Follow-up patterns of cancer survivors: a survey of Canadian radiation oncologists

Myths and Presumptions About Cancer Survivorship

Identifying cancer survivorship myths and presumptions perpetuated in survivorship circles.

Impact of Cancer Survivorship Care Training on Rural Primary Care Practice Teams: a Mixed Methods Approach

With the increasing numbers of individuals surviving a diagnosis of cancer, an aging population, and more individuals experiencing multi-morbidity, primary care providers (PCPs) are seeing more patients with a history of cancer. Effective strategies are needed to adequately prepare the primary care workforce for the phase of cancer care now widely recognized as survivorship. A survivorship education program for rural primary care practices was developed using a community engagement process and delivered at the practice level by community health liaisons. A mixed method approach was used to evaluate the program impact which included a questionnaire and interviews. Descriptive analyses and generalized linear regression were used to evaluate quantitative outcomes from the questionnaires. Immersion crystallization was used to define themes from the qualitative components. Thirty-two (32) practices participated, averaging 10.3 team members/practice. The percent of correct responses to the knowledge questionnaire increased significantly, almost doubling between baseline and post-test (25% vs 46%, p < .001). Four major themes emerged from the interviews which included positive impact of the training, putting the training into practice, intention to change care delivery, contextual influences in survivorship care. Evidence from the cancer survivorship education program evaluation supports its value to key stakeholders and the potential wider dissemination of the iSurvive Program. These data also suggest the need for additional investigation into other ways beyond education that primary care practices can be supported to ensure the needs of the growing cancer survivor population in the US are met.

Cancer survivorship care after curative treatment: Chinese oncology practitioners' practices

PURPOSE

To establish oncology practitioners' perceptions of responsibility, confidence levels, and frequency of survivorship care practice in relation to the post-treatment phase of survivorship care in Mainland China; to identify factors associated with oncology practitioners' perceptions of responsibility, confidence levels, and frequency of survivorship care practice; and to examine factors that impede the provision of quality survivorship care.

METHODS

A cross-sectional survey of Chinese oncology practitioners was conducted using a test battery consisting of a self-developed information sheet, a 29-item survivorship care scale (29-SCS), and a 16-item impeding factors scale.

RESULTS

There were 331 participants. Mean values of the four subscales (8.87, 61.82, 18.62, and 40.49) on perceptions of responsibility were relatively higher than those of the mean values of confidence levels and frequency of survivorship care practice. Participant characteristics, including professional discipline, highest educational qualification achieved, work status, work role, and work setting, were identified as factors associated with oncology practitioners' responsibility perceptions, confidence levels, and survivorship care practice frequency. The top three barriers to quality survivorship care perceived by participants were lack of time, an appropriate physical location, and evidence-based practice guidelines to inform survivorship care.

CONCLUSIONS

Findings of relatively high levels of perception of responsibility and low levels of confidence in survivorship care suggest that survivorship care is needed, with the aim of implementing oncology practitioners' responsibility and improving their confidence in providing survivorship care in cancer practice. Future multiple levels of cooperation for overcoming barriers and implementing quality survivorship care are highly recommended.

Bridging the gap from the oncology setting to community care through a cross-Canada environmental scan

Due to the growing number of cancer survivors, there is a need to evaluate the provision of follow-up care to ensure the needs of patients are met. An environmental scan was conducted provincially and nationally, which aimed to gain a broader understanding of survivorship care, highlight any trends, and report disparities in care during the transition from the oncology to the community setting. The environmental scan involved gathering data from nine out of 10 provinces through telephone interviews, seeking relevant documentation, and identifying areas of good practice. There was a wide variation in practice across the provinces and some recommendations for improving care are made. Findings emphasize the need to promote increased patient self-management and self-advocacy. Implications from the study are that cancer survivorship is a complex topic that requires communication and coordination across services to ensure a seamless transition.

Surveillance Practice Patterns after Curative Intent Therapy for Stage I Non-Small-Cell Lung Cancer in the Medicare Population

OBJECTIVES

Recurrence after treatment for non-small cell lung cancer (NSCLC) is common, and routine imaging surveillance is recommended by evidence-based guidelines. Little is known about surveillance patterns after curative intent therapy for early stage NSCLC. We sought to understand recent practice patterns for surveillance of stage I NSCLC in the first two years after curative intent therapy in the Medicare population.

MATERIALS AND METHODS

Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database we selected patients diagnosed with stage I NSCLC between 1998 and 2008. We studied adherence to surveillance guidelines based on specialty society recommendations for chest radiography and computed tomography (CT) scanning. We also tracked the use of Positron Emission Tomography (PET) scans, which are not recommended for surveillance. We calculated the percent of patients who received guideline-adherent surveillance imaging and used logistic regression to determine associations between patient and provider factors and guideline adherence.

RESULTS

Overall, 61.4% of patients received guideline-adherent surveillance during the initial 2 years after treatment. Use of CT scans in the first year after treatment increased from 47.4% in 1998-78.5% in 2008, and PET use increased from 5.8% to 28.9%. Adherence with surveillance imaging was associated with younger age, higher income, more comorbidities, access to primary care, and receipt of SBRT as the primary treatment.

CONCLUSIONS

Adherence to specialty society guidelines for surveillance after treatment for stage I NSCLC was poor in this population of Medicare beneficiaries, with less than two-thirds of patients receiving recommended imaging, and almost 30% receiving non-recommended PET scans.