clinical risk profiles and organisational factors. Future qualitative research using the TFA constructs is warranted to inform clinical practice change.
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Affiliation(s)
- Tiffany Sandell
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Cancer Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
| | - Heike Schütze
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Andrew Miller
- Cancer Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Rowena Ivers
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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7
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O'Malley DM, Davis SN, Amare R, Sanabria B, Sullivan B, Devine KA, Ferrante JM, Findley PA, Miller SM, Hudson SV. User-Centered Development and Patient Acceptability Testing of a Health-Coaching Intervention to Enhance Cancer Survivorship Follow-up in Primary Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:788-797. [PMID: 33025453 PMCID: PMC8024404 DOI: 10.1007/s13187-020-01883-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 05/07/2023]
Abstract
We describe an iterative three-phase approach used to develop a cancer survivorship health-coaching intervention to guide self-management and follow-up care for post-treatment breast, colorectal, and prostate cancer survivors. Informed by theory (e.g., Cognitive-Social Health Information Processing Model (C-SHIP)), relevant literature, and clinical guidelines, we engaged in a user-centered design process. In phase I, we conducted depth interviews with survivors of breast (n = 34), prostate (n = 4), and colorectal (n = 6) cancers to develop a health coaching prototype. In phase II, we utilized user-testing interviews (n = 9) to test and refine the health coaching prototype. For both phases, we used a template analysis independently coding each interview. In phase I, majority (n = 34, 81%) of survivors were positive about the utility of health coaching. Among these survivors (n = 34), the top areas of identified need were emotional support (44%), general health information (35.3%), changes in diet and exercise (29.3%), accountability and motivation (23.5%), and information about treatment effects (17.7%). The prototype was developed and user-tested and refined in phase III to address the following concerns: (1) the amount of time for calls, (2) density of reading materials, (3) clarity about health coaches' role, (4) customization. Collectively, this resulted in the development of the Extended Cancer Educational for Long-Term Cancer Survivors health-coaching (EXCELSHC) program, which represents the first cancer survivorship follow-up program to support follow-up care designed-for-dissemination in primary care settings. EXCELSHC is being tested in a clinical efficacy trial. Future research will focus on program refinement and testing for effectiveness in primary care.
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Affiliation(s)
- Denalee M O'Malley
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.
- Rutgers Biomedical and Health Sciences, New Brunswick, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA.
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
| | - Stacy N Davis
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
- Rutgers, School of Public Health, Department of Health Behavior, Society, and Policy, New Brunswick, USA
| | - Rahwana Amare
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
| | - Bianca Sanabria
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
| | - Brittany Sullivan
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Katie A Devine
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Jeanne M Ferrante
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Patricia A Findley
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
- Rutgers School of Social Work, New Brunswick, USA
| | | | - Shawna V Hudson
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
- Rutgers, School of Public Health, Department of Health Behavior, Society, and Policy, New Brunswick, USA
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8
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Risk Stratification and Cancer Follow-Up: Towards More Personalized Post-Treatment Care in Canada. Curr Oncol 2022; 29:3215-3223. [PMID: 35621651 PMCID: PMC9139666 DOI: 10.3390/curroncol29050261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/15/2022] Open
Abstract
After treatment, cancer survivors require ongoing, comprehensive care to improve quality of life, reduce disability, limit complications, and restore function. In Canada and internationally, follow-up care continues to be delivered most often by oncologists in institution-based settings. There is extensive evidence to demonstrate that this model of care does not work well for many survivors or our cancer systems. Randomized controlled trials have clearly demonstrated that alternate approaches to follow-up care are equivalent to oncologist-led follow-up in terms of patient outcomes, such as recurrence, survival, and quality of life in a number of common cancers. In this paper, we discuss the state of follow-up care for survivors of prevalent cancers and the need for more personalized models of follow-up. Indeed, there is no one-size-fits-all solution to post-treatment follow-up care, and more personalized approaches to follow-up that are based on individual risks and needs after cancer treatment are warranted. Canada lags behind when it comes to personalizing follow-up care for cancer survivors. There are many reasons for this, including difficulty in determining who is best served by different follow-up pathways, a paucity of evidence-informed self-management education and supports for most survivors, poorly developed IT solutions and systems, and uneven coordination of care. Using implementation science theories, approaches, and methods may help in addressing these challenges and delineating what might work best in particular settings and circumstances.
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9
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Garcia R, Henderson C, Randell K, Villaveces A, Katz A, Abioye F, DeGue S, Premo K, Miller-Wallfish S, Chang JC, Miller E, Ragavan MI. The Impact of the COVID-19 Pandemic on Intimate Partner Violence Advocates and Agencies. JOURNAL OF FAMILY VIOLENCE 2021; 37:893-906. [PMID: 34720393 PMCID: PMC8547898 DOI: 10.1007/s10896-021-00337-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 05/07/2023]
Abstract
Relatively few studies have considered the impact of the COVID-19 pandemic on intimate partner violence (IPV) advocates or the agencies where they work. In this study, based on United States IPV advocates' experiences working with survivors during the COVID-19 pandemic, we conducted interviews to explore: 1) personal challenges and resilience working as IPV advocates during the COVID-19 pandemic; 2) how agencies adapted to the pandemic to support IPV survivors and advocates; and 3) specific needs and challenges of culturally-specific agencies. We conducted semi-structured interviews with 53 IPV advocates from June to November 2020. Participants were included if they worked directly with survivors, identified as an IPV advocate, worked at a US-based agency, and spoke and understood English. We created a sampling matrix to ensure adequate representation from IPV advocates serving survivors from communities which have been marginalized. Interviews were conducted through a virtual platform by a trained member of the research team. We used an inductive thematic analysis approach, with weekly coding meetings to resolve discrepancies in coding. Five themes emerged from the data: 1) IPV advocates described how working as an IPV advocate during the COVID-19 pandemic impacted them personally; 2) agencies developed new methods of addressing IPV advocates' needs; 3) agencies developed new solutions to address pandemic-related client needs; 4) transitioning advocacy work to virtual formats created challenges but also opportunities and; 5) pandemic limitations and impacts compounded pre-pandemic challenges for culturally specific agencies. IPV advocates are frontline workers who have played essential roles in adjusting services to meet survivor needs during the COVID-19 pandemic while simultaneously coping with pandemic impacts on themselves and their agencies. Developing inter-agency collaborations and promoting advocates' safety and wellbeing during future public health crises will help support IPV survivors.
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Affiliation(s)
- Rebecca Garcia
- Women’s Center & Shelter of Greater Pittsburgh, PO Box 9024, Pittsburgh, PA 15224 USA
| | - Cynterria Henderson
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213 USA
| | - Kimberly Randell
- Division of Pediatric Emergency Medicine, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64110 USA
- University of Kansas City-Missouri School of Medicine, Kansas City, MO USA
- University of Kansas School of Medicine, Kansas City, KS USA
| | - Andrés Villaveces
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway., S106-10, Atlanta, GA 30341 USA
| | - Abbey Katz
- Futures Without Violence, 101 Montgomery Street, San Francisco, CA 94129 USA
| | - Fatimah Abioye
- Child Welfare, Trauma, and Resilience Initiatives, American Academy of Pediatrics, 345 Park Blvd, Itasca, IL 60413 USA
| | - Sarah DeGue
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway., S106-10, Atlanta, GA 30341 USA
| | - Kelley Premo
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213 USA
| | - Summer Miller-Wallfish
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213 USA
| | - Judy C. Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213 USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213 USA
| | - Maya I. Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh, 3420 Fifth Avenue, Pittsburgh, PA 15213 USA
- University of Pittsburgh, 3415 Fifth Avenue, Pittsburgh, PA 15213 USA
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10
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Survivors' preferences for the organization and delivery of supportive care after treatment: An integrative review. Eur J Oncol Nurs 2021; 54:102040. [PMID: 34571444 DOI: 10.1016/j.ejon.2021.102040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Quality supportive care during cancer survivorship contributes to positive physical and psychosocial health. However, the potential positive impacts are influenced by survivors' perceptions of and ability to access the supportive care services that they deem important to their well-being. The purpose of this integrative review was to examine cancer survivors' preferences for the organization and delivery of supportive care services in the post-treatment period. METHODS We conducted a systematic search for relevant quantitative, qualitative and mixed methods studies. Included studies were analyzed using directed content analysis, focused on models of care and type of provider, site of care, specialized services, structural supports through transitions, and sources of information. RESULTS Sixty-nine studies were included. Overall, survivors' preferences are not static and fluctuate over time based on their perceived health needs, concerns and points of transition in care. While specialist supportive care led by consultant oncologists is often identified as the preferred model of care, survivors' also express preferences for integrated and shared models of care, involving oncology nurses, primary care and multidisciplinary professionals to optimise coordination and impact of supportive care. Flexibility in care delivery, leveraging technology and expertise, was preferred to ensure convenient and timely access to supportive care. CONCLUSIONS Cancer survivors express preferences for the organization and delivery of supportive care in the post-treatment phase that fluctuate based on their perceived health needs. The development of novel survivorship health services must consider survivors' preferences and allow flexibility in care delivery to facilitate engagement, uptake, and effectiveness.
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11
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Pham Q, Hearn J, Bender JL, Berlin A, Brown I, Bryant-Lukosius D, Feifer AH, Finelli A, Gotto G, Hamilton R, Rendon R, Cafazzo JA. Virtual care for prostate cancer survivorship: protocol for an evaluation of a nurse-led algorithm-enhanced virtual clinic implemented at five cancer centres across Canada. BMJ Open 2021; 11:e045806. [PMID: 33883153 PMCID: PMC8061848 DOI: 10.1136/bmjopen-2020-045806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Prostate cancer (PCa) is the most common cancer in Canadian men. Current models of survivorship care are no longer adequate to address the chronic and complex survivorship needs of patients today. Virtual care models for cancer survivorship have recently been associated with comparable clinical outcomes and lower costs to traditional follow-up care, with patients favouring off-site and on-demand visits. Building on their viability, our research group conceived the Ned Clinic-a virtual PCa survivorship model that provides patients with access to lab results, collects patient-reported outcomes, alerts clinicians to emerging issues, and promotes patient self-care. Despite the promise of the Ned Clinic, the model remains limited by its dependence on oncology specialists, lack of an autonomous triage algorithm, and has only been implemented among PCa survivors living in Ontario. METHODS AND ANALYSIS Our programme of research comprises two main research objectives: (1) to evaluate the process and cost of implementing and sustaining five nurse-led virtual PCa survivorship clinics in three provinces across Canada and identify barriers and facilitators to implementation success and (2) to assess the impact of these virtual clinics on implementation and effectiveness outcomes of enrolled PCa survivors. The design phase will involve developing an autonomous triage algorithm and redesigning the Ned Clinic towards a nurse-led service model. Site-specific implementation plans will be developed to deploy a localised nurse-led virtual clinic at each centre. Effectiveness will be evaluated using a historical control study comparing the survivorship outcomes of 300 PCa survivors enrolled in the Ned Clinic with 300 PCa survivors receiving traditional follow-up care. ETHICS AND DISSEMINATION Appropriate site-specific ethics approval will be secured prior to each research phase. Knowledge translation efforts will include diffusion, dissemination, and application approaches to ensure that knowledge is translated to both academic and lay audiences.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jason Hearn
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Jacqueline L Bender
- ELLICSR Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alejando Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ian Brown
- Division of Urology, Niagara Health System, Saint Catharines, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Denise Bryant-Lukosius
- Faculty of Health Sciences, School of Nursing and Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Andrew H Feifer
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Department of Surgery, Division of Urology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Geoffrey Gotto
- Department of Surgery, Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Robert Hamilton
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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12
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Chahine S, Walsh G, Urquhart R. Factors Associated with Meeting the Psychosocial Needs of Cancer Survivors in Nova Scotia, Canada. ACTA ACUST UNITED AC 2020; 28:13-25. [PMID: 33704113 PMCID: PMC7816177 DOI: 10.3390/curroncol28010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Purpose: The purpose of this study is to describe the psychosocial needs of cancer survivors and examine whether sociodemographic factors and health care providers accessed are associated with needs being met. Methods: All Nova Scotia survivors meeting specific inclusion and exclusion criteria are identified from the Nova Scotia Cancer Registry and sent an 83-item survey to assess psychosocial concerns and whether and how their needs were met. Descriptive statistics (frequencies, percentages) and Chi-square analyses are used to examine associations between sociodemographic and provider factors and outcomes. Results: Anxiety and fear of recurrence, depression, and changes in sexual intimacy are major areas of concern for survivors. Various sociodemographic factors, such as immigration status, education, employment, and internet use, are associated with reported psychosocial health and having one’s needs met. Having both a specialist and primary care provider in charge of follow-up care is associated with a significantly (p < 0.05) higher degree of psychosocial and informational needs met compared to only one physician or no follow-up physician in charge. Accessing a patient navigator also is significantly associated with a higher degree of needs met. Conclusions: Our study identifies the most prevalent psychosocial needs of cancer survivors and the factors associated with having a higher degree of needs met, including certain sociodemographic factors, follow-up care by both a primary care practitioner and specialist, and accessing a patient navigator.
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Affiliation(s)
- Soleil Chahine
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Correspondence: ; Tel.: +1-902-220-1703; Fax: +1-902-473-4631
| | - Gordon Walsh
- Nova Scotia Health Authority, Halifax, NS B3H 2Y9, Canada; (G.W.); (R.U.)
| | - Robin Urquhart
- Nova Scotia Health Authority, Halifax, NS B3H 2Y9, Canada; (G.W.); (R.U.)
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada
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13
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Pham Q, Hearn J, Gao B, Brown I, Hamilton RJ, Berlin A, Cafazzo JA, Feifer A. Virtual care models for cancer survivorship. NPJ Digit Med 2020; 3:113. [PMID: 32923690 PMCID: PMC7468136 DOI: 10.1038/s41746-020-00321-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
Virtual care models for cancer survivorship are needed to support patients living with the chronic effects of cancer treatment, while increasing health system capacity. Characteristics that may be critical to their success have not been adequately studied. This scoping review summarizes previous efforts to virtualize survivorship care to inform future innovations in the field. Four databases were searched for articles published before January 2020, and 24 articles that met selection criteria were included in this analysis. Rationale for pursuing virtual models of care shared two common objectives: (1) the need for sustainable survivorship care, and (2) the opportunity to improve survivorship outcomes. Breast cancer (N = 10) and prostate cancer (N = 4) were the most targeted cancers for virtual survivorship care. The implemented technologies included web platforms (N = 15), telephone calls (N = 12), and smartphone or tablet applications (N = 5). A variety of healthcare professionals were effectively involved in the provision of virtual care. Future virtual care models may benefit from integrating with existing health systems and services, repurposing common technologies, involving allied health professionals, and engaging patients and caregivers from diverse communities in the design of virtual services.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jason Hearn
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL Canada
| | - Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Ian Brown
- Division of Urology, Niagara Health, Niagara, ON Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON Canada
- Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, ON Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON Canada
| | - Joseph A. Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Andrew Feifer
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON Canada
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14
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Kline RM, Temple LKF, Nekhlyudov L. Implementing Quality Colon Cancer Survivorship Care: A Practical Proposal for a Path Forward. JCO Oncol Pract 2020; 17:77-84. [PMID: 32822258 DOI: 10.1200/op.20.00290] [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
There are currently close to 17 million survivors of cancer in the United States. This number is expected to grow as both an aging population and improved treatment increase the number of survivors. Consequently, the importance of quality survivorship care has been recognized, but implementing, measuring, and paying for this care in a highly fragmented health care system, across a broad spectrum of diseases, is difficult. Quality measurement tied to payment is one approach that has commonly been used to improve the quality of care in the US health care system, but the complexity of applying quality measurement metrics across the spectrum of cancer survivorship care had led to stalemate. In this article, we draw on prior work to develop a quality cancer survivorship framework and propose a practical path forward with a focus on the provision of colon cancer survivorship care within integrated health care delivery networks. With this narrowly defined approach, we hope that we can promote a practical solution that can be extended to other diseases and payment systems over time.
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Affiliation(s)
- Ronald M Kline
- Healthcare and Insurance Program Office, US Office of Personnel Management, Washington, DC
| | - Larissa K F Temple
- Division of Colorectal Surgery, University of Rochester School of Medicine, Rochester, NY
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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15
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Al Achkar M, Marchand L, Thompson M, Chow LQM, Revere D, Baldwin LM. Unmet needs and opportunities for improving care for patients with advanced lung cancer on targeted therapies: a qualitative study. BMJ Open 2020; 10:e032639. [PMID: 32205370 PMCID: PMC7103815 DOI: 10.1136/bmjopen-2019-032639] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Lung cancer is increasingly recognised as a heterogeneous disease. Recent advances with targeted therapies for lung cancer with oncogenic mutations have greatly improved the prognosis for this subset of patients, yet little is known about their experiences. This study aimed to identify the needs and explore the healthcare experiences of these advanced patients with oncogenic mutation driven lung cancer. DESIGN Qualitative interviews with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations in anaplastic lymphoma kinase, epidermal growth factor receptor or c-ros oncogene 1. SETTINGS Patients were recruited from online lung cancer support groups within the USA. Interviews were conducted remotely or in person, transcribed verbatim and analysed using an iterative inductive and deductive process. PARTICIPANTS We included 39 patients (11 males and 28 females) with a median age of 48. RESULTS Two primary theme categories emerged: patients' unmet needs and improving healthcare experiences. Unmet needs are related to patients' desire to view their disease as a chronic illness, aspire to live a meaningful existence without financial devastation, desire for understanding along with emotional support and needing help with practical matters. Improving healthcare experiences involved patients' desire to trust the expertise of clinical providers, receive reliable care and be treated holistically and as informed partners. CONCLUSIONS Patients with lung cancer with oncogenic mutations live uncharted experiences. Targeted therapy brings hope, but uncertainty is daunting. Patients grapple with the meaning and purpose of their lives while day-to-day obligations remain challenging. Healthcare teams are instrumental in their care experiences, and patients desire providers who are up-to-date on advances in the field and treat them as whole persons.
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Affiliation(s)
- Morhaf Al Achkar
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Lucille Marchand
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew Thompson
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Laura Q M Chow
- Department of Oncology, University of Texas at Austin, Dell Medical School, Austin, Texas, USA
| | - Debra Revere
- School of Public Health, University of Washington, Seattle, Washington, USA
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