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Pradhan P, Sharman AR, Palme CE, Elliott MS, Clark JR, Venchiarutti RL. Models of survivorship care in patients with head and neck cancer in regional, rural, and remote areas: a systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01643-x. [PMID: 39031309 DOI: 10.1007/s11764-024-01643-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Rural people with head and neck cancers (HNC) are likely to experience poorer health outcomes due to limited access to health services, so many benefit from models of care that account for rurality. The aim of this review was to synthesise literature on models of care in this population. METHODS Studies were identified using seven databases: PubMed, PsycINFO, Scopus, Embase, CINAHL, Medline, and Web of Science. Studies that tested or reported a model of care in rural HNC survivors were included. Data on characteristics and outcomes of the models were synthesised according to the domains in the Cancer Survivorship Care Quality Framework, and study quality was appraised. RESULTS Seventeen articles were included. Eight were randomised controlled trials (seven with a control group and one single-arm study). Three models were delivered online, nine via telehealth, and five in-person. Majority were led by nurses and allied health specialists and most addressed management of physical (n = 9) and psychosocial effects (n = 6), while only a few assessed implementation outcomes such as cost-effectiveness. None evaluated the management of chronic health conditions. CONCLUSION Positive outcomes were reported for domains of survivorship care that were measured; however, further evaluation of models of care for rural people with HNC is needed to assess effectiveness across all domains of care. IMPLICATIONS FOR CANCER SURVIVORS Rural cancer survivors are a diverse population with unique needs. Alternative models of care such as shared care, or models personalised to the individual, could be considered to reduce disparities in access to care and outcomes.
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Affiliation(s)
- Poorva Pradhan
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Ashleigh R Sharman
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Rebecca L Venchiarutti
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
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Stal J, Piombo SE, Kysh L, Kagramanov D, Freyer DR, Turner BJ, Hempel S, Miller KA. The integration of primary care and childhood cancer survivorship care: a scoping review. J Cancer Surviv 2024; 18:635-650. [PMID: 36534343 DOI: 10.1007/s11764-022-01296-8] [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: 08/30/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This scoping review describes existing care models that integrate primary care and childhood cancer survivorship care, examines the effectiveness of these models, and characterizes barriers and facilitators to their integration. METHODS A systematic search (PubMed®, CINAHL®, Embase®) was conducted to identify citations which were evaluated against inclusion criteria using the PICOTTS framework. The PRISMA-ScR extension for scoping reviews was used to report review findings (protocol https://osf.io/92xbg ). RESULTS Twenty-three studies were included. Three care models integrating primary care and childhood cancer survivorship care were identified: consultative shared care in a primary care setting (N = 3); longitudinal shared care (N = 2); and PCP-led care employing a survivorship care plan (N = 5). While many described risk-adapted care, few used risk stratification approaches to inform care. Measures of model effectiveness varied, with discrepant findings regarding late effects detection in PCP-led approaches. The most frequently cited barriers and facilitators reflected provider- and system-level factors (PCP knowledge/experience identified as greatest barrier (N = 11); clinical information from oncologist identified as greatest facilitator (N = 9)). CONCLUSIONS Identified models depended on PCP knowledge and healthcare system coordination, and studies suggested the need for strong oncologic involvement in follow-up care. Improved training for PCPs and the coordinated transfer of clinical information could facilitate their involvement in such care. Overall, standardized measures of effectiveness are needed to deliver optimal childhood cancer survivorship care. IMPLICATIONS FOR CANCER SURVIVORS The literature revealed three care models defined by SCP use, provider involvement, and continuity of care, with several studies recommending oncologic involvement in follow-up care for high-risk survivors.
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Affiliation(s)
- Julia Stal
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Sarah E Piombo
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Dalia Kagramanov
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - David R Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Barbara J Turner
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Gehr Family Center for Health Systems Research and Innovation, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Susanne Hempel
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Morabito A, Mercadante E, Muto P, Manzo A, Palumbo G, Sforza V, Montanino A, Sandomenico C, Costanzo R, Esposito G, Totaro G, Cecio RD, Picone C, Porto A, Normanno N, Capasso A, Pinto M, Tracey M, Caropreso G, Pascarella G. Improving the quality of patient care in lung cancer: key factors for successful multidisciplinary team working. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2024; 5:260-277. [PMID: 38751383 PMCID: PMC11093720 DOI: 10.37349/etat.2024.00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/08/2024] [Indexed: 05/18/2024] Open
Abstract
International Guidelines as well as Cancer Associations recommend a multidisciplinary approach to lung cancer care. A multidisciplinary team (MDT) can significantly improve treatment decision-making and patient coordination by putting different physicians and other health professionals "in the same room", who collectively decide upon the best possible treatment. However, this is not a panacea for cancer treatment. The impact of multidisciplinary care (MDC) on patient outcomes is not univocal, while the effective functioning of the MDT depends on many factors. This review presents the available MDT literature with an emphasis on the key factors that characterize high-quality patient care in lung cancer. The study was conducted with a bibliographic search using different electronic databases (PubMed Central, Scopus, Google Scholar, and Google) referring to multidisciplinary cancer care settings. Many key elements appear consolidated, while others emerge as prevalent and actual, especially those related to visible barriers which work across geographic, organizational, and disciplinary boundaries. MDTs must be sustained by strategic management, structured within the entity, and cannot be managed as a separate care process. Furthermore, they need to coordinate with other teams (within and outside the organization) and join with the broad range of services delivered by multiple providers at various points of the cancer journey or within the system, with the vision of integrated care.
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Affiliation(s)
- Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Edoardo Mercadante
- Thoracic Surgery, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Paolo Muto
- Radiotherapy, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Anna Manzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Giuliano Palumbo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Agnese Montanino
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Claudia Sandomenico
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Raffaele Costanzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Giovanna Esposito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Giuseppe Totaro
- Radiotherapy, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Rossella De Cecio
- Pathology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Carmine Picone
- Radiology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Annamaria Porto
- Radiology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Nicola Normanno
- Cellular Biology and Biotherapy, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Arturo Capasso
- WSB Merito University in Wroclaw, Fabryczna 29-31, 53-609 Wroclaw, Poland
| | - Monica Pinto
- Rehabilitative Medicine Unit, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Maura Tracey
- Rehabilitative Medicine Unit, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Giuseppe Caropreso
- Division of Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Giacomo Pascarella
- Scientific Directorate, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
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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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Gore C, Lisy K, O'Callaghan C, Wood C, Emery J, Martin A, De Abreu Lourenco R, Schofield P, Jefford M. Colorectal cancer survivors' experiences and views of shared and telehealth models of survivorship care: A qualitative study. Psychooncology 2024; 33:e6265. [PMID: 38072641 DOI: 10.1002/pon.6265] [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: 08/11/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVES The number of colorectal cancer (CRC) survivors is increasing and current models of survivorship care are unsustainable. There is a drive to implement alternative models of care including shared care between general practitioners (GPs) and hospital-based providers. The primary objective of this study was to explore perspectives on facilitators and barriers to shared care. The secondary objective was to explore experiences of telehealth-delivered care. METHOD Qualitative data were collected via semi-structured interviews with participants in the Shared Care for Colorectal Cancer Survivors (SCORE) randomised controlled trial. Interviews explored patient experiences of usual and shared survivorship care during the SCORE trial. In response to the COVID pandemic, participant experiences of telehealth appointments were also explored. Interviews were recorded and transcribed for thematic analysis. RESULTS Twenty survivors of CRC were interviewed with an even number in the shared and usual care arms; 14 (70%) were male. Facilitators to shared care included: good relationships with GPs; convenience of GPs; good communication between providers; desire to reduce public health system pressures. Barriers included: poor communication between clinicians; inaccessibility of GPs; beliefs about GP capacity; and a preference for follow-up care with the hospital after positive treatment experiences. Participants also commonly expressed a preference for telehealth-based follow-up when there was no need for a clinical examination. CONCLUSIONS This is one of few studies that have explored patient experiences with shared and telehealth-based survivorship care. Findings can guide the implementation of these models, particularly around care coordination, communication, preparation, and personalised pathways of care.
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Affiliation(s)
- Claire Gore
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Clare O'Callaghan
- Departments of Psychosocial Cancer Care and Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Colin Wood
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice and Primary Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Martin
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Jefford M, Emery JD, James Martin A, De Abreu Lourenco R, Lisy K, Grunfeld E, Mohamed MA, King D, Tebbutt NC, Lee M, Mehrnejad A, Burgess A, Marker J, Eggins R, Carrello J, Thomas H, Schofield P. SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer. EClinicalMedicine 2023; 66:102346. [PMID: 38094163 PMCID: PMC10716007 DOI: 10.1016/j.eclinm.2023.102346] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 05/27/2024] Open
Abstract
BACKGROUND SCORE is the first randomised controlled trial (RCT) to examine shared oncologist and general practitioner (GP) follow-up for survivors of colorectal cancer (CRC). SCORE aimed to show that shared care (SC) was non-inferior to usual care (UC) on the EORTC QLQ-C30 Global Health Status/Quality of Life (GHQ-QoL) scale to 12 months. METHODS The study recruited patients from five public hospitals in Melbourne, Australia between February 2017 and May 2021. Patients post curative intent treatment for stage I-III CRC underwent 1:1 randomisation to SC and UC. SC replaced two oncologist visits with GP visits and included a survivorship care plan and primary care management guidelines. Assessments were at baseline, 6 and 12 months. Difference between groups on GHQ-QoL to 12 months was estimated from a mixed model for repeated measures (MMRM), with a non-inferiority margin (NIM) of -10 points. Secondary endpoints included quality of life (QoL); patient perceptions of care; costs and clinical care processes (CEA tests, recurrences). Registration ACTRN12617000004369p. FINDINGS 150 consenting patients were randomised to SC (N = 74) or UC (N = 76); 11 GPs declined. The mean (SD) GHQ-QoL scores at 12 months were 72 (20.2) for SC versus 73 (17.2) for UC. The MMRM mean estimate of GHQ-QoL across the 6 month and 12 month follow-up was 69 for SC and 73 for UC, mean difference -4.0 (95% CI: -9.0 to 0.9). The lower limit of the 95% CI did not cross the NIM. There was no clear evidence of differences on other QoL, unmet needs or satisfaction scales. At 12 months, the majority preferred SC (40/63; 63%) in the SC group, with equal preference for SC (22/62; 35%) and specialist care (22/62; 35%) in UC group. CEA completion was higher in SC. Recurrences similar between arms. Patients in SC on average incurred USD314 less in health costs versus UC patients. INTERPRETATION SC seems to be an appropriate and cost-effective model of follow-up for CRC survivors. FUNDING Victorian Cancer Agency and Cancer Australia.
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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, Parkville, VIC, Australia
| | - Jon D. Emery
- Centre for Cancer Research and Department of General Practice and Primary Care, University of Melbourne, Melbourne, VIC, Australia
| | | | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - 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, Parkville, VIC, Australia
| | - Eva Grunfeld
- Department of Community and Family Medicine and Ontario Institute for Cancer Research, University of Toronto, Canada
| | - Mustafa Abdi Mohamed
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dorothy King
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Margaret Lee
- Department of Medical Oncology, Western Health, Melbourne, VIC, Australia
| | - Ashkan Mehrnejad
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Adele Burgess
- Olivia Newton John Cancer Centre, Heidelberg, VIC, Australia
| | - Julie Marker
- Primary Care Collaborative Cancer Clinical Trials Group, Centre for Cancer Research and Department of General Practice and Primary Care, University of Melbourne, Melbourne, VIC, Australia
| | - Renee Eggins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Joseph Carrello
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Hayley Thomas
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Penelope Schofield
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Department of Psychology and Iverson Health Innovation Research Institute, Swinburne University, Melbourne, VIC, Australia
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Contiero P, Boffi R, Borgini A, Fabiano S, Tittarelli A, Mian M, Vittadello F, Epifani S, Ardizzone A, Cirilli C, Boschetti L, Marguati S, Cascone G, Tumino R, Fanetti AC, Giumelli P, Candela G, Scuderi T, Castelli M, Bongiorno S, Barigelletti G, Perotti V, Veronese C, Turazza F, Crivaro M, Tagliabue G. Causes of death in women with breast cancer: a risks and rates study on a population-based cohort. Front Oncol 2023; 13:1270877. [PMID: 38023134 PMCID: PMC10646497 DOI: 10.3389/fonc.2023.1270877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors. Materials and methods Using data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area. Results The study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age <50 years, 72.94% in women diagnosed at age 50-69 and 48.25% in women diagnosed at age ≥70. Greater CIF variations were observed according to stage: the contribution of causes other than breast cancer to CIF for all causes was 73.4% in women with stage I disease, 42.9% in stage II-III and only 13.2% in stage IV. CSH computation revealed temporal variations: in women diagnosed at age ≥70 the CSH for breast cancer was equaled by that for cardiovascular disease and "other diseases" in the sixth year following diagnosis, and an early peak for breast cancer was identified in the first year following diagnosis. Among women aged 50-69 we identified an early peak for breast cancer followed by a further peak near the second year of follow-up. Comparison by geographic area highlighted conspicuous variations: the highest CIF for cardiovascular disease was more than 70% higher than the lowest, while for breast cancer the highest CIF doubled the lowest. Conclusion The integrated interpretation of absolute risks and hazards suggests the need for multidisciplinary surveillance and prevention using community-based, holistic and well-coordinated survivorship care models.
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Affiliation(s)
- Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Boffi
- Respiratory Disease Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Borgini
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabrina Fabiano
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Tittarelli
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michael Mian
- Innovation, Research and Teaching Service, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Bozen, Italy
| | | | - Susi Epifani
- Statistics and Epidemiology Unit, ASL Brindisi, Brindisi, Italy
| | | | - Claudia Cirilli
- Servizio di Epidemiologia e Comunicazione del Rischio-Unità Funzionale di Modena, Registro Tumori Regione, Modena, Italy
| | | | - Stefano Marguati
- Pavia Cancer Registry, Public Health Agency of Pavia, Pavia, Italy
| | - Giuseppe Cascone
- Ragusa Cancer Registry Unit, Azienda Sanitaria Provinciale di Ragusa (ASP), Ragusa, Italy
| | - Rosario Tumino
- Ragusa Cancer Registry Unit, Azienda Sanitaria Provinciale di Ragusa (ASP), Ragusa, Italy
| | | | | | | | | | - Maurizio Castelli
- Dipartimento di Prevenzione Azienda USL Valle d’Aosta Loc, Quart, Italy
| | | | - Giulio Barigelletti
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Viviana Perotti
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Veronese
- Respiratory Disease Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fabio Turazza
- Cardiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Crivaro
- Cardiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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8
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Attai DJ, Katz MS, Streja E, Hsiung JT, Marroquin MV, Zavaleta BA, Nekhlyudov L. Patient preferences and comfort for cancer survivorship models of care: results of an online survey. J Cancer Surviv 2023; 17:1327-1337. [PMID: 35113306 DOI: 10.1007/s11764-022-01177-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/21/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Workforce shortages will impact oncologists' ability to provide both active and survivorship care. While primary care provider (PCP) or survivorship clinic transition has been emphasized, there is little evidence regarding patient comfort. METHODS We developed an online survey in partnership with patient advocates to assess survivors' comfort with PCP or survivorship clinic care and distributed the survey to online, cancer-specific patient communities from June to August 2020. Descriptive and logistic regression analyses were conducted. RESULTS A total of 975 surveys were complete. Most respondents were women (91%) and had private insurance (65%). Thirty-six cancer types were reported. Ninety-three percent had a PCP. Twenty-four percent were comfortable seeing a PCP for survivorship care. Higher odds of comfort were seen among respondents who were Black or had stage 0 cancer; female sex was associated with lower odds. Fifty-five percent were comfortable with a survivorship clinic. Higher odds of comfort were seen with lymphoma or ovarian cancer, > 15 years from diagnosis, and non-US government insurance. Lower odds were seen with melanoma, advanced stage, Medicaid insurance, and one late effect. Preference for PCP care was 87% for general health, 32% for recurrence monitoring, and 37% for late effect management. CONCLUSIONS One quarter of cancer survivors were comfortable with PCP-led survivorship care and about half with a survivorship clinic. Most preferred oncologist care for recurrence monitoring and late-effect management. IMPLICATIONS FOR CANCER SURVIVORS Patient preference and comfort should be considered when developing survivorship care models. Future efforts should focus on facilitating patient-centered transitions to non-oncologist care.
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Affiliation(s)
- Deanna J Attai
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- UCLA Health Burbank Breast Care, 191 S. Buena Vista #415, Burbank, CA, 91505, USA.
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, MA, USA
| | - Elani Streja
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jui-Ting Hsiung
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | | | - Beverly A Zavaleta
- Department of Medicine, Valley Baptist Medical Center - Brownsville, Brownsville, TX, USA
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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9
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Oswald TK, Azadi L, Sinclair S, Lawn S, Redpath P, Beecroft L, Ranogajec M, Yoo J, Venning A. "Somebody was standing in my corner": a mixed methods exploration of survivor, coach, and hospital staff perspectives and outcomes in an Australian cancer survivorship program. Support Care Cancer 2023; 31:478. [PMID: 37477703 PMCID: PMC10361845 DOI: 10.1007/s00520-023-07908-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Cancer survivorship in Australia continues to increase due to new methods for early detection and treatment. Cancer survivors face challenges in the survivorship phase and require ongoing support. A telephone-delivered cancer survivorship program (CSP), including health and mental health coaches, was developed, piloted, and evaluated in Eastern Australia. METHODS Cancer survivors' (n = 7), coaches' (n = 7), and hospital staff (n = 3) experiences of the CSP were explored through semi-structured interviews. Quantitative data routinely collected throughout the pilot of the CSP was described (N = 25). RESULTS Three syntheses and 11 themes were generated through thematic analysis. The first synthesis centred around operational factors and highlighted a need to streamline communication from the point of recruitment, through to program delivery, emphasising that the program could be beneficial when timed right and tailored correctly. The second synthesis indicated that the CSP focused on appropriate information, filled a gap in support, and met the needs of cancer survivors by empowering them. The third synthesis focussed on the value of mental health support in the CSP, but also highlighted challenges coaches faced in providing this support. Descriptive analysis of quantitative data indicated improvements in self-management, weekly physical activity, and meeting previously unmet needs. CONCLUSIONS Cancer survivors expressed appreciation for the support they received through the CSP and, in line with other cancer survivorship research, predominantly valued just having somebody in their corner. IMPLICATIONS FOR CANCER SURVIVORS Recommendations are made for improving cancer survivorship programs in the future.
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Affiliation(s)
- Tassia Kate Oswald
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford, South Australia, 5042, Australia
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AB, UK
| | - Leva Azadi
- Remedy Healthcare Group, 271 Spring Street, Melbourne, VIC, 3000, Australia
| | - Sue Sinclair
- Ramsay Health, Level 3, 5 Talavera Rd, Macquarie Park, New South Wales, 2113, Australia
| | - Sharon Lawn
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford, South Australia, 5042, Australia
| | - Paula Redpath
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford, South Australia, 5042, Australia
| | - Liam Beecroft
- Remedy Healthcare Group, 271 Spring Street, Melbourne, VIC, 3000, Australia
| | - Miles Ranogajec
- Remedy Healthcare Group, 271 Spring Street, Melbourne, VIC, 3000, Australia
| | - Jeannie Yoo
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford, South Australia, 5042, Australia
- Remedy Healthcare Group, 271 Spring Street, Melbourne, VIC, 3000, Australia
| | - Anthony Venning
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford, South Australia, 5042, Australia.
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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11
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Foley J, Ward EC, Burns CL, Nund RL, Wishart LR, Graham N, Patterson C, Ashley A, Fink J, Tiavaasue E, Comben W. Enhancing speech-language pathology head and neck cancer service provision in rural Australia: Using a plan, do, study, act approach. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:292-305. [PMID: 35532005 DOI: 10.1080/17549507.2022.2050300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE People with head and neck cancer (HNC) require ongoing speech-language pathology (SLP) services into the post-acute recovery phase of care. However, there are recognised service inequities/barriers for people from rural areas who are unable to access SLP services locally, necessitating travel to metropolitan centres. This study implemented strategies to assist rural speech-language pathologists to work to full scope of practice and support post-acute rehabilitation services for people with HNC. METHOD The study involved five SLP departments within a rural health referral network (one tertiary cancer centre, four rural sites). It involved a Plan-Do-Study-Act (PDSA) method, across two six month cycles, to achieve implementation of a model to support local SLP delivery of HNC care. Data collected included service activity, consumer feedback from people accessing local care, staff perceptions of the model and changes to local SLP service capabilities. RESULT Staff identified four objectives for change across the two PDSA cycles including resource development, upskilling/training and improving communication, and handover processes. In cycle 1, multiple resources were developed such as an eLearning program for training and skill development. In cycle 2, a pilot trial of a shared-care model was implemented, which successfully supported a transfer of care to local services for eight people with HNC. The majority of consumers accessing HNC care locally were satisfied with the service and would recommend future people with HNC receive similar care. CONCLUSION The PDSA process supported development and implementation of a model enabling local speech-language pathologists to offer post-acute care for people with HNC. This model helps rural people with HNC to access care closer to home by supporting rural clinicians to work to full scope of practice.
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Affiliation(s)
- Jasmine Foley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Department of Speech Pathology, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Rebecca L Nund
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Australia
| | - Nicky Graham
- Department of Speech Pathology, Children's Health Queensland Hospital and Health Service, Wondai Hospital, Australia
| | - Corey Patterson
- Department of Speech Pathology, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Australia
| | - Amy Ashley
- Department of Speech Pathology, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Australia
| | - Julie Fink
- Department of Speech Pathology, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Australia
| | - Emily Tiavaasue
- Department of Speech Pathology, The Mount Isa Hospital, North West Hospital and Health service, Mount Isa, Australia
| | - Wendy Comben
- Department of Speech Pathology, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Australia
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Giallauria F, Testa C, Cuomo G, Di Lorenzo A, Venturini E, Lauretani F, Maggio MG, Iannuzzo G, Vigorito C. Exercise Training in Elderly Cancer Patients: A Systematic Review. Cancers (Basel) 2023; 15:cancers15061671. [PMID: 36980559 PMCID: PMC10046194 DOI: 10.3390/cancers15061671] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
Due to the aging of the population, in 70% of cases, a new cancer diagnosis equals a cancer diagnosis in a geriatric patient. In this population, beyond the concept of mortality and morbidity, functional capacity, disability, and quality of life remain crucial. In fact, when the functional status is preserved, the pathogenetic curve towards disability will stop or even regress. The present systematic review investigated the effectiveness of physical exercise, as part of a holistic assessment of the patient, for preventing disability and improving the patient’s quality of life, and partially reducing all-cause mortality. This evidence must point towards decentralization of care by implementing the development of rehabilitation programs for elderly cancer patients either before or after anti-cancer therapy.
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Affiliation(s)
- Francesco Giallauria
- Department of Translational Medical Sciences, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
- Faculty of Sciences and Technology, University of New England, Armidale, NSW 2351, Australia
- Correspondence:
| | - Crescenzo Testa
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
| | - Gianluigi Cuomo
- Department of Translational Medical Sciences, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
| | - Elio Venturini
- Cardiac Rehabilitation Unit and Department of Cardiology, Azienda USL Toscana Nord-Ovest, “Cecina Civil Hospital”, 57023 Cecina, Italy
| | - Fulvio Lauretani
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
- Cognitive and Motor Center, Medicine and Geriatric-Rehabilitation Department of Parma, University Hospital of Parma, 43126 Parma, Italy
| | - Marcello Giuseppe Maggio
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
- Cognitive and Motor Center, Medicine and Geriatric-Rehabilitation Department of Parma, University Hospital of Parma, 43126 Parma, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
| | - Carlo Vigorito
- Department of Translational Medical Sciences, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
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13
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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: 42] [Impact Index Per Article: 42.0] [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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14
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Watson L, Link C, Qi S, DeIure A. Quantifying the Impact of Family Doctors on the Care Experiences of Patients with Cancer: Exploring Evidence from the 2021 Ambulatory Oncology Patient Satisfaction Survey in Alberta, Canada. Curr Oncol 2023; 30:641-652. [PMID: 36661698 PMCID: PMC9857946 DOI: 10.3390/curroncol30010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Oncology programs across Canada are reaching capacity as more Canadians are diagnosed with and treated for cancer each year. There is an increasing need to share care with family doctors, however it is unclear how this type of care impacts patient experiences, particularly while receiving active treatment. Retrospective data from the 2021 Ambulatory Oncology Patient Satisfaction Survey (AOPSS) in Alberta, Canada was used in this study. A unique question on the Alberta survey asks patients about their family doctor's involvement during their cancer care. Patient satisfaction across the six domains of person-centred care on the AOPSS was analyzed based on how involved a patient's family doctor was. Compared to patients who indicated their family doctor was "Not involved", patients with "Very involved" family doctors had significantly higher satisfaction scores in all six domains of care. The three domains which showed the largest positive impact of family doctor involvement were: Coordination & Integration of Care, Emotional Concerns, and Information, Communication & Education. The results demonstrate that involving family doctors in cancer care can be beneficial for patients. Based on the observed satisfaction increases in this study, shared care models may be preferred by many patients. These models of care can also help alleviate strain and capacity issues within cancer programs. The results could be used to support recommendations for cancer care teams to regularly involve and communicate with family doctors, to ensure that patients receive comprehensive and tailored care from all their health care providers.
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Affiliation(s)
- Linda Watson
- Applied Research & Patient Experience, Cancer Research & Analytics, Cancer Care Alberta—Alberta Health Services, Calgary, AB T2S 3C3, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Claire Link
- Applied Research & Patient Experience, Cancer Research & Analytics, Cancer Care Alberta—Alberta Health Services, Calgary, AB T2S 3C3, Canada
| | - Siwei Qi
- Applied Research & Patient Experience, Cancer Research & Analytics, Cancer Care Alberta—Alberta Health Services, Calgary, AB T2S 3C3, Canada
| | - Andrea DeIure
- Applied Research & Patient Experience, Cancer Research & Analytics, Cancer Care Alberta—Alberta Health Services, Calgary, AB T2S 3C3, Canada
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15
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Ke Y, Cheng I, Tan GSH, Fok RWY, Chan JJ, Loh KWJ, Chan A. Development and pilot testing of a decision aid for navigating breast cancer survivorship care. BMC Med Inform Decis Mak 2022; 22:330. [PMID: 36522635 PMCID: PMC9753367 DOI: 10.1186/s12911-022-02056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The predominant oncologist-led model in many countries is unsustainable to meet the needs of a growing cohort of breast cancer survivors (BCS). Despite available alternative models, adoption rates have been poor. To help BCS navigate survivorship care, we aimed to systematically develop a decision aid (DA) to guide their choice of follow-up care model and evaluate its acceptability and usability among BCS and health care providers (HCPs). METHODS We recruited BCS aged ≥ 21 years who have completed primary treatment and understand English. BCS receiving palliative care or with cognitive impairment were excluded. HCPs who routinely discussed post-treatment care with BCS were purposively sampled based on disciplines. Each participant reviewed the DA during a semi-structured interview using the 'think aloud' approach and completed an acceptability questionnaire. Descriptive statistics and directed content analysis were used. RESULTS We conducted three rounds of alpha testing with 15 BCS and 8 HCPs. All BCS found the final DA prototype easy to navigate with sufficient interactivity. The information imbalance favouring the shared care option perceived by 60% of BCS in early rounds was rectified. The length of DA was optimized to be 'just right'. Key revisions made included (1) presenting care options side-by-side to improve perceived information balance, (2) creating dedicated sections explaining HCPs' care roles to address gaps in health system contextual knowledge, and (3) employing a multicriteria decision analysis method for preference clarification exercise to reflect the user's openness towards shared care. Most BCS (73%) found the DA useful for decision-making, and 93% were willing to discuss the DA with their HCPs. Most HCPs (88%) agreed that the DA was a reliable tool and would be easily integrated into routine care. CONCLUSIONS Our experience highlighted the need to provide contextual information on the health care system for decisions related to care delivery. Developers should address potential variability within the care model and clarify inherent biases, such as low confidence levels in primary care. Future work could expand on the developed DA's informational structure to apply to other care models and leverage artificial intelligence to optimize information delivery.
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Affiliation(s)
- Yu Ke
- grid.4280.e0000 0001 2180 6431Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Ivy Cheng
- grid.410724.40000 0004 0620 9745Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Gretchen Ser Hua Tan
- grid.4280.e0000 0001 2180 6431Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Rose Wai Yee Fok
- grid.410724.40000 0004 0620 9745Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Jack Junjie Chan
- grid.410724.40000 0004 0620 9745Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Kiley Wei-Jen Loh
- grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Alexandre Chan
- grid.410724.40000 0004 0620 9745Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, Singapore, Singapore ,grid.266093.80000 0001 0668 7243Department of Clinical Pharmacy Practice, University of California Irvine, 515 Bison Modular 147B, Irvine, CA 92697 USA
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16
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Implementing a community-based shared care breast cancer survivorship model in Singapore: a qualitative study among primary care practitioners. BMC PRIMARY CARE 2022; 23:73. [PMID: 35395732 PMCID: PMC8991467 DOI: 10.1186/s12875-022-01673-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
Background The adaptability of existing recommendations on shared care implementation to Asian settings is unknown. This qualitative study aims to elicit public- and private-sectors primary care practitioners’ (PCPs) perspectives on the sustainable implementation of a shared care model among breast cancer survivors in Singapore. Methods Purposive sampling was employed to engage 70 PCPs from SingHealth Polyclinics, National University Polyclinics, National Healthcare Group Polyclinics, and private practice. Eleven focus groups and six in-depth interviews were conducted between June to November 2018. All sessions were audio-recorded and transcribed verbatim. Guided by the RE-AIM framework, we performed deductive thematic analysis in QSR NVivo 12. Results PCPs identified low-risk breast cancer survivors who demonstrated clear acceptability of PCPs’ involvement in follow-up as suitable candidates for shared care. Engagement with institution stakeholders as early adopters is crucial with adequate support through PCP training, return pathways to oncologists, and survivorship care plans as communication tools. Implementation considerations differed across practices. Selection of participating PCPs could consider seniority and interest for public and private practice, respectively. Proposed adoption incentives included increased renumeration for private PCPs and work recognition for public PCPs. Public PCPs further proposed integrating shared care elements to their existing family medicine clinics. Conclusions PCPs perceived shared care favorably as it echoed principles of primary care to provide holistic and well-coordinated care. Contextual factors should be considered when adapting implementation recommendations to Asian settings like Singapore. With limited competitive pressure, the government is then pivotal in empowering primary care participation in survivorship shared care delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01673-3.
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17
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Vaz-Luis I, Masiero M, Cavaletti G, Cervantes A, Chlebowski RT, Curigliano G, Felip E, Ferreira AR, Ganz PA, Hegarty J, Jeon J, Johansen C, Joly F, Jordan K, Koczwara B, Lagergren P, Lambertini M, Lenihan D, Linardou H, Loprinzi C, Partridge AH, Rauh S, Steindorf K, van der Graaf W, van de Poll-Franse L, Pentheroudakis G, Peters S, Pravettoni G. ESMO Expert Consensus Statements on Cancer Survivorship: promoting high-quality survivorship care and research in Europe. Ann Oncol 2022; 33:1119-1133. [PMID: 35963481 DOI: 10.1016/j.annonc.2022.07.1941] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of cancer survivorship. DESIGN AND METHODS Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research. RESULTS We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patient-centered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care. CONCLUSIONS The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward (a) promoting the development of high-quality survivorship care programs, (b) providing educational material and (c) aiding groundbreaking research by reflecting on priorities and by supporting research networking.
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Affiliation(s)
- I Vaz-Luis
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif; UMR 981, Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy-Cancer Campus, Villejuif, France.
| | - M Masiero
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - A Cervantes
- Department of Medical Oncology, INCLIVA, Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - E Felip
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon; Catolica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - P A Ganz
- UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, USA
| | - J Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - J Jeon
- Exercise Medicine Center for Cancer and Diabetes Patients (ICONS), Department of Sport Industry, Cancer Prevention Center, Yonsei Cancer Center, Shinchon Severance Hospital, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - C Johansen
- Centre for Cancer Late Effect Research (CASTLE), Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F Joly
- Department of Medical Oncology, Centre François Baclesse, U1086 Anticipe, Unicaen Normandy Universtity, Caen, France
| | - K Jordan
- Department for Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam; Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - B Koczwara
- Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - P Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - D Lenihan
- International Cardio-Oncology Society, Tampa, USA
| | - H Linardou
- Fourth Oncology Department & Comprehensive Clinical Trials Center, Metropolitan Hospital, Athens, Greece
| | | | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Rauh
- Department of Medical Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - W van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer institute, Erasmus University Medical Center, Rotterdam
| | - L van de Poll-Franse
- Division of Psychosocial Research & Epidemiology, Department of Psycological Research, The Netherlands Cancer Institute, Amsterdam; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - S Peters
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
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18
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Doose M, Verhoeven D, Sanchez JI, Livinski AA, Mollica M, Chollette V, Weaver SJ. Team-Based Care for Cancer Survivors With Comorbidities: A Systematic Review. J Healthc Qual 2022; 44:255-268. [PMID: 36036776 PMCID: PMC9429049 DOI: 10.1097/jhq.0000000000000354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coordination of quality care for the growing population of cancer survivors with comorbidities remains poorly understood, especially among health disparity populations who are more likely to have comorbidities at the time of cancer diagnosis. This systematic review synthesized the literature from 2000 to 2022 on team-based care for cancer survivors with comorbidities and assessed team-based care conceptualization, teamwork processes, and outcomes. Six databases were searched for original articles on adults with cancer and comorbidity, which defined care team composition and comparison group, and assessed clinical or teamwork processes or outcomes. We identified 1,821 articles of which 13 met the inclusion criteria. Most studies occurred during active cancer treatment and nine focused on depression management. Four studies focused on Hispanic or Black cancer survivors and one recruited rural residents. The conceptualization of team-based care varied across articles. Teamwork processes were not explicitly measured, but teamwork concepts such as communication and mental models were mentioned. Despite team-based care being a cornerstone of quality cancer care, studies that simultaneously assessed care delivery and outcomes for cancer and comorbidities were largely absent. Improving care coordination will be key to addressing disparities and promoting health equity for cancer survivors with comorbidities.
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Affiliation(s)
- Michelle Doose
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Dana Verhoeven
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Janeth I. Sanchez
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alicia A. Livinski
- National Institutes of Health Library, Office of Research Services, OD, National Institutes of Health, Bethesda, MD, USA
| | - Michelle Mollica
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Veronica Chollette
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Sallie J. Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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19
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Eikeland SA, Smeland KB, Brekke M, Kiserud CE, Fosså A. Late-effect awareness and follow-up of cancer in general practice. Scand J Prim Health Care 2022; 40:360-369. [PMID: 36380478 PMCID: PMC9848261 DOI: 10.1080/02813432.2022.2139457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE With increasing cancer incidence and survival rates, follow-up care becomes a major healthcare concern, placing increased demands on general practitioners (GPs). We explored GPs' awareness of late effects (LEs) after cancer treatment. Their degree of involvement and attitudes towards follow-up care was studied separately for solid cancers and Hodgkin's lymphoma (HL). DESIGN AND SETTING Mailed questionnaire study in Norwegian general practice. SUBJECTS 185 responding GPs with responsibility for HL survivors, more than 10 years since diagnosis. MAIN OUTCOME MEASURES AND RESULTS All GPs reported some awareness of LEs. Increasing awareness of LEs was associated with female sex, being a specialist, having experience from hospital-based cancer care and familiarity with official guidelines on LEs after treatment. The majority of GPs were involved in follow-up care, which increased with patients' time since treatment and was associated with higher awareness of LEs. GPs with work experience in hospital-based cancer care were more likely to be engaged in HL follow-up. Most GPs were willing to provide follow-up care at some point after treatment. Older and more experienced GPs, and those satisfied with the collaboration with hospital specialists, were more likely to provide follow-up earlier. CONCLUSION GPs' awareness of LEs and their willingness to provide follow-up care were related to familiarity with guidelines and experience. GPs more involved in follow-up care also had higher knowledge of LEs. Distribution of guidelines on LEs and follow-up care, and improving collaboration with hospital specialists, might increase GPs' knowledge and willingness to become involved in follow-up care, especially early in their careers. GPs' involvement and attitude towards follow-up of survivors of common solid cancers and HL, a rare malignant disease, were similar.KEY POINTSNorwegian general practitioners (GPs) are involved in survivorship care after cancer treatment. We investigated their awareness of late effects (LEs), their involvement and their attitude towards follow-up care of solid cancers and Hodgkin's lymphoma. • GPs registered as specialists, aware of guidelines and with experience from hospital-based cancer care reported higher awareness of LEs. • GPs with higher awareness of LEs were more frequently involved in follow-up care. • GPs with longer experience in general practice were comfortable with follow-up care at an earlier stage after treatment. • Results were similar for follow-up care of survivors of solid cancers and Hodgkin's lymphoma.
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Affiliation(s)
- Siri A. Eikeland
- National Advisory Unit for Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- CONTACT Siri A. Eikeland Department of Oncology, Oslo University Hospital, P.O. Box 4953, Nydalen, Oslo0424, Norway
| | - Knut B. Smeland
- National Advisory Unit for Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Mette Brekke
- General Practice Research Unit, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cecilie E. Kiserud
- National Advisory Unit for Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Alexander Fosså
- Department of Oncology and Radiotherapy, Oslo University Hospital, Oslo, Norway
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20
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Sandell T, Schütze H. Factors influencing the translation of shared cancer follow-up care into clinical practice: a systematic review. BMJ Open 2022; 12:e055460. [PMID: 36038175 PMCID: PMC9438010 DOI: 10.1136/bmjopen-2021-055460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care and the need to find alternative models of care. Shared cancer follow-up care in general practice is a safe option in terms of quality of life and cancer recurrence; however, there are barriers to translating this into practice. This review aimed to identify factors that influence the translation of shared cancer follow-up care into clinical practice. METHODS Systematic review. Seven electronic databases: MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psychinfo, Health Source: Nursing/Academic Edition and Psychology and Behavioural Sciences Collection, were searched for published papers between January 1999 and December 2021. The narrative review included papers if they were available in full-text, English, peer-reviewed and focused on shared cancer follow-up care. RESULTS Thirty-eight papers were included in the final review. Five main themes emerged: (1) reciprocal clinical information sharing is needed between oncologists and general practitioners, and needs to be timely and relevant; (2) responsibility of care should be shared with the oncologist overseeing care; (3) general practitioners skills and knowledge to provide cancer follow-up care; (4) need for clinical management guidelines and rapid referral to support general practitioners to provide shared follow-up care and (5) continuity of care and satisfaction of care is vital for shared care. CONCLUSION The acceptability of shared cancer follow-up care is increasing. Several barriers still exist to translating this into practice. Work is required to develop a shared-care model that can support general practitioners, while the oncologist can oversee the care and implement two-way communication between general and oncologists' clinics. The move towards integrating electronic healthcare records and web-based platforms for information exchange provides a promise to the timely exchange of information. PROSPERO REGISTRATION NUMBER CRD42020191538.
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Affiliation(s)
- Tiffany Sandell
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Radiation Oncology, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Heike Schütze
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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21
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Ee C, MacMillan F, Boyages J, McBride K. Barriers and enablers of weight management after breast cancer: a thematic analysis of free text survey responses using the COM-B model. BMC Public Health 2022; 22:1587. [PMID: 35987564 PMCID: PMC9392910 DOI: 10.1186/s12889-022-13980-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Weight gain is common after breast cancer. The aim of this study was to identify and describe the barriers to and enablers of successful weight management for women with breast cancer. Methods This was a combined inductive and deductive framework analysis of free text responses to an anonymous cross-sectional survey on weight after breast cancer. Women were recruited mainly through the Breast Cancer Network Australia Review and Survey Group. We applied deductive thematic analysis to free text responses to questions on barriers, enablers, research priorities, and one open-ended question at the end of the survey using the Capability, Opportunity, Motivation and Behaviour (COM-B) model as a framework. Subthemes that arose from the inductive analysis were mapped onto the COM-B model framework. Findings were used to identify behaviour change intervention functions. Results One hundred thirty-three women provided free text responses. Most women were of Caucasian origin and had been diagnosed with non-metastatic breast cancer, with a mean age of 59.1 years. Women's physical capability to adopt and sustain healthy lifestyle habits was significantly affected by treatment effects and physical illness, and some lacked psychological capability to self-regulate the face of stress and other triggers. Limited time and finances, and the social impact of undergoing cancer treatment affected the ability to control their diet. Frustration and futility around weight management were prominent. However, some women were confident in their abilities to self-regulate and self-monitor lifestyle behaviours, described support from friends and health professionals as enablers, and welcomed the physical and psychological benefits of being active in the context of embracing transformation and self-care after cancer. Conclusion Women need specific advice and support from peers, friends and families and health professionals. There is a substantial gap in provision of supportive care to enable women to adopt and sustain healthy lifestyles. Environmental restructuring (including financial support), incentivization (creating an expectation of looking and feeling better), persuasion and coercion (aiming to prevent recurrence), and equipping women with specific knowledge and skills, would also facilitate optimal lifestyle behaviours and weight management. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13980-6.
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22
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Long D, Gibbons K, Dow B, Best J, Webb KL, Liley HG, Stocker C, Thoms D, Schlapbach LJ, Wharton C, Lister P, Matuschka L, Castillo MI, Tyack Z, Bora S. Effectiveness-implementation hybrid-2 randomised trial of a collaborative Shared Care Model for Detecting Neurodevelopmental Impairments after Critical Illness in Young Children (DAISY): pilot study protocol. BMJ Open 2022; 12:e060714. [PMID: 35840297 PMCID: PMC9295674 DOI: 10.1136/bmjopen-2021-060714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION In Australia, while paediatric intensive care unit (PICU) mortality has dropped to 2.2%, one in three survivors experience long-term neurodevelopmental impairment, limiting their life-course opportunities. Unlike other high-risk paediatric populations, standardised routine neurodevelopmental follow-up of PICU survivors is rare, and there is limited knowledge regarding the best methods. The present study intends to pilot a combined multidisciplinary, online screening platform and general practitioner (GP) shared care neurodevelopmental follow-up model to determine feasibility of a larger, future study. We will also assess the difference between neurodevelopmental vulnerability and parental stress in two intervention groups and the impact of child, parent, sociodemographic and illness/treatment risk factors on child and parent outcomes. METHODS AND ANALYSIS Single-centre randomised effectiveness-implementation (hybrid-2 design) pilot trial for parents of children aged ≥2 months and <4 years discharged from PICU after critical illness or injury. One intervention group will receive 6 months of collaborative shared care follow-up with GPs (supported by online outcome monitoring), and the other will be offered self-directed screening and education about post-intensive care syndrome and child development. Participants will be followed up at 1, 3 and 6 months post-PICU discharge. The primary outcome is feasibility. Secondary outcomes include neurodevelopmental vulnerability and parental stress. An implementation evaluation will analyse barriers to and facilitators of the intervention. ETHICS AND DISSEMINATION The study is expected to lead to a full trial, which will provide much-needed guidance about the clinical effectiveness and implementation of follow-up models of care for children after critical illness or injury. The Children's Health Queensland Human Research Ethics Committee approved this study. Dissemination of the outcomes of the study is expected via publication in a peer-reviewed journal, presentation at relevant conferences, and via social media, podcast presentations and open-access medical education resources. REGISTRATION DETAILS The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry as 'Pilot testing of a collaborative Shared Care Model for Detecting Neurodevelopmental Impairments after Critical Illness in Young Children' (the DAISY Pilot Study). TRIAL REGISTRATION NUMBER ACTRN12621000799853.
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Affiliation(s)
- Debbie Long
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Kristen Gibbons
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Belinda Dow
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - James Best
- General Practice, Junction Street Family Practice, Nowra, New South Wales, Australia
| | - Kerri-Lyn Webb
- Developmental Paediatrics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Helen G Liley
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- Newborn Medicine, Mater Mother's Hospital, South Brisbane, Queensland, Australia
| | - Christian Stocker
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Debra Thoms
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Luregn J Schlapbach
- Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Carolyn Wharton
- Consumer Representative, Health Consumers Queensland, Brisbane, Queensland, Australia
| | - Paula Lister
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Critical Care Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Lori Matuschka
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Maria Isabel Castillo
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samudragupta Bora
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
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23
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Brauer ER, Ganz PA. Moving the Translational Needle in Breast Cancer Survivorship: Connecting Intervention Research to Clinical Practice. J Clin Oncol 2022; 40:2069-2073. [PMID: 35439031 DOI: 10.1200/jco.22.00174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Eden R Brauer
- School of Nursing, University of California, Los Angeles, Los Angeles, CA
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA.,Fielding School of Public Health and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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24
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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: 92] [Impact Index Per Article: 46.0] [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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25
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Ke Y, Tan CJ, Yeo HLA, Chan A. Adherence to Cancer Survivorship Care Guidelines and Health Care Utilization Patterns Among Nonmetastatic Breast Cancer Survivors in Singapore. JCO Glob Oncol 2022; 8:e2100246. [PMID: 35377727 PMCID: PMC9005251 DOI: 10.1200/go.21.00246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Currently, limited information is available on care provided to breast cancer survivors in Singapore. This study aims to assess the quality of post-treatment cancer survivorship care among breast cancer survivors on the basis of compliance with international guidelines up to 5 years post-primary treatment. We evaluated the adherence to international breast cancer survivorship care guidelines in Singapore.![]()
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Affiliation(s)
- Yu Ke
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Hui Ling Angie Yeo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore.,Department of Clinical Pharmacy Practice, University of California Irvine, Irvine, CA
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26
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Foley J, Nund RL, Ward EC, Burns CL, Wishart LR, Graham N, Patterson C, Ashley A, Fink J, Tiavaasue E, Comben W. Clinician and consumer perceptions of head and neck cancer services in rural areas: Implications for speech pathology service delivery. Aust J Rural Health 2022; 30:175-187. [DOI: 10.1111/ajr.12829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jasmine Foley
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
| | - Rebecca L. Nund
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
| | - Elizabeth C. Ward
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
- Centre of Functioning and Health Research Metro South Hospital and Health Service Brisbane OLD Australia
| | - Clare L. Burns
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
- Speech Pathology Department The Royal Brisbane and Women's HospitalQueensland Health Brisbane QLD Australia
| | - Laurelie R. Wishart
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
- Centre of Functioning and Health Research Metro South Hospital and Health Service Brisbane OLD Australia
- Princess Alexandra Hospital Metro South Hospital and Health Service Brisbane QLD Australia
| | - Nicky Graham
- Speech Pathology Department Children’s Health Queensland Hospital andHealth Service, Wondai Hospital Wondai QLD Australia
| | - Corey Patterson
- Speech Pathology Department The Townsville University Hospital The Townsville Hospital and Health Service Townsville QLD Australia
| | - Amy Ashley
- Speech Pathology Department The Townsville University Hospital The Townsville Hospital and Health Service Townsville QLD Australia
| | - Julie Fink
- Speech Pathology Department The Townsville University Hospital The Townsville Hospital and Health Service Townsville QLD Australia
| | - Emily Tiavaasue
- Speech Pathology Department The Mount Isa HospitalNorth West Hospital and Health Service Mount Isa QLD Australia
| | - Wendy Comben
- Speech Pathology Department The Townsville University Hospital The Townsville Hospital and Health Service Townsville QLD Australia
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O’Malley DM, Alfano CM, Doose M, Kinney AY, Lee SJC, Nekhlyudov L, Duberstein P, Hudson SV. Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research. Transl Behav Med 2021; 11:1989-1997. [PMID: 34850934 PMCID: PMC8634312 DOI: 10.1093/tbm/ibab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this commentary, we discuss opportunities to optimize cancer care delivery in the next decade building from evidence and advancements in the conceptualization and implementation of multi-level translational behavioral interventions. We summarize critical issues and discoveries describing new directions for translational behavioral research in the coming decade based on the promise of the accelerated application of this evidence within learning health systems. To illustrate these advances, we discuss cancer prevention, risk reduction (particularly precision prevention and early detection), and cancer treatment and survivorship (particularly risk- and need-stratified comprehensive care) and propose opportunities to equitably improve outcomes while addressing clinician shortages and cross-system coordination. We also discuss the impacts of COVID-19 and potential advances of scientific knowledge in the context of existing evidence, the need for adaptation, and potential areas of innovation to meet the needs of converging crises (e.g., fragmented care, workforce shortages, ongoing pandemic) in cancer health care delivery. Finally, we discuss new areas for exploration by applying key lessons gleaned from implementation efforts guided by advances in behavioral health.
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Affiliation(s)
- Denalee M O’Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
| | - Catherine M Alfano
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michelle Doose
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anita Y Kinney
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Simon J Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Department of Population and Data Sciences, UT-Southwestern, Dallas, TX, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Brigham & Womens’ Primary Care Medical Associates, Boston, MA, USA
| | - Paul Duberstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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28
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Foley J, Ward EC, Burns CL, Nund RL, Wishart L, Graham N, Patterson C, Ashley A, Fink J, Tiavaasue E, Comben W. Speech pathology service enhancement for people with head and neck cancer living in rural areas: Using a concept mapping approach to inform service change. Head Neck 2021; 43:3504-3521. [PMID: 34477267 DOI: 10.1002/hed.26850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Speech pathology (SP) services provide swallowing and communication intervention to people with head and neck cancer (HNC) across the continuum of care. However, difficulties exist with access and delivery of services in rural areas. The study aim was to identify actionable goals for SP change, utilizing a concept mapping approach. METHODS Eleven SP staff from two regional/remote services completed the concept mapping process. Multivariate analysis and multidimensional scaling were used to develop a final set of prioritized goals for change. RESULTS Between the two participating health services, 30 actionable goals were identified within the "green-zone" on the go-zone graph of importance and changeability. Among the most highly rated areas for change was the need to deliver and receive more support for training, mentoring, and supervision to consolidate skills. CONCLUSIONS This methodology enabled identification of prioritized, actionable changes to improve SP services for people with HNC living in regional/remote areas.
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Affiliation(s)
- Jasmine Foley
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Speech Pathology Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Clare L Burns
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Speech Pathology Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rebecca L Nund
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Laurelie Wishart
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Nicky Graham
- Speech Pathology Department, Children's Health Queensland Hospital and Health Service, Wondai Hospital, Wondai, Queensland, Australia
| | - Corey Patterson
- Speech Pathology Department, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Amy Ashley
- Speech Pathology Department, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Julie Fink
- Speech Pathology Department, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Emily Tiavaasue
- Speech Pathology Department, The Mount Isa Hospital, North West Hospital and Health Service, Mount Isa, Queensland, Australia
| | - Wendy Comben
- Speech Pathology Department, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Queensland, Australia
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Biopsychosocial Factors Associated with Supportive Care Needs in Canadian Adolescent and Young Adult Cancer Survivors. J Clin Med 2021; 10:jcm10122628. [PMID: 34203795 PMCID: PMC8232806 DOI: 10.3390/jcm10122628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
Adolescents and young adults (AYAs) represent an overlooked population in cancer survivorship care. Identifying the needs of AYAs can guide the development of tailored programs for this population. We conducted a cross-sectional descriptive analysis to identify biopsychosocial factors associated with AYA post-treatment supportive care needs and unmet needs using data obtained from the Experiences of Cancer Patients in Transitions Study of the Canadian Partnership Against Cancer, in collaboration with cancer agencies in the 10 Canadian provinces. The analysis focused on data from n = 530 AYAs between the ages of 18 and 34 who had undergone treatment within the past 5 years. Respondents reported a median of two moderate to big (MTB) physical needs (out of 9) and one unmet physical need, two MTB emotional needs (out of 6) with two unmet MTB emotional needs, and one (out of 5) practical need reported and one unmet MTB practical need. We found some common associations across supportive care domains. Income (lower) and more complex treatment were associated with high needs and unmet needs across the three domains. Respondents with a family doctor who was “very involved” in their cancer care had a lower number of unmet physical and emotional needs. Identifying those at risk of supportive care needs and developing tailored pathways in which they are proactively connected with tailored and appropriate resources and programs may help to reduce the number of unmet needs and improve cancer survivors’ quality of life.
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Yang LS, Ma CT, Chan CH, Luk MS, Woo HK, Lee VWY, Leung AWK, Lee SLK, Yeung NCY, Li CK, Cheung YT. Awareness of diagnosis, treatment and risk of late effects in Chinese survivors of childhood cancer in Hong Kong. Health Expect 2021; 24:1473-1486. [PMID: 34101943 PMCID: PMC8369092 DOI: 10.1111/hex.13288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/22/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND For survivors of childhood cancer, awareness of personal health risks is a critical component of long-term health management. OBJECTIVE To evaluate the awareness of the diagnosis, treatment and risk of late effects among survivors of childhood cancer in Hong Kong. METHODS Between June 2019 and March 2020, this cross-sectional study recruited 155 adult survivors (mean age = 26.9, standard deviation [SD] = 6.4 years) and 45 parents of paediatric survivors (mean age = 11.1, SD = 3.6 years) from a long-term follow-up clinic. At >10 years post-treatment (mean = 13.4, SD = 7.6 years), they completed a structured questionnaire to report their cancer-specific knowledge. Multiple linear regression analysis was conducted to identify clinical, socioeconomic and behavioural factors associated with poor awareness. RESULTS The majority of participants accurately recalled their diagnoses (73.5%) and major treatment modalities (chemotherapy 92.4%, radiation 82.9% and surgery 88.2%). However, less than half (45%) of the participants recognized more than 25% of the total late effects for which they were at risk. The highest levels of awareness were reported for endocrine problems (49%), neurocognitive impairment (44%) and secondary cancers (43%), and the lowest for peripheral neuropathy (21%) and vision problems (23%). Compared with survivors of haematological malignancies, those of central nervous system (CNS) tumours (standardized estimate [B] = -9.33, 95% confidence interval [95% CI]: -13.41 to -5.26) and non-CNS solid tumours (B = -8.47, 95% CI: -12.39 to -4.94) had less knowledge about their diagnosis. Retaining medical records (P < .0001) and better medical information-seeking habits (P = .048) were associated with better awareness. CONCLUSIONS Survivors of childhood cancer in Hong Kong have deficient awareness of their personal health risks. They may benefit from the provision of a survivorship care plan and personalized education regarding treatment-related late effects. PATIENT CONTRIBUTION Patients contributed in designing the study tools. Results were presented at a non-governmental organization.
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Affiliation(s)
- Lok Sum Yang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chung Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chun Him Chan
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mei Shum Luk
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hoi Kei Woo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vivian Wai-Yan Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alex Wing Kwan Leung
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samantha Lai-Ka Lee
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Nelson Chun-Yiu Yeung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chi-Kong Li
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Hansen DG, Trabjerg TB, Sisler JJ, Søndergaard J, Jensen LH. Cross-sectoral communication by bringing together patient with cancer, general practitioner and oncologist in a video-based consultation: a qualitative study of oncologists' and nurse specialists' perspectives. BMJ Open 2021; 11:e043038. [PMID: 33952540 PMCID: PMC8103367 DOI: 10.1136/bmjopen-2020-043038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Shared care models in the field of cancer aim to improve care coordination, role clarification and patient satisfaction. Cross-sectoral communication is pivotal. Involvement of patients may add to intended mechanisms.A randomised controlled trial 'The Partnership Study' tested the effect of bringing together patient, general practitioner (GP) and oncologist for a consultation conducted by video. PURPOSE As part of the process evaluation, this study aimed to explore experiences, attitudes and perspectives of the oncological department on sharing patient consultations with GPs using video. METHODS Four semistructured interviews with five oncologists and four nurse specialists were conducted in February 2020. We focused on the informants' experiences and reflections on the potential of future implementation of the concept 'inviting the GP for a shared consultation by video'. The analyses were based on an inductive, open-minded, hermeneutic phenomenological approach. RESULTS A total of six overall themes were identified: structuring consultation and communication, perceptions of GP involvement in cancer care, stressors, making a difference, alternative ways of cross-sector communication and needs for redesigning the model. The concept made sense and was deemed useful, but solving the many technical and organisational problems is pivotal. Case-specific tasks and relational issues were targeted by pragmatically rethinking protocol expectations and the usual way of communication and structuring patient encounters. Case selection was discussed as one way of maturing the concept. CONCLUSION This Danish study adds new insight into understanding different aspects of the process, causal mechanisms as well as the potential of future implementation of video-based tripartite encounters. Beyond solving the technical problems, case selection and organisational issues are important. Acknowledging the disruption of the usual workflow, the introduction of new phases of the usual encounter and the variety of patient-GP relationships to be embraced may help to better understand and comply with barriers and facilitators of communication and sharing. TRIAL REGISTRATION NUMBER NCT02716168.
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Affiliation(s)
- Dorte Gilså Hansen
- Research Unit for General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Shared Decision Making, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Theis Bitz Trabjerg
- Research Unit for General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jeffrey James Sisler
- Department of Family Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Jens Søndergaard
- Research Unit for General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Henrik Jensen
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
- Department of Oncology, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Danish Colorectal Cancer Center South, Center of Clinical Excellence, Lillebaelt Hospital, University Hospital of Southern Denmark, University of Southern Denmark, Vejle, Denmark
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32
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Perceptions of Chinese Patients Treated for Gynaecological Cancer about Sexual Health and Sexual Information Provided by Healthcare Professionals: A Qualitative Study. Cancers (Basel) 2021; 13:cancers13071654. [PMID: 33916096 PMCID: PMC8037367 DOI: 10.3390/cancers13071654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022] Open
Abstract
Patients treated for gynaecological cancer (GC) generally experience impaired sexual function. Research on their sexual life experiences and perceptions on the sexuality care they receive is warranted. This study aimed to examine the perceptions of Chinese patients treated for GC regarding the effects of cancer treatment on their sexual function and femininity, their relationships with their partners, and the adequacy of the sexual information received from healthcare professionals during treatment. Individual, semi-structured interviews were conducted with 21 Chinese patients treated for GC, collecting data on their perceptions regarding the effects of cancer treatment on their sexual lives, femininity, and relationships with partners; and their views about the quality of sexuality care received. Data were analysed using content analysis. Participants experienced impaired sexual function, reduced sex drive, and expressed dissatisfaction with their sex lives. They perceived a loss of femininity and poor body image. They desired more information about how to address sexual problems and opted to receive this information from female healthcare professionals in individual counselling sessions during which the professionals could initiate such discussions. Overall, Chinese patients treated for GC have concerns about multiple sexual issues and a strong desire for information about strategies to address these issues. Nurse-led interventions should be implemented via a shared care approach to enhance patients' awareness about managing their sexual and psychological symptoms.
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Cheung YT, Zhang H, Cai J, Au-Doung LWP, Yang LS, Yan C, Zhou F, Chen X, Guan X, Pui CH, Hudson MM, Li CK. Identifying Priorities for Harmonizing Guidelines for the Long-Term Surveillance of Childhood Cancer Survivors in the Chinese Children Cancer Group (CCCG). JCO Glob Oncol 2021; 7:261-276. [PMID: 33591820 PMCID: PMC8081494 DOI: 10.1200/go.20.00534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Survivors of childhood cancer often experience treatment-related chronic health conditions. Given its vast population, China shares a large proportion of the global childhood cancer burden. Yet, screening and treatment of late effects in survivors of childhood cancer remain underaddressed in most regions of China. This study aimed to identify high-priority late effects for harmonizing screening guidelines within the Chinese Children's Cancer Group (CCCG), as well as barriers and enablers of the implementation of surveillance recommendations in local practice. METHODS To establish clinical consensus, 12 expert panelists who represent major institutions within the CCCG completed a Delphi survey and participated in a focus group discussion. The survey solicited ratings of the prevalence, severity, and priority for screening of 45 late effects. Major themes identified from the focus group were analyzed using thematic analysis. RESULTS The Delphi survey identified eight high-priority late effects for harmonization within CCCG: osteonecrosis, osteoporosis, left ventricular dysfunction, secondary brain tumors, treatment-related myeloid leukemia, gonadal dysfunction, growth hormone deficiency, and neurocognitive deficits. The common barriers to implementing survivorship programs include lack of support and resources for clinicians to provide follow-up care. Patients were also concerned about privacy issues and lacked awareness of late effects. Many institutions also lacked rehabilitation expertise and referral pathways. CONCLUSION By identifying obstacles related to the professional setting, patient behavior, and organization of care, our study identified resources and a framework for establishing collaborative strategies to facilitate follow-up care of childhood cancer survivors in China.
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Affiliation(s)
- Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Hui Zhang
- Department of Hematology and Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiaoyang Cai
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Department of Hematology and Oncology, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Lok Sum Yang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Cuixia Yan
- Department of Hematology and Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Fen Zhou
- Pediatric Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojuan Chen
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianmin Guan
- Division of Hematology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Chi-kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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Doose M, Steinberg MB, Xing CY, Lin Y, Cantor JC, Hong CC, Demissie K, Bandera EV, Tsui J. Comorbidity Management in Black Women Diagnosed with Breast Cancer: the Role of Primary Care in Shared Care. J Gen Intern Med 2021; 36:138-146. [PMID: 32974725 PMCID: PMC7858725 DOI: 10.1007/s11606-020-06234-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Black women are more likely to have comorbidity at breast cancer diagnosis compared with White women, which may account for half of the Black-White survivor disparity. Comprehensive disease management requires a coordinated team of healthcare professionals including primary care practitioners, but few studies have examined shared care in the management of comorbidities during cancer care, especially among racial/ethnic minorities. OBJECTIVE To examine whether the type of medical team composition is associated with optimal clinical care management of comorbidities. DESIGN We used the Women's Circle of Health Follow-up Study, a population-based cohort of Black women diagnosed with breast cancer. The likelihood of receiving optimal comorbidity management after breast cancer diagnosis was compared by type of medical team composition (shared care versus cancer specialists only) using binomial regression. PARTICIPANTS Black women with a co-diagnosis of diabetes and/or hypertension at breast cancer diagnosis between 2012 and 2016 (N = 274). MAIN MEASURES Outcome-optimal clinical care management of diabetes (i.e., A1C test, LDL-C test, and medical attention for nephropathy) and hypertension (i.e., lipid screening and prescription for hypertension medication). Main predictor-shared care, whether the patient received care from both a cancer specialist and a primary care provider and/or a medical specialist within the 12 months following a breast cancer diagnosis. KEY RESULTS Primary care providers were the main providers involved in managing comorbidities and 90% of patients received shared care during breast cancer care. Only 54% had optimal comorbidity management. Patients with shared care were five times (aRR: 4.62; 95% CI: 1.66, 12.84) more likely to have optimal comorbidity management compared with patients who only saw cancer specialists. CONCLUSIONS Suboptimal management of comorbidities during breast cancer care exists for Black women. However, our findings suggest that shared care is more beneficial at achieving optimal clinical care management for diabetes and hypertension than cancer specialists alone.
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Affiliation(s)
- Michelle Doose
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 3E502, Rockville, MD, 20850, USA.
- Rutgers School of Public Health, Piscataway, NJ, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | | | | | - Yong Lin
- Rutgers School of Public Health, Piscataway, NJ, USA
| | - Joel C Cantor
- Rutgers Center for State Health Policy, New Brunswick, NJ, USA
- Rutgers Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ, USA
| | - Chi-Chen Hong
- University at Buffalo, Buffalo, NY, USA
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kitaw Demissie
- SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Elisa V Bandera
- Rutgers School of Public Health, Piscataway, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jennifer Tsui
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Cross-sectoral video consultation in cancer care: GPs' evaluation of a randomised controlled trial. BJGP Open 2020; 5:BJGPO.2020.0114. [PMID: 33293407 PMCID: PMC8170612 DOI: 10.3399/bjgpo.2020.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 11/09/2022] Open
Abstract
Background Shared care models present an opportunity for patients to receive the benefits of specialist care combined with the continuity of care provided by a GP. Aim To test the effects on GP-perceived involvement in cancer care and their satisfaction with this cross-sectoral information after bringing the patient, GP, and oncologist together in a shared video consultation. Design & setting GPs from the Region of Southern Denmark evaluated a randomised controlled trial testing shared video consultations. Method This study describes secondary outcomes based on a 4 months' follow-up survey from GPs participating in The Partnership Project (PSP). Patient perception of coordination of care at 7 months' follow-up was the primary outcome of the PSP. A tripartite video consultation was conducted during cancer treatment to share tasks and roles between health professionals with the patient. Results The study included 281 patients, and 105 unique GPs returned 124 questionnaires. Video consultations were accomplished in 68% of scheduled cases. The study found an increased odds ratio (OR) of 3.03 for GP satisfaction with the distribution of tasks and roles, and they experienced more involvement in the cancer patients' trajectory. The study found an increased OR of 6.95 for the GP perception of more direct contact and dialogue with the Department of Oncology. There was a decreased OR of 0.88 for the GP to be engaged in handling anxiety and psychological concerns. Conclusion The study showed that involving the GP in one shared consultation increased the odds of the GP being satisfied with the distribution of tasks and roles, and feeling more involved in the cancer patient’s trajectory. However, recruitment and response rates from GPs were limiting factors.
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36
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Biddell CB, Spees LP, Mayer DK, Wheeler SB, Trogdon JG, Rotter J, Birken SA. Developing personalized survivorship care pathways in the United States: Existing resources and remaining challenges. Cancer 2020; 127:997-1004. [PMID: 33259060 DOI: 10.1002/cncr.33355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Deborah K Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.,School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | | | - Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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37
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Cancer survivors referred to a long-term survivorship outpatient service within academic medical oncology: descriptive study. J Cancer Surviv 2020; 15:811-817. [PMID: 33230726 DOI: 10.1007/s11764-020-00973-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Long-term cancer survivors (LTCS) are a vulnerable and continued growing population. To date, only few studies have been conducted in the Spanish population; none of them with a comprehensive analysis of the most common problems identified for cancer survivors in order to improve their care and quality of life. METHODS We conducted an observational descriptive study in 347 patients recruited between January 2015 and December 2016 from our newly created medical office for the specific care and follow-up of LTCS. Variables that describe the medical history were completed by the oncologist and measures on common problems previously reported for LTCS, related to cancer diagnosis and treatment, function, lifestyle, and emotional concerns, were collected from the patient. RESULTS The mean age of our patients was 65.1 years at the time of the study and a median time without any antitumor treatment of 5.7 years. At the time of cancer diagnosis, 298 patients (85.9%) had at least one related chronic disease and 184 patients (53%) were retired. In addition, in 17.9% of those who continued working, income had been reduced. The incidence of health problems showed an increase during follow-up, even after 5 years, and required evaluation in an emergency department in 157 cases (45.3%). Regardless of age or sex, 239 patients (68.9%) had a significant decrease in sexual activity and 120 (34.6%) were diagnosed with clinical depression. CONCLUSIONS LTCS are patients with significantly high socioeconomic, labor, sexual, health, and psychological problems, 5 years after completion of cancer treatment, especially in older survivors. IMPLICATIONS FOR CANCER SURVIVOR Common concerns of LTCS were identified and are consistent across many countries. It is important to realize that even 5 or so years following treatment, both medical and non-medical problems can exist and may need attention by an expert.
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Vuong K, Uebel K, Agaliotis M, Jun S, Taggart J, Suchy S, Liauw W, Chin M, Webber K, Harris M. Assessing suitability for long-term colorectal cancer shared care: a scenario-based qualitative study. BMC FAMILY PRACTICE 2020; 21:240. [PMID: 33220715 PMCID: PMC7680065 DOI: 10.1186/s12875-020-01311-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022]
Abstract
Background Shared care is the preferred model for long-term survivorship care by cancer survivors, general practitioners and specialists. However, survivorship care remains specialist-led. A risk-stratified approach has been proposed to select suitable patients for long-term shared care after survivors have completed adjuvant cancer treatment. This study aims to use patient scenarios to explore views on patient suitability for long-term colorectal cancer shared care across the risk spectrum from survivors, general practitioners and specialists. Methods Participants completed a brief questionnaire assessing demographics and clinical issues before a semi-structured in-depth interview. The interviews focused on the participant’s view on suitability for long term cancer shared care, challenges and facilitators in delivering it and resources that would be helpful. We conducted thematic analysis using an inductive approach to discover new concepts and themes. Results Interviews were conducted with 10 cancer survivors, 6 general practitioners and 9 cancer specialists. The main themes that emerged were patient-centredness, team resilience underlined by mutual trust and stronger system supports by way of cancer-specific training, survivorship care protocols, shared information systems, care coordination and navigational supports. Conclusions Decisions on the appropriateness of this model for patients need to be made collaboratively with cancer survivors, considering their trust and relationship with their general practitioners and the support they need. Further research on improving mutual trust and operationalising support systems would assist in the integration of shared survivorship care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01311-w.
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Affiliation(s)
- Kylie Vuong
- School of Population Health, University of New South Wales, Sydney, Australia.
| | - Kerry Uebel
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Maria Agaliotis
- Australian Institute of Health Service Management, University of Tasmania, Sydney, Australia
| | - Stella Jun
- Translational Cancer Research Network, University of New South Wales, Sydney, Australia
| | - Jane Taggart
- School of Population Health, University of New South Wales, Sydney, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Sue Suchy
- Translational Cancer Research Network, University of New South Wales, Sydney, Australia
| | - Winston Liauw
- Saint George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
| | - Melvin Chin
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Kate Webber
- School of Clinical Sciences, Monash University, Clayton, Australia.,Department of Medical Oncology, Monash Health, Clayton, Australia
| | - Mark Harris
- School of Population Health, University of New South Wales, Sydney, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Fok RWY, Low LL, Quah HMJ, Vasanwala F, Low SG, Soh LL, Mohamad F, Loh KWJ, Soong YL, Ke Y, Chan A, Tan NC. Roles and recommendations from primary care physicians towards managing low-risk breast cancer survivors in a shared-care model with specialists in Singapore-a qualitative study. Fam Pract 2020; 37:547-553. [PMID: 32030402 PMCID: PMC7474530 DOI: 10.1093/fampra/cmaa009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Breast cancer is prevalent and has high cure rates. The resultant increase in numbers of breast cancer survivors (BCS) may overwhelm the current oncology workforce in years to come. We postulate that primary care physicians (PCPs) could play an expanded role in comanaging survivors, provided they are given the appropriate tools and training to do so. OBJECTIVE To explore the perspectives of PCPs towards managing BCS in a community-based shared-care programme with oncologists. METHODS Eleven focus groups and six in-depth interviews were conducted with seventy PCPs recruited by purposive sampling. All sessions were audio-recorded, transcribed verbatim and coded by three independent investigators. Thematic data analysis was performed and the coding process facilitated by NVivo 12. RESULTS Majority of PCPs reported currently limited roles in managing acute and non-cancer issues, optimizing comorbidities and preventive care. PCPs aspired to expand their role to include cancer surveillance, risk assessment and addressing unmet psychosocial needs. PCPs preferred to harmonize cancer survivorship management of their primary care patients who are also BCS, with defined role distinct from oncologists. Training to understand the care protocol, enhancement of communication skills, confidence and trust were deemed necessary. PCPs proposed selection criteria of BCS and adequacy of their medical information; increased consultation time; contact details and timely access to oncologists (if needed) in the shared-care programme. CONCLUSIONS PCPs were willing to share the care of BCS with oncologists but recommended role definition, training, clinical protocol, resources and access to oncologist's consultation to optimize the programme implementation.
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Affiliation(s)
- Rose Wai-Yee Fok
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Lian Leng Low
- Family Medicine and Continuing Care, Singapore General Hospital, Singapore.,Family Medicine Academy Clinical Programme, Duke-NUS Graduate Medical School Singapore, Singapore
| | - Hui Min Joanne Quah
- Family Medicine Academy Clinical Programme, Duke-NUS Graduate Medical School Singapore, Singapore.,SingHealth Polyclinics, Singapore
| | | | - Sher Guan Low
- Post-Acute and Continuing Care, Sengkang Community Hospital, Singapore
| | - Ling Ling Soh
- Post-Acute and Continuing Care, Sengkang Community Hospital, Singapore
| | - Farid Mohamad
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Kiley Wei-Jen Loh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Yu Ke
- Department of Pharmacy, National University of Singapore, Singapore
| | - Alexandre Chan
- Family Medicine Academy Clinical Programme, Duke-NUS Graduate Medical School Singapore, Singapore.,Department of Pharmacy, National University of Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Ngiap-Chuan Tan
- Family Medicine Academy Clinical Programme, Duke-NUS Graduate Medical School Singapore, Singapore.,SingHealth Polyclinics, Singapore
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Lisy K, Kent J, Piper A, Jefford M. Facilitators and barriers to shared primary and specialist cancer care: a systematic review. Support Care Cancer 2020; 29:85-96. [PMID: 32803729 DOI: 10.1007/s00520-020-05624-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To care for the growing population of cancer survivors, health services worldwide must reconsider how to deliver care to people living with and beyond a cancer diagnosis. Shared care, defined as cancer care that is shared between specialist and primary care providers, is one model that has been investigated; however, practical guidance to support implementation is lacking. This systematic review aimed to explore facilitators and barriers to implementing shared cancer care and to develop practice and policy recommendations to support implementation. METHODS A systematic literature search was conducted in June 2019 across MEDLINE, Embase, Emcare, and PsycINFO databases. Quantitative and qualitative data relevant to the review question were extracted and synthesized following a mixed methods approach. RESULTS Thirteen papers were included in the review, 10 qualitative and three quantitative. Included articles were from Australia (n = 8), the USA (n = 3), and one each from the UK and the Netherlands. Sixteen themes were developed under four categories of patient, healthcare professional, process, and policy factors. Key themes included the perceived need for primary care provider training, having clearly defined roles for each healthcare provider, providing general practitioners with diagnostic and treatment summaries, as well as protocols or guidelines for follow-up care, ensuring rapid and accurate communication between providers, utilizing electronic medical records and survivorship care plans as communication tools, and developing consistent policy to reduce fragmentation across services. CONCLUSION Recommendations for practice and policy were generated based on review findings that may support broader implementation of shared cancer care.
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Affiliation(s)
- Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.
| | - Jennifer Kent
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amanda Piper
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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Shakeel S, Tung J, Rahal R, Finley C. Evaluation of Factors Associated With Unmet Needs in Adult Cancer Survivors in Canada. JAMA Netw Open 2020; 3:e200506. [PMID: 32142127 PMCID: PMC7060489 DOI: 10.1001/jamanetworkopen.2020.0506] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Understanding the challenges faced by an increasing number of cancer survivors can guide the development and implementation of effective survivorship care models. OBJECTIVE To identify the physical, emotional, and practical concerns and associated unmet needs reported by cancer survivors. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study obtained data from the Experiences of Cancer Patients in Transitions Study of the Canadian Partnership Against Cancer, in collaboration with cancer agencies in the 10 Canadian provinces, that was disseminated in 2016. This analysis included only adult survivors aged 30 years or older who underwent chemotherapy, radiation therapy, surgical treatment, or a combination of these therapies for breast, prostate, colorectal, melanoma, or hematological cancer within the past 1 to 3 years. Data synthesis and quality assessment were conducted in 2017. Data analysis was completed in July 2019. MAIN OUTCOMES AND MEASURES The outcomes were the (1) quantification of the magnitude and multiplicity of the physical, emotional, and practical concerns of adult survivors of breast, colorectal, prostate, melanoma, or hematological cancer; (2) exploration of the magnitude of associated unmet needs; and (3) identification of patient-, treatment-, and cancer-specific factors associated with the reporting of unmet needs. RESULTS Overall, 10 717 adult respondents were included (5660 [53%] female and 6367 [60%] aged ≥65 years). The median number of concerns per respondent was 6 (interquartile range [IQR], 3-10). Among respondents with concerns, help was sought for a median of 2 (IQR, 0-4) concerns. Unmet needs were reported for a median of 4 (IQR, 2-7) concerns. Emotional concerns were reported by 8330 respondents (78%), physical concerns by 9236 respondents (86%), and practical concerns by 4668 respondents (44%). At least 1 unmet need was reported by 7033 survivors (84%) with emotional concerns, 7475 (81%) with physical concerns, and 3459 (74%) with practical concerns. Age, sex, annual income, marital status, geographic location, language, and treatment type were significant factors associated with unmet needs. Survivors of melanoma cancer had a significantly higher likelihood of reporting unmet emotional needs (odds ratio [OR], 1.75; 95% CI, 1.17-2.61; P = .01), whereas survivors of prostate (OR, 0.60; 95% CI, 0.43-0.84; P < .001) and hematological (OR, 0.70; 95% CI, 0.50-0.99; P = .04) cancers were significantly less likely to report unmet needs for physical concerns when compared with breast cancer survivors. Involvement of the general practitioner combined with the oncologist in providing care was associated with a significantly lower likelihood of reporting unmet emotional (OR, 0.78; 95% CI, 0.62-1.00; P = .05) and practical (OR, 0.72; 95% CI, 0.55-0.94; P = .01) needs. CONCLUSIONS AND RELEVANCE The extent of unmet needs among cancer survivors found in this study suggests the need for enhancements in survivorship care, including better awareness of the realities of survivorship, earlier interventions for emerging concerns among survivors, and greater integration of cancer programs and primary care for more seamless transitions.
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Affiliation(s)
- Saad Shakeel
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jasmine Tung
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Rami Rahal
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christian Finley
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Ristevski E, Thompson S, Kingaby S, Nightingale C, Iddawela M. Understanding Aboriginal Peoples' Cultural and Family Connections Can Help Inform the Development of Culturally Appropriate Cancer Survivorship Models of Care. JCO Glob Oncol 2020; 6:124-132. [PMID: 32031446 PMCID: PMC6998014 DOI: 10.1200/jgo.19.00109] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To explore the cancer diagnosis, treatment, and survivorship experiences of Aboriginal people in the Gippsland region, Victoria, Australia, and identify factors critical to the development of a culturally appropriate cancer survivorship model of care. PATIENTS AND METHODS Yarning circles were used to capture the stories of 15 people diagnosed with cancer and/or those of family members. Yarning circles were conducted in two locations in the Gippsland region. Sessions were facilitated by an Aboriginal Elder, audio recorded, and transcribed verbatim. Thematic analysis of the data were triangulated among three researchers and incorporated researcher reflexivity. RESULTS Cultural connections and family were critical supports on the cancer journey. Putting the needs of the family first and caring for sick family members were more important than an individual's own health. There was "no time to grieve" for one's own cancer diagnosis and look after oneself. Cancer was a private experience; however, the constancy of deaths highlighted the importance of raising family awareness. Health professionals did not always understand the importance of people's cultural and family supports in their treatment and recovery. There were negatives attitudes in hospitals when family come to visit, seeing family as too large and overstaying visiting times. Health professionals did not seek family assistance with communication of information to family members whose literacy level was low, nor did they include family in treatment decision-making. Access to services depended on family support with transport, finances, and family responsibilities, often resulting in lapses in treatment and follow-up services. CONCLUSION Understanding the importance of Aboriginal peoples' cultural and family connections can help to inform the development of culturally safe cancer survivorship models of care.
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Affiliation(s)
| | | | - Sharon Kingaby
- Latrobe Community Health Service, Traralgon, Victoria, Australia
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Jefford M. Improving the Care of Adult Cancer Survivors. Asia Pac J Oncol Nurs 2020; 7:2-5. [PMID: 31879677 PMCID: PMC6927155 DOI: 10.4103/apjon.apjon_42_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/26/2019] [Indexed: 02/01/2023] Open
Abstract
Internationally, there are growing numbers of cancer survivors. Survivors report a range of persistent symptoms and unmet needs, which are quite consistent, internationally. Current models of post-treatment survivorship care are suboptimal, and unsustainable given the number of survivors, and limited health workforce. The most appropriate model of care for an individual will depend on a range of patient, disease and treatment factors. Alternatives to traditional follow up have been evaluated including nurse led follow up, follow up led by a primary care physician and formalized models of shared care. There should be greater focus on implementation of proven models.
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Affiliation(s)
- Michael Jefford
- Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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Girgis A. The role of self-management in cancer survivorship care. Lancet Oncol 2019; 21:8-9. [PMID: 31838013 DOI: 10.1016/s1470-2045(19)30715-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia; University of New South Wales, Liverpool, NSW, Australia.
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Alfano CM, Jefford M, Maher J, Birken SA, Mayer DK. Building Personalized Cancer Follow-up Care Pathways in the United States: Lessons Learned From Implementation in England, Northern Ireland, and Australia. Am Soc Clin Oncol Educ Book 2019; 39:625-639. [PMID: 31099658 DOI: 10.1200/edbk_238267] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
There is a global need to transform cancer follow-up care to address the needs of cancer survivors while efficiently using the health care system to limit the effects of provider shortages, gaps in provider knowledge, and already overburdened clinics; improve the mental health of clinicians; and limit costs to health care systems and patients. England, Northern Ireland, and Australia are implementing an approach that triages patients to personalized follow-up care pathways depending on the types and levels of resources needed for patients' long-term care that has been shown to meet patients' needs, more efficiently use the health care system, and reduce costs. This article discusses lessons learned from these implementation efforts, identifying the necessary components of these care models and barriers and facilitators to implementation of this care. Specifically, the United States and other countries looking to transform follow-up care should consider how to develop six key principles of this care: algorithms to triage patients to pathways; methods to assess patient issues to guide care; remote monitoring systems; methods to support patients in self-management; ways to coordinate care and information exchange between oncology, primary care, specialists, and patients; and methods to engage all stakeholders and secure their ongoing buy-in. Next steps to advance this work in the United States are discussed.
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Affiliation(s)
| | - Michael Jefford
- 2 The University of Melbourne, Melbourne, Victoria, Australia and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jane Maher
- 3 Macmillan Cancer Support, London, United Kingdom
| | - Sarah A Birken
- 4 Gillings School of Global Public Health & Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill; Chapel Hill, NC
| | - Deborah K Mayer
- 5 School of Nursing and Linegerger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, Chapel Hill, NC and National Cancer Institute, Rockville, MD
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