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Tsai MH, Bevel MS, Andrzejak SE, Moore JX. Receipt of follow-up care plans on colorectal cancer screening among breast, prostate, and lung cancer survivors. J Cancer Surviv 2024; 18:781-790. [PMID: 36574189 PMCID: PMC10293471 DOI: 10.1007/s11764-022-01309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Our study aimed to examine whether receipt of follow-up care plans is associated with greater guideline-concordant CRC screening stratified by breast, prostate, and lung cancer survivors. METHODS We used data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3339 eligible treatment-utilizing cancer survivors with complete treatment. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. RESULTS We observed that 83.9% of breast and 88.2% of prostate cancer survivors with follow-care plans received CRC screening (p-value < 0.001). The lowest CRC screening use was observed among lung cancer (70.8%). In multivariable analysis, receipt of follow-up care plans was strongly associated with greater odds of receiving CRC screening in breast (OR, 2.67; 95% CI: 1.71-4.16) and prostate (OR, 3.81; 95% CI: 2.30-6.31) cancer survivors. Regardless of provider type, 84 to 88% reduced likelihood of receipt of CRC screening when they received follow-up care plans among lung cancer survivors. Among those without follow-up care plans, breast (OR, 0.29; 95% CI: 0.09-0.92) and lung (OR, 0.05; 95% CI: 0.01-0.25) cancer survivors who received care from general practices were less likely to receive CRC screening compared to those who received care from non-general practices. CONCLUSIONS Receipt of follow-up care plans was associated with greater CRC screening use in breast and prostate cancers. Lung cancer survivors demonstrated lower screening use despite receipt of follow-up care plans. IMPLICATION FOR CANCER SURVIVORS Patient and provider communication regarding CRC screening recommendation should be included in their follow-up care plans.
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Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA.
- Georgia Prevention Institute, Augusta University, 1457 Walton Way, Augusta, GA, 30901, USA.
| | - Malcolm S Bevel
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Sydney E Andrzejak
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Justin X Moore
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
- Institute of Public and Preventive Health, Augusta University, 1120 15Th Street, Augusta, GA, 30912, USA
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Cancel M, Sauger C, Biogeau J, Dardaine-Giraud V, Lecomte T, Solub D, Combe P, Wilmet R, Aubard E, Deloigne A, Hébrard P, Dorval É. FASTOCH: Feasibility of Electronic Patient-Reported Outcomes in Older Patients With Cancer-A Multicenter Prospective Study. J Clin Oncol 2024:JCO2302150. [PMID: 38709983 DOI: 10.1200/jco.23.02150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/09/2024] [Accepted: 02/21/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE Multiple studies have demonstrated that electronic patient-reported outcomes (ePROs) improve overall survival and quality of life in cancer care. However, there are no specific prospective data on remote ePRO monitoring in the older population, although they represent a significant proportion of patients with cancer. PATIENTS AND METHODS From February 2021 to April 2022, patients age 75 years and older under active anticancer treatment were consecutively recruited in six institutions. Remote ePRO feasibility was determined in intention-to-test (ITT) on the basis of the number of active users in the overall population. Primary failure applied to patients who had no Internet access or declined to test ePROs, while the other patients were assigned to the ITT population. Feasibility was also determined per-protocol on the basis of the number of active patients in the ITT population. RESULTS Of the 473 patients included, primary failure applied to 288 patients (233 of whom had no Internet access). Among the 185 patients in ITT, 122 used ePROs, leading to a 26% feasibility in ITT and a 66% feasibility per protocol. In a multivariate analysis, the intent to test population was from a higher socioprofessional category (P = .009) and felt in better general condition in the Geriatric 8-score evaluation (P = .002). Active patients significantly differed from the inactive on their self-assessment of a better general condition (P < .001) only. CONCLUSION Our multicenter study showed a limited feasibility rate (26%) of remote ePROs monitoring for older patients with cancer, mainly because of technology barriers. Yet, among the patients who did have Internet access, most of them indeed used ePROs (66%). Given the expected benefit of ePROs, the technology barriers therefore need to be lifted to improve cancer care in older patients.
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Affiliation(s)
- Mathilde Cancel
- Department of Medical Oncology, Regional University Hospital Center, Tours, France
| | - Carine Sauger
- Antenne d'OncoGériatrie, Regional Cancer Network, Regional University Hospital Center, Tours, France
| | - Julie Biogeau
- Department of Geriatrics, Regional University Hospital Center, Tours, France
| | | | - Thierry Lecomte
- Department of Gastroenterology and Digestive Oncology, Regional University Hospital Center, Tours, France
| | | | - Pierre Combe
- Recherche Oncologique Clinique 37 (ROC37), Centre d'Oncologie et Radiothérapie 37 (CORT37), Chambray-lès-Tours, France
| | - Rémy Wilmet
- Centre Saint Jean de Saint Doulchard, Saint-Doulchard, France
| | - Eugénie Aubard
- CH de Châteauroux, Infirmière en Pratiques Avancées mention Oncologie, Châteauroux, France
| | | | | | - Étienne Dorval
- Antenne d'OncoGériatrie, Regional Cancer Network, Regional University Hospital Center, Tours, France
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Geng J, Li R, Wang X, Xu R, Liu J, Jiang H, Wang G, Hesketh T. Eliciting Older Cancer Patients' Preferences for Follow-Up Care to Inform a Primary Healthcare Follow-Up Model in China: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00697-4. [PMID: 38702574 DOI: 10.1007/s40271-024-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Increasing longevity and advances in treatment have increased the cancer burden in the elderly, resulting in complex follow-up care needs; however, in China, little is known about the follow-up care preferences of these patients. This study quantified older cancer patients' preferences for follow-up care and examined the trade-offs they are willing to make to accept an alternative follow-up model. METHODS A discrete choice experiment was conducted among inpatients aged over 60 years with breast, prostate, or colorectal cancer, at two large tertiary hospitals in Nantong, China. Preference weights for follow-up care were estimated using mixed logit analysis. Subgroup analysis and latent class analysis were used to explore preference heterogeneity. RESULTS Complete results were obtained from 422 patients (144 with breast cancer, 133 with prostate cancer, 145 with colorectal cancer), with a mean age of 70.81 years. Older cancer patients stated a preference for follow-up by specialists over primary healthcare (PHC) providers ( β = -1.18, 95% confidence interval -1.40 to -0.97). The provider of follow-up care services was the most valued attribute among patients with breast cancer (relative importance [RI] 37.17%), while remote contact services were prioritized by patients with prostate (RI 43.50%) and colorectal cancer (RI 33.01%). The uptake rate of an alternative care model integrating PHC increased compared with the baseline setting when patients were provided with preferred services (continuity of care, individualized care plans, and remote contact services). CONCLUSION To encourage older cancer patients to use PHC-integrated follow-up care, alternative follow-up care models need to be based on patients' preferences before introducing them as a routine option.
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Affiliation(s)
- Jiawei Geng
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Ran Li
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Insititute of Global Health, University College London, London, UK
| | - Xinyu Wang
- School of Public Health, Nantong University, Nantong, China
| | - Rongfang Xu
- Department of Nursing, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Jibin Liu
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Haiyan Jiang
- Department of Health Management, Affiliated Hospital of Nantong University, Nantong, China
| | - Gaoren Wang
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China.
| | - Therese Hesketh
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China.
- Insititute of Global Health, University College London, London, UK.
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Radhakrishnan A, Haymart MR. Team-Based Care for Thyroid Cancer: What Is the Role of the Primary Care Physician? Endocr Pract 2024; 30:476-478. [PMID: 38325628 DOI: 10.1016/j.eprac.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Archana Radhakrishnan
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Megan R Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Signorelli C, Høeg BL, Asuzu C, Centeno I, Estapé T, Fisher P, Lam W, Levkovich I, Manne S, Miles A, Mullen L, Nekhlyudov L, Sade C, Shaw J, Singleton A, Travado L, Tsuchiya M, Lemmen J, Li J, Jefford M. International Survey of Psychosocial Care for Cancer Survivors in Low-/Middle- and High-Income Countries: Current Practices, Barriers, and Facilitators to Care. JCO Glob Oncol 2024; 10:e2300418. [PMID: 38781550 DOI: 10.1200/go.23.00418] [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: 11/09/2023] [Revised: 01/24/2024] [Accepted: 03/26/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE The number of cancer survivors living with and beyond cancer treatment is rising globally. It is fundamental to understand the extent and type of psychosocial care services offered worldwide. We evaluated models of cancer survivorship care, psychosocial care practices in the post-treatment survivorship phase, and barriers/facilitators to delivery of psychosocial care services, including in low- and middle-income countries (LMICs). METHODS The International Psycho-Oncology Society (IPOS) Survivorship Special Interest Group led a cross-sectional online survey between March and November 2022. Health care professionals and researchers in psycho-oncology were invited through the IPOS global membership, social media, and snowballing. The survey was administered to individuals but included questions related to practices in their country at a national level. RESULTS Two hundred eighty-three respondents from 37 countries participated (40% from LMICs), with a median of 12 years of experience (IQR, 6-20) in the psycho-oncology field. Participants reported that the most common elements of routine survivorship care were related to the prevention/management of recurrences/new cancers (74%), physical late effects (59%), and chronic medical conditions (53%), whereas surveillance/management of psychosocial late effects (27%) and psychosocial/supportive care (25%) were least common. Service availability was more commonly reported in high-income countries (HICs) than LMICs related to reproductive health (29% v 17%), genetic counseling/support (40% v 20%), and identifying/managing distress (39% v 26%) and pain (66% v 48%). Key barriers included providers focusing on treatment not survivorship (57%), medical not psychosocial care (60%), and a lack of allied health providers to deliver psychosocial care (59%). CONCLUSION The psychosocial needs of people living with cancer are not adequately available and/or provided in post-treatment survivorship even in HICs, because of barriers at patient, provider, and system levels.
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Affiliation(s)
- Christina Signorelli
- Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | | | - Chioma Asuzu
- Unit of Psycho-Oncology, Department of Radiation Oncology, College of Medicine, Ibadan, Nigeria
| | - Isabel Centeno
- Breast Cancer Center, Hospital Zambrano Hellion, Monterrey, Mexico
| | - Tania Estapé
- Psychosocial Oncology Department, FEFOC Foundation, Barcelona, Spain
| | - Peter Fisher
- University of Liverpool; Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Wendy Lam
- School of Public Health, LSK Faculty of Medicine Jockey Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, China
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv'on, Israel
| | - Sharon Manne
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Louise Mullen
- National Cancer Control Programme, Health Services Executive, Kings Inns House, Dublin, Ireland
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Cristina Sade
- Psychosocial Oncology Department, Instituto Nacional del Cáncer, Santiago, Chile
| | - Joanne Shaw
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Anna Singleton
- Faculty of Medicine and Health, Engagement and Co-design Research Hub, University of Sydney, Sydney, Australia
| | - Luzia Travado
- Champalimaud Clinical and Research Center, Champalimaud Foundation, Lisbon, Portugal
| | - Miyako Tsuchiya
- Division of Healthcare Delivery, Survivorship and Policy Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
- Research Institute of Nursing, Musashino University, Tokyo, Japan
| | - Jesse Lemmen
- Pediatric Oncology, Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jie Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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6
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Hart NH, Nekhlyudov L, Smith TJ, Yee J, Fitch MI, Crawford GB, Koczwara B, Ashbury FD, Lustberg MB, Mollica M, Smith AL, Jefford M, Chino F, Zon R, Agar MR, Chan RJ. Survivorship Care for People Affected by Advanced or Metastatic Cancer: MASCC-ASCO Standards and Practice Recommendations. JCO Oncol Pract 2024:OP2300716. [PMID: 38684036 DOI: 10.1200/op.23.00716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared with those with early-stage disease or those nearing the end of life. These Multinational Association for Supportive Care in Cancer (MASCC)-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer. METHODS A MASCC-ASCO expert panel was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process. RESULTS A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including eight people with lived experience) across 33 countries (33% were low- to middle-resource countries) participated in the Delphi study and achieved ≥94.8% agreement for seven standards, (1) Person-Centered Care; (2) Coordinated and Integrated Care; (3) Evidence-Based and Comprehensive Care; (4) Evaluated and Communicated Care; (5) Accessible and Equitable Care; (6) Sustainable and Resourced Care; and (7) Research and Data-Driven Care, and ≥84.2% agreement across 45 practice recommendations. CONCLUSION Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards support optimization of health outcomes and care experiences by providing guidance to stakeholders (health care professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers). Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts.Additional information is available at www.mascc.org, www.asco.org/standards and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
| | - Larissa Nekhlyudov
- Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas J Smith
- Division of General Internal Medicine and Sidney Kimmel Comprehensive Cancer Center, John Hopkins Medical Institutions, Baltimore, MD
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Cancer and Innovation Centre, Flinders Medical Centre, Adelaide, SA, Australia
| | - Fredrick D Ashbury
- VieCure, Clinical and Scientific Division, Greenwood Village, CO
- Department of Oncology, University of Calgary, Calgary, ON, Canada
| | - Maryam B Lustberg
- Department of Medicine, School of Medicine, Yale University, New Haven, CT
- Medical Oncology Division, Yale Cancer Centre, New Haven, CT
| | - Michelle Mollica
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Andrea L Smith
- The Daffodil Centre and University of Sydney: a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Zon
- Michiana Hematology-Oncology, Mishawaka, IN
- Cincinnati Cancer Advisors, Norwood, OH
| | - Meera R Agar
- IMPACCT Research Centre, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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7
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Hart NH, Nekhlyudov L, Smith TJ, Yee J, Fitch MI, Crawford GB, Koczwara B, Ashbury FD, Lustberg MB, Mollica M, Smith AL, Jefford M, Chino F, Zon R, Agar MR, Chan RJ. Survivorship care for people affected by advanced or metastatic cancer: MASCC-ASCO standards and practice recommendations. Support Care Cancer 2024; 32:313. [PMID: 38679639 PMCID: PMC11056340 DOI: 10.1007/s00520-024-08465-8] [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] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared to those with early-stage disease or those nearing the end-of-life. These MASCC-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer. METHODS An expert panel comprising MASCC and ASCO members was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting: (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process. RESULTS A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including 8 people with lived experience) across 33 countries (33% were low-to-middle resource countries) participated in the Delphi study and achieved ≥ 94.8% agreement for seven standards (1. Person-Centred Care; 2. Coordinated and Integrated Care; 3. Evidence-Based and Comprehensive Care; 4. Evaluated and Communicated Care; 5. Accessible and Equitable Care; 6. Sustainable and Resourced Care; 7. Research and Data-Driven Care) and ≥ 84.2% agreement across 45 practice recommendations. CONCLUSION Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards will support optimization of health outcomes and care experiences by providing guidance to stakeholders in cancer care (healthcare professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers. Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts.
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Affiliation(s)
- Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia.
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia.
| | - Larissa Nekhlyudov
- Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas J Smith
- Division of General Internal Medicine and Sidney Kimmel Comprehensive Cancer Center, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Cancer and Innovation Centre, Flinders Medical Centre, Adelaide, SA, Australia
| | - Fredrick D Ashbury
- VieCure, Clinical and Scientific Division, Greenwood Village, CO, USA
- Department of Oncology, University of Calgary, Calgary, ON, Canada
- Internal Medicine-Medical Oncology, College of Medicine, The Ohio State University, Columbus , OH, USA
| | - Maryam B Lustberg
- Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA
- Medical Oncology Division, Yale Cancer Centre, New Haven, CT, USA
| | - Michelle Mollica
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Andrea L Smith
- The Daffodil Centre and University of Sydney: a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robin Zon
- Michiana Hematology-Oncology, Mishawaka, IN, USA
- Cincinnati Cancer Advisors, Norwood, OH, USA
| | - Meera R Agar
- IMPACCT Research Centre, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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8
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Hayes BD, Young HG, Atrchian S, Vis-Dunbar M, Stork MJ, Pandher S, Samper S, McCorquodale S, Loader A, Voss C. Primary care provider-led cancer survivorship care in the first 5 years following initial cancer treatment: a scoping review of the barriers and solutions to implementation. J Cancer Surviv 2024; 18:352-365. [PMID: 36376712 DOI: 10.1007/s11764-022-01268-y] [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: 06/02/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To synthesize the barriers to primary care provider (PCP)-led cancer survivorship care (≤ 5 years after initial cancer treatment) experienced by healthcare systems around the world, and to explore potential solutions that would succeed within a developed country. METHODS A scoping review of peer-reviewed articles and grey literature was conducted. Four electronic databases (Medline, Embase, Web of Science Core Collection, and Google Scholar) were searched for articles prior to April 2021. RESULTS Ninety-seven articles published across the globe (USA, Canada, Australia, European Union, and UK) met the review inclusion/exclusion criteria. The four most frequently discussed barriers to PCP-led survivorship care in healthcare systems were as follows: (1) insufficient communication between PCPs and cancer specialists, (2) limited PCP knowledge, (3) time restrictions for PCPs to provide comprehensive survivorship care, and (4) a lack of resources (e.g., survivorship care guidelines). Potential solutions to combat these barriers were as follows: (1) improving interdisciplinary communication, (2) bolstering PCP education, and (3) providing survivorship resources. CONCLUSIONS This scoping review identified and summarized key barriers and solutions to the provision of PCP-led cancer survivorship care. Importantly, the findings from this review provide insight and direction to guide optimization of cancer care practice within BC's healthcare system. IMPLICATIONS FOR CANCER SURVIVORS Optimizing the PCP-led survivorship care model will be a valuable contribution to the field of cancer survivorship care and will hopefully lead to more widespread use of this model, ultimately lessening the growing demand for cancer-specific care by cancer specialists.
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Affiliation(s)
- Brian D Hayes
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Hannah G Young
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Siavash Atrchian
- BC Cancer, Kelowna, Canada
- Department of Surgery, Division of Radiation Oncology and Developmental Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Matthew J Stork
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Satvir Pandher
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sofia Samper
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Sarah McCorquodale
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | | | - Christine Voss
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada.
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada.
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Spooner AJ, Turner J, Button E, Yates P, Kennedy G, Butler J, Bradford N, Chan A, Hart NH, Chan RJ. Supporting Cancer Survivors Following Treatment for Non-Hodgkin's and Hodgkin's Lymphoma: A Pilot Study Assessing the Feasibility and Process Outcomes of a Nurse-Led Intervention. Semin Oncol Nurs 2024; 40:151592. [PMID: 38368204 DOI: 10.1016/j.soncn.2024.151592] [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: 11/28/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Lymphoma is the sixth most common cancer in Australia and comprises 2.8% of worldwide cancer diagnoses. Research targeting development and evaluation of post-treatment care for debilitating complications resulting from the disease and its treatment is limited. This study aimed to assess the feasibility and acceptability of a nurse-led survivorship intervention, post-treatment in Hodgkin's and non-Hodgkin's lymphoma survivors. METHODS A single-center, prospective, 3-arm, pilot, randomized controlled, parallel-group trial was used. People with lymphoma were recruited and randomized to the intervention (ENGAGE), education booklet only, or usual care arm. Participants receiving ENGAGE received an educational booklet and were offered 3 consultations (via various modes) with a cancer nurse to develop a survivorship care plan and healthcare goals. Participant distress and intervention acceptability was measured at baseline and 12-wk. Acceptability was measured via a satisfaction survey using a 11-point scale. Feasibility was measured using participation, retention rates, and process outcomes. Data were analyzed using descriptive statistics. RESULTS Thirty-four participants with HL and NHL were recruited to the study (11 = intervention, 11 = information only, 12 = usual care). Twenty-seven participants (79%) completed all time points from baseline to 12 wk. Seven (88%) of the 8 participants receiving ENGAGE completed all consultations using various modes to communicate with the nurse (videoconference 14/23, 61%; phone 5/23, 22%; face-to-face 4/23, 17%). Participants who completed the intervention were highly satisfied with ENGAGE. CONCLUSION The ENGAGE intervention is feasible and highly acceptable for lymphoma survivors. These findings will inform a larger trial assessing effectiveness and cost effectiveness of ENGAGE.
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Affiliation(s)
- Amy J Spooner
- School of Nursing, Queensland University of Technology, Brisbane Australia; Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Brisbane Australia
| | - Jane Turner
- Faculty of Medicine, University of Queensland, Brisbane Australia
| | - Elise Button
- School of Nursing, Queensland University of Technology, Brisbane Australia; Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Brisbane Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Brisbane Australia; Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Brisbane Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Glen Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia; Mater Cancer Care Centre, Mater Health, Brisbane, Australia
| | - Jason Butler
- Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Natalie Bradford
- School of Nursing, Queensland University of Technology, Brisbane Australia; Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Brisbane Australia; Youth Cancer Services, Queensland Children's Hospital, Brisbane, Australia
| | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, United States of America
| | - Nicolas H Hart
- School of Nursing, Queensland University of Technology, Brisbane Australia; Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Brisbane Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney, Sydney, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; Institute for Health Research, University of Notre Dame Australia, Perth, Australia
| | - Raymond J Chan
- School of Nursing, Queensland University of Technology, Brisbane Australia; Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Brisbane Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Australia.
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10
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Tuckey N, Agteren JV, Chur-Hansen A, Ali K, Fassnacht DB, Beatty L, Bareham M, Wardill H, Iasiello M. Implementing a group-based online mental well-being program for women living with and beyond breast cancer - A mixed methods study. Asia Pac J Clin Oncol 2024. [PMID: 38558488 DOI: 10.1111/ajco.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE There is a gap in available mental well-being services in Australia for women diagnosed with breast cancer. This pilot mixed-methods uncontrolled study aimed to assess the feasibility of an online mental health and well-being intervention, the Be Well Plan (BWP), which enables participants to create a personalized, flexible well-being strategy. METHODS Women diagnosed with stages I-IV breast cancer were recruited into 4 asynchronous groups to participate in the BWP, a 5-week facilitator-led group-based mental health and well-being program. Psychological measures used at baseline and post-intervention included: the Warwick Edinburgh Mental Well-Being Scale, Brief Resilience Scale, Self-compassion Scale, 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder scale, and EORC QLQ-C30. Multivariate analysis of variance and effect sizes were calculated on pre- and post-psychological measures, followed by qualitative content analysis on post-completion interviews with participants. RESULTS Nineteen women (mean age 45.7, standard deviation = 7.74) were included in the study. Large effect sizes were reported for mental well-being, depressive symptoms, and anxiety (partial ω2 = 0.28, 0.21, and 0.20, respectively). Self-compassion, resilience, and quality of life results were not statistically significant. Qualitative content analysis provided insight into experiences with Program Delivery Experience, Application of the BWP, Mental Health Improvements, Supporter Involvement, Adopted Interventions, and Recruitment. Participants reported benefits in mindfulness, grounding techniques, and physical activities. CONCLUSION The BWP has the potential to be an effective intervention to support the mental health and well-being of breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS This study highlights flexible interventions that accommodate the diverse needs of breast cancer survivors to improve mental well-being and alleviate psychological distress.
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Affiliation(s)
- Natalie Tuckey
- Mental Health and Well-being Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Joep van Agteren
- Mental Health and Well-being Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kathina Ali
- School of Health, University of the Sunshine Coast, Queensland, Australia
| | - Daniel B Fassnacht
- School of Health, University of the Sunshine Coast, Queensland, Australia
| | - Lisa Beatty
- Flinders University Institute of Mental Health & Well-being, College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Monique Bareham
- Patient Advocate and Cancer Survivor - SA 2022 Local Hero, Adelaide, Australia
| | - Hannah Wardill
- Supportive Oncology Research Group, Precision Medicine Theme (Cancer Program), The South Australian Health and Medical Research Institute, Adelaide, Australia
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Matthew Iasiello
- Mental Health and Well-being Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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11
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Gupta A, Chant ED, Mohile S, Vogel RI, Parsons HM, Blaes AH, Booth CM, Rocque GB, Dusetzina SB, Ganguli I. Health Care Contact Days Among Older Cancer Survivors. JCO Oncol Pract 2024:OP2300590. [PMID: 38452315 DOI: 10.1200/op.23.00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/10/2023] [Accepted: 12/13/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Health care contact days-days spent receiving health care outside the home-represent an intuitive, practical, and person-centered measure of time consumed by health care. METHODS We linked 2019 Medicare Current Beneficiary Survey and traditional Medicare claims data for community-dwelling older adults with a history of cancer. We identified contact days (ie, spent in a hospital, emergency department, skilled nursing facility, or inpatient hospice or receiving ambulatory care including an office visit, procedure, treatment, imaging, or test) and described patterns of total and ambulatory contact days. Using weighted Poisson regression models, we identified factors associated with contact days. RESULTS We included 1,168 older adults representing 4.51 million cancer survivors (median age, 76.4 years, 52.8% women). The median (IQR) time from cancer diagnosis was 65 (27-126) months. In 2019, these adults had mean (standard deviation) total contact days of 28.4 (27.6) and ambulatory contact days of 24.2 (23.6). These included days for tests (8.0 [8.8]), imaging (3.6 [4.1]), visits with any clinicians (12.4 [11.5]), and visits with primary care clinicians (4.4 [4.7]), and nononcology specialists (7.1 [9.4]) specifically. Sixty-four percent of days with a nonvisit ambulatory service (eg, a test) were not on the same day as a clinician visit. Factors associated with more total contact days included younger age, lower income, more chronic conditions, poor self-rated health, and tendency to "go to doctor as soon as feel bad." CONCLUSION Older adult cancer survivors spent nearly 1 month of the year receiving health care outside the home. This care was largely ambulatory, often delivered by nononcologists, and varied by factors beyond clinical characteristics. These results highlight the need to recognize patient burdens and improve survivorship care delivery, including through care coordination.
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Affiliation(s)
| | - Emma D Chant
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
| | - Supriya Mohile
- Department of Medicine, University of Rochester, Rochester, NY
| | | | | | | | | | | | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Ishani Ganguli
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
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12
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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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13
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Rodriguez SA, Lee SC, Higashi RT, Chen PM, Eary RL, Sadeghi N, Santini N, Balasubramanian BA. Factors influencing implementation of a care coordination intervention for cancer survivors with multiple comorbidities in a safety-net system: an application of the Implementation Research Logic Model. Implement Sci 2023; 18:68. [PMID: 38049844 PMCID: PMC10694894 DOI: 10.1186/s13012-023-01326-8] [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: 05/18/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Under- and uninsured cancer survivors have significant medical, social, and economic complexity. For these survivors, effective care coordination between oncology and primary care teams is critical for high-quality, comprehensive care. While evidence-based interventions exist to improve coordination between healthcare teams, testing implementation of these interventions for cancer survivors seen in real-world safety-net settings has been limited. This study aimed to (1) identify factors influencing implementation of a multicomponent care coordination intervention (nurse coordinator plus patient registry) focused on cancer survivors with multiple comorbidities in an integrated safety-net system and (2) identify mechanisms through which the factors impacted implementation outcomes. METHODS We conducted semi-structured interviews (patients, providers, and system leaders), structured observations of primary care and oncology operations, and document analysis during intervention implementation between 2016 and 2020. The practice change model (PCM) guided data collection to identify barriers and facilitators of implementation; the PCM, Consolidated Framework for Implementation Research, and Implementation Research Logic Model guided four immersion/crystallization data analysis and synthesis cycles to identify mechanisms and assess outcomes. Implementation outcomes included appropriateness, acceptability, adoption, and penetration. RESULTS The intervention was appropriate and acceptable to primary care and oncology teams based on reported patient needs and resources and the strength of the evidence supporting intervention components. Active and sustained partnership with system leaders facilitated these outcomes. There was limited adoption and penetration early in implementation because the study was narrowly focused on just breast and colorectal cancer patients. This created barriers to real-world practice where patients with all cancer types receive care. Over time, flexibility intentionally designed into intervention implementation facilitated adoption and penetration. Regular feedback from system partners and rapid cycles of implementation and evaluation led to real-time adaptations increasing adoption and penetration. DISCUSSION Evidence-based interventions to coordinate care for underserved cancer survivors across oncology and primary care teams can be implemented successfully when system leaders are actively engaged and with flexibility in implementation embedded intentionally to continuously facilitate adoption and penetration across the health system.
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Affiliation(s)
- Serena A Rodriguez
- Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), 2777 North Stemmons Freeway, Dallas, TX, 75207, USA.
- Center for Health Promotion & Prevention Research, UTHealth Houston School of Public Health, 7000 Fannin, Houston, TX, 77030, USA.
- UTHealth Houston Institute for Implementation Science, 2777 North Stemmons Freeway, Dallas, TX, 75207, USA.
| | - Simon Craddock Lee
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
- University of Kansas Cancer Center, 2650 Shawnee Mission Parkway, Westwood, KS, 66205, USA
| | - Robin T Higashi
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Patricia M Chen
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd., Suite 303, Dallas, TX, 75390, USA
| | - Navid Sadeghi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 6202 Harry Hines Blvd, Dallas, TX, 75235, USA
- Parkland Health, 5200 Harry Hines Blvd, Dallas, TX, 75235, USA
| | - Noel Santini
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Parkland Health, 5200 Harry Hines Blvd, Dallas, TX, 75235, USA
| | - Bijal A Balasubramanian
- Center for Health Promotion & Prevention Research, UTHealth Houston School of Public Health, 7000 Fannin, Houston, TX, 77030, USA
- UTHealth Houston Institute for Implementation Science, 2777 North Stemmons Freeway, Dallas, TX, 75207, USA
- Department of Epidemiology, Human Genetics & Environmental Sciences, UTHealth Houston School of Public Health, 2777 North Stemmons Freeway, Dallas, TX, 75207, USA
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14
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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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15
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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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16
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Takahashi M. Cancer survivorship care: challenges and opportunities in Japan. Jpn J Clin Oncol 2023; 53:757-763. [PMID: 37279595 DOI: 10.1093/jjco/hyad054] [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: 03/10/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
This article discusses the current international scope and practices of cancer survivorship care and the challenges and opportunities of survivorship care in Japan. Cancer is a common illness in Japan; however, the national cancer control plan focuses only on limited survivorship-related issues, and there is no official national-level survivorship care strategy that addresses the diverse unmet needs of survivors. There is an urgent need to discuss and implement measures for quality survivorship care delivery under the current healthcare system in Japan. The Development of Survivorship Care Coordination Model Research Group, 2022, organized under the National Cancer Center Japan research grant from 2019 to 2022, identified four tasks that are required to realize quality survivorship care: (i) providing education opportunities for survivorship care stakeholders to raise awareness about the concept and the necessity of cancer survivorship care, (ii) providing training opportunities and cancer survivorship care certification for community healthcare providers, (iii) enforcing the economic basis of survivorship care and (iv) creating simpler systems that are organically linked with existing care systems. Collaboration among multiple players is indispensable to developing the philosophy of survivorship care and efficient care delivery. For this purpose, we need a platform where diverse players can participate equally towards the same goal: cancer survivors' optimal wellness.
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Affiliation(s)
- Miyako Takahashi
- Japan Cancer Survivorship Network, Iwate Medical University, The Jikei University School of Medicine, Tokyo, Japan
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17
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Kasherman L, Yoon WH, Tan SYC, Malalasekera A, Shaw J, Vardy J. Cancer survivorship programs for patients from culturally and linguistically diverse (CALD) backgrounds: a scoping review. J Cancer Surviv 2023:10.1007/s11764-023-01442-w. [PMID: 37572196 DOI: 10.1007/s11764-023-01442-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE People of Culturally and Linguistically Diverse (CALD) backgrounds face disparities in cancer care. This scoping review aims to identify the breadth of international literature focused on cancer survivorship programs/interventions specific to CALD populations, and barriers and facilitators to program participation. METHODS Scoping review included studies focused on interventions for CALD cancer survivors after curative-intent treatment. Electronic databases: Medline, Embase, CINAHL, PsycInfo and Scopus were searched, for original research articles from database inception to April 2022. RESULTS 710 references were screened with 26 included: 14 randomized (54%), 6 mixed-method (23%), 4 non-randomized experimental (15%), 2 qualitative studies (8%). Most were United States-based (85%), in breast cancer survivors (88%; Table 1), of Hispanic/Latinx (54%) and Chinese (27%) backgrounds. Patient-reported outcome measures were frequently incorporated as primary endpoints (65%), or secondary endpoints (15%). 81% used multi-modal interventions with most encompassing domains of managing psychosocial (85%) or physical (77%) effects from cancer, and most were developed through community-based participatory methods (46%) or informed by earlier work by the same research groups (35%). Interventions were usually delivered by bilingual staff (88%). 17 studies (77%) met their primary endpoints, such as meeting feasibility targets or improvements in quality of life or psychological outcomes. Barriers and facilitators included cultural sensitivity, health literacy, socioeconomic status, acculturation, and access. CONCLUSIONS Positive outcomes were associated with cancer survivorship programs/interventions for CALD populations. As we identified only 26 studies over the last 14 years in this field, gaps surrounding provision of cancer survivorship care in CALD populations remain. IMPLICATIONS FOR CANCER SURVIVORS Ensuring culturally sensitive and specific delivery of cancer survivorship programs and interventions is paramount in providing optimal care for survivors from CALD backgrounds.
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Affiliation(s)
- Lawrence Kasherman
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2138, Australia
- Department of Medical Oncology, Illawarra Cancer Care Centre, Wollongong, NSW, Australia
- Sydney Cancer Survivorship Centre, Department of Medical Oncology, Concord Hospital, Concord, NSW, Australia
| | - Won-Hee Yoon
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sim Yee Cindy Tan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2138, Australia
- Sydney Cancer Survivorship Centre, Department of Medical Oncology, Concord Hospital, Concord, NSW, Australia
| | - Ashanya Malalasekera
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2138, Australia
- Sydney Cancer Survivorship Centre, Department of Medical Oncology, Concord Hospital, Concord, NSW, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Janette Vardy
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2138, Australia.
- Sydney Cancer Survivorship Centre, Department of Medical Oncology, Concord Hospital, Concord, NSW, Australia.
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18
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Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship. Nat Rev Clin Oncol 2023; 20:527-542. [PMID: 37231127 PMCID: PMC10211308 DOI: 10.1038/s41571-023-00776-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.
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Affiliation(s)
- Maryam B Lustberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Aakash Desai
- Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cristiane Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Brazil
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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19
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Bashkin O, Asna N, Amoyal M, Dopelt K. The Role of Nurses in the Quality of Cancer Care Management: Perceptions of Cancer Survivors and Oncology Teams. Semin Oncol Nurs 2023; 39:151423. [PMID: 37055296 DOI: 10.1016/j.soncn.2023.151423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES This study aimed to explore the perceptions of cancer survivors and oncology professionals of quality in cancer care and the role of oncology nurses in prompting and maintaining quality across the cancer care continuum. DATA SOURCES Semistructured in-depth interviews were conducted with 16 cancer survivors and 22 healthcare professionals between August and October 2021. The interviews were transcribed and analyzed using ATLAS.ti v8 software according to a thematic analysis method based on grounded theory. The COnsolidated criteria for REporting Qualitative research (COREQ) was used to guide the report of the study. CONCLUSION Four main themes emerged from the interviews, which are outlined as follows. (1) Patient participation in the cancer care plan: shared information and decision-making; (2) emotional and support aspects in cancer care; (3) continuity in cancer care: from being a patient at the hospital to a survivor in the community; and (4) cancer care management. Cancer survivors pointed to elements that can increase the quality of cancer care, including the ongoing provision of information, support in decision-making, and continuity of care. Oncology staff interviewees mentioned the need for a single staff member to manage the cancer care plan and serve as a case manager for patients and survivors. IMPLICATIONS FOR NURSING PRACTICE Nurses have a central role in achieving the highest possible quality of cancer care for the growing number of survivors and their families. It is recommended to expand the role of oncology nurses, providing them the training and competencies needed to formally declare them as care managers throughout the continuum of cancer care.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel.
| | - Noam Asna
- Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Mazal Amoyal
- Palliative Care Unit, Barzilai Medical Center, Ashkelon, Israel
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel; Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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20
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Vos JAM, Wollersheim BM, Cooke A, Ee C, Chan RJ, Nekhlyudov L. Primary care physicians' knowledge and confidence in providing cancer survivorship care: a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01397-y. [PMID: 37171716 DOI: 10.1007/s11764-023-01397-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To systematically review existing literature on knowledge and confidence of primary care physicians (PCPs) in cancer survivorship care. METHODS PubMed, Ovid MEDLINE, CINAHL, Embase, and PsycINFO were searched from inception to July 2022 for quantitative and qualitative studies. Two reviewers independently assessed studies for eligibility and quality. Outcomes were characterized by domains of quality cancer survivorship care. RESULTS Thirty-three papers were included, representing 28 unique studies; 22 cross-sectional surveys, 8 qualitative, and 3 mixed-methods studies. Most studies were conducted in North America (n = 23) and Europe (n = 8). For surveys, sample sizes ranged between 29 and 1124 PCPs. Knowledge and confidence in management of physical (n = 19) and psychosocial effects (n = 12), and surveillance for recurrences (n = 14) were described most often. Generally, a greater proportion of PCPs reported confidence in managing psychosocial effects (24-47% of PCPs, n= 5 studies) than physical effects (10-37%, n = 8). PCPs generally thought they had the necessary knowledge to detect recurrences (62-78%, n = 5), but reported limited confidence to do so (6-40%, n = 5). There was a commonly perceived need for education on long-term and late physical effects (n = 6), and cancer surveillance guidelines (n = 9). CONCLUSIONS PCPs' knowledge and confidence in cancer survivorship care varies across care domains. Suboptimal outcomes were identified in managing physical effects and recurrences after cancer. IMPLICATIONS FOR CANCER SURVIVORS These results provide insights into the potential role of PCPs in cancer survivorship care, medical education, and development of targeted interventions.
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Affiliation(s)
- Julien A M Vos
- Department of General Practice, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health, research programme Quality of Care, and Personalized Medicine, Amsterdam, the Netherlands.
| | - Barbara M Wollersheim
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Adelaide Cooke
- MS1 at University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, Adelaide, Australia
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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21
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Rowe A, Crawford-Williams F, Goodwin BC, Myers L, Stiller A, Dunn J, Aitken JF, March S. Survivorship care plans and information for rural cancer survivors. J Cancer Surviv 2023; 17:441-448. [PMID: 35334076 PMCID: PMC10036447 DOI: 10.1007/s11764-022-01204-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was to investigate the amount and type of survivorship care information received by cancer survivors living in rural Australia and whether this varies according to demographic factors or cancer type. METHODS Self-reported receipt of a survivorship care plan (SCP) and information on various aspects of survivorship care (e.g., managing side effects, healthy lifestyles, psychosocial advice and monitoring for recurrence) were collected from 215 cancer survivors who had returned home to a rural area in Queensland Australia after receiving cancer treatment in a major city within the previous 5 years (72% in the previous 12 months). Logistic regression was used to assess for differences across demographic factors and cancer type. RESULTS Only 35% of participants reported receiving a SCP and proportions of those reporting the receipt of specific information varied from 74% for information on short-term side effects to less than 30% for information on finances, chemoprevention and monitoring for signs of recurrence. No significant differences were found in the receipt of survivorship care information across demographic factors or cancer type. CONCLUSIONS Findings suggest that cancer survivors living in rural areas are not consistently provided with adequate survivorship care information, particularly that pertaining to long-term health and recovery. IMPLICATIONS FOR CANCER SURVIVORS Without improved systems for delivering survivorship care information to patients returning home to rural communities after treatment, these cancer survivors risk missing out on necessary information and advice to maintain their health, wellbeing and long-term recovery.
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Affiliation(s)
- Arlen Rowe
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
| | - Fiona Crawford-Williams
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Belinda C Goodwin
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia.
- Cancer Council Queensland, Fortitude Valley, QLD, Australia.
| | - Larry Myers
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Anna Stiller
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jeff Dunn
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia
- Prostate Cancer Foundation of Australia, St Leonards, Sydney, NSW, Australia
| | - Joanne F Aitken
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
- School of Public Health, The University of Queensland, Springfield, QLD, 4300, Australia
| | - Sonja March
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
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22
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Soldato D, Arecco L, Agostinetto E, Franzoi MA, Mariamidze E, Begijanashvili S, Brunetti N, Spinaci S, Solinas C, Vaz-Luis I, Di Meglio A, Lambertini M. The Future of Breast Cancer Research in the Survivorship Field. Oncol Ther 2023:10.1007/s40487-023-00225-8. [PMID: 37005952 DOI: 10.1007/s40487-023-00225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 04/04/2023] Open
Abstract
Prevalence of survivors of breast cancer has been steadily increasing in the last 20 years. Currently, more than 90% of women diagnosed with early-stage breast cancer are expected to be alive at 5 years from diagnosis thanks to early detection and breakthrough innovations in multimodal treatment strategies. Alongside this advancement in clinical outcomes, survivors of breast cancer might experience several specific challenges and present with unique needs. Survivorship trajectories after diagnosis and treatment of breast cancer can be significantly impacted by long-lasting and severe treatment-related side effects, including physical problems, psychological distress, fertility issues in young women, and impaired social and work reintegration, which add up to patients' individual risk of cancer recurrence and second primary malignancies. Alongside cancer-specific sequelae, survivors still present with general health needs, including management of chronic preexisting or ensuing conditions. Survivorship care should implement high-quality, evidence-based strategies to promptly screen, identify, and address survivors' needs in a comprehensive way and minimize the impact of severe treatment sequelae, preexisting comorbidities, unhealthy lifestyles, and risk of recurrence on quality of life. This narrative review focuses on core areas of survivorship care and discuss the state of the art and future research perspectives in key domains including selected long-term side effects, surveillance for recurrences and second cancers, well-being promotion, and specific survivors' needs.
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Affiliation(s)
- D Soldato
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - L Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - E Agostinetto
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M A Franzoi
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - E Mariamidze
- Department of Oncology and Hematology, Todua Clinic, Tbilisi, Georgia
| | - S Begijanashvili
- Department of Clinical Oncology, American Hospital Tbilisi, Tbilisi, Georgia
| | - N Brunetti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - S Spinaci
- Division of Breast Surgery, Villa Scassi Hospital, Genoa, Italy
| | - C Solinas
- Medical Oncology, AOU Cagliari, Policlinico Duilio Casula, Monserrato, Italy
| | - I Vaz-Luis
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy.
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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23
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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: 1] [Impact Index Per Article: 1.0] [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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24
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Perez-Concha O, Goldstein D, Harris MF, Laaksonen MA, Hanly M, Suchy S, Vajdic CM. Uptake of Team Care Arrangements for adults newly diagnosed with cancer. Aust J Prim Health 2023; 29:20-29. [PMID: 36076333 DOI: 10.1071/py22078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Medicare-subsidised Team Care Arrangements (TCAs) support Australian general practitioners to implement shared care between collaborating health professionals for patients with chronic medical conditions and complex needs. We assessed the prevalence of TCAs, factors associated with TCA uptake and visits to TCA-subsidised allied health practitioners, for adults newly diagnosed with cancer in New South Wales, Australia. METHODS We carried out a retrospective individual patient data linkage study with 13 951 45 and Up Study participants diagnosed with incident cancer during 2006-16. We used a proportional hazards model to estimate the factors associated with receipt of a TCA after cancer diagnosis. RESULTS In total, 6630 patients had a TCA plan initiated (47.5%). A TCA was more likely for patients aged ≥65years, those with higher service utilisation 4-15months prior to cancer diagnosis, a higher number of comorbidities, lower self-rated overall health status, living in areas of greater socio-economic disadvantage, lower educational attainment and those with no private health insurance. A total of 4084 (61.6%) patients with a TCA had at least one TCA-subsidised allied health visit within 24months of the TCA. CONCLUSIONS TCAs appear to be well targeted at cancer patients with chronic health conditions and lower socioeconomic status. Nevertheless, not all patients with a TCA subsequently attended a TCA-subsidised allied healthcare professional. This suggests either a misunderstanding of the plan, the receipt of allied health via other public schemes, a low prioritisation of the plan compared to other health care, or suboptimal availability of these services.
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Affiliation(s)
- Oscar Perez-Concha
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, NSW, Australia
| | - Maarit A Laaksonen
- School of Mathematics and Statistics, UNSW Sydney, Sydney, NSW, Australia
| | - Mark Hanly
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Sue Suchy
- Consumer Advisory Panel, Translational Cancer Research Network, Sydney, NSW, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
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25
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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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26
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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: 26] [Impact Index Per Article: 13.0] [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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Harada T, Schmitz K, Helsper CW, Campbell G, Nekhlyudov L. Long-COVID and long-term cancer survivorship-Shared lessons and opportunities. Eur J Cancer Care (Engl) 2022; 31:e13712. [PMID: 36151916 PMCID: PMC9539058 DOI: 10.1111/ecc.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022]
Abstract
As of 2022, close to 90 million persons in the United States, 243 million persons in Europe and 585 million worldwide have been infected with the novel SARS‐CoV‐2 (COVID‐19) virus and survived. Estimates vary but suggest that up to 50% may experience long‐term sequelae, termed ‘Long‐COVID’. While Long‐COVID is a new condition, the phenomenon of disabling long‐term effects following an illness requiring ongoing surveillance and management is not. In this commentary, we discuss how Long‐COVID parallels the experiences of long‐term cancer survivors, highlight shared challenges and offer opportunities to improve research and clinical care for both growing populations of patients as well as other long‐term chronic, disabling conditions.
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Affiliation(s)
- Taku Harada
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn Schmitz
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Charles W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Grace Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Duquesne University School of Nursing and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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28
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Factors influencing cancer survivors' experiences with follow-up cancer care: results from the pan-Canadian Experiences of Cancer Patients in Transition Study survey. Support Care Cancer 2022; 30:9559-9575. [PMID: 36123549 DOI: 10.1007/s00520-022-07357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care. METHODS In 2016, the Canadian Partnership Against Cancer collected survey responses from cancer survivors about their experiences with follow-up cancer care. We included respondents from this survey if they were diagnosed with non-metastatic breast, hematologic, colon, melanoma, and prostate cancer. Our primary outcome was cancer survivors' self-reported overall experience with follow-up cancer care. We used multivariable logistic regression to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care. RESULTS Of the 8402 cancer survivors included in our study, 81.8% (n = 6,875) reported a positive experience with their follow-up cancer care. The individual factors associated with positive overall experiences were more commonly those associated with self-perceptions of respondents' personal health and well-being rather than baseline sociodemographic factors, such as sex, income, or education. For example, respondents were more likely to report a positive experience if they perceived their quality of life as good (OR 1.9, 95% CI 1.0-3.5, p < 0.01) or reported not having an unmet practical concern (OR 1.3, 95% CI 1.1-1.6, p < 0.01). The structural factors most strongly associated with positive overall experiences included respondents perceiving their oncology specialist was in charge of their follow-up cancer care (OR 5.2, 95% CI 3.6-7.5, p < 0.01) and reporting the coordination of their follow-up cancer care among healthcare providers was good or very good (OR 8.4, 95% CI 6.7-10.6, p < 0.01). CONCLUSION While real-world experiences with follow-up cancer care in Canada are reported to be positive by most cancer survivors included in this study, we found differences exist based on individual and structural factors. A better understanding of the reasons for these differences is required to guide the provision of high-quality follow-up care that is adapted to the needs and resources of individuals and contexts.
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Johnston EA, Goodwin BC, Myers L, March S, Aitken JF, Chambers SK, Dunn J. Support-seeking by cancer caregivers living in rural Australia. Aust N Z J Public Health 2022; 46:850-857. [PMID: 36121279 DOI: 10.1111/1753-6405.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/01/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Rural cancer caregivers report poor wellbeing and high unmet needs for support. This study investigates sources of support sought by cancer caregivers living in rural Australia, and factors associated with support-seeking. METHODS Informal caregivers of people with cancer completed a questionnaire assessing sociodemographic characteristics, caregiver factors and support-seeking. Descriptive statistics, bivariate analyses and logistic regression were used to identify common sources of support and factors associated with support-seeking. Alluvial and radar plots were used to identify and describe support-seeking profiles. FINDINGS Of 244 rural caregivers, 64% reported seeking support for themselves, 72% for the cancer patient, and 22% did not seek any support. The most common sources of support were general practitioners and online. Higher caregiver burden, higher income, caring for someone with anxiety/depression or caring for someone who has difficulty completing their usual activities were associated with seeking support from a greater number of sources. The 'No support-seekers' profile had the highest proportions of caregivers who were male, caring for someone <12 months post-diagnosis and lower income earners. CONCLUSIONS Many rural caregivers seek support for themselves and the cancer patient, commonly from medical and online sources. IMPLICATIONS FOR PUBLIC HEALTH Further work may be needed to reduce caregiver burden and support caregivers who are male, caring for someone recently diagnosed, and those with lower incomes.
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Affiliation(s)
- Elizabeth A Johnston
- Viertel Cancer Research Centre, Cancer Council Queensland, Queensland.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Queensland.,Population Health Program, QIMR Berghofer Medical Research Institute, Queensland
| | - Belinda C Goodwin
- Viertel Cancer Research Centre, Cancer Council Queensland, Queensland.,Centre for Health Research, University of Southern Queensland, Queensland
| | - Larry Myers
- Viertel Cancer Research Centre, Cancer Council Queensland, Queensland.,School of Psychology and Wellbeing, University of Southern Queensland, Queensland
| | - Sonja March
- Centre for Health Research, University of Southern Queensland, Queensland.,School of Psychology and Wellbeing, University of Southern Queensland, Queensland
| | - Joanne F Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Queensland.,Centre for Health Research, University of Southern Queensland, Queensland.,School of Public Health and Social Work, Queensland University of Technology, Queensland.,School of Public Health, The University of Queensland, Queensland
| | - Suzanne K Chambers
- Faculty of Health Sciences, Australian Catholic University, Queensland.,St Vincent's Health Network Sydney, New South Wales.,Menzies Health Institute Queensland, Griffith University, Queensland
| | - Jeff Dunn
- Viertel Cancer Research Centre, Cancer Council Queensland, Queensland.,Centre for Health Research, University of Southern Queensland, Queensland.,Faculty of Health Sciences, Australian Catholic University, Queensland.,Menzies Health Institute Queensland, Griffith University, Queensland.,Exercise Medicine Research Institute, Edith Cowan University, Western Australia.,Prostate Cancer Foundation of Australia, New South Wales
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30
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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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31
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Risk Stratification and Cancer Follow-Up: Towards More Personalized Post-Treatment Care in Canada. Curr Oncol 2022; 29:3215-3223. [PMID: 35621651 PMCID: PMC9139666 DOI: 10.3390/curroncol29050261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/15/2022] Open
Abstract
After treatment, cancer survivors require ongoing, comprehensive care to improve quality of life, reduce disability, limit complications, and restore function. In Canada and internationally, follow-up care continues to be delivered most often by oncologists in institution-based settings. There is extensive evidence to demonstrate that this model of care does not work well for many survivors or our cancer systems. Randomized controlled trials have clearly demonstrated that alternate approaches to follow-up care are equivalent to oncologist-led follow-up in terms of patient outcomes, such as recurrence, survival, and quality of life in a number of common cancers. In this paper, we discuss the state of follow-up care for survivors of prevalent cancers and the need for more personalized models of follow-up. Indeed, there is no one-size-fits-all solution to post-treatment follow-up care, and more personalized approaches to follow-up that are based on individual risks and needs after cancer treatment are warranted. Canada lags behind when it comes to personalizing follow-up care for cancer survivors. There are many reasons for this, including difficulty in determining who is best served by different follow-up pathways, a paucity of evidence-informed self-management education and supports for most survivors, poorly developed IT solutions and systems, and uneven coordination of care. Using implementation science theories, approaches, and methods may help in addressing these challenges and delineating what might work best in particular settings and circumstances.
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32
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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: 63] [Impact Index Per Article: 31.5] [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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Mehnert-Theuerkauf A, Esser P. [Survivorship care plans for cancer patients: the importance of risk stratification, self-management and health literacy in the age of digital care]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:412-419. [PMID: 35275217 PMCID: PMC8979897 DOI: 10.1007/s00103-022-03514-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
In Deutschland wie allen anderen Industrieländern weltweit nimmt mit einer älter werdenden Bevölkerung und einer verbesserten Krebsfrüherkennung, Diagnostik und onkologischen Behandlung die Zahl der Patienten, die geheilt werden oder lange Zeit mit der Erkrankung leben, deutlich zu (Cancer Survivors). Ein Leben mit und nach einer Krebserkrankung bedeutet für viele Patienten ein Leben mit körperlichen und psychosozialen krankheits- und behandlungsbedingten Langzeit- und Spätfolgen. Angesichts des demografischen Wandels, der steigenden Krebsprävalenz sowie des medizinischen Fortschritts ist eine der dringenden Fragen, wie eine qualitativ hochwertige individualisierte und gleichzeitig finanzierbare Krebsversorgung für älter werdende, häufig multimorbide Patienten sichergestellt werden kann. Diese Entwicklungen erfordern neben einer Stärkung der Krebsprävention die Erforschung und Umsetzung einer individualisierten Nachsorge im Rahmen von Survivorship-Care-Programmen (SCP). Übergreifende Zielsetzung von SCP ist es, den körperlichen wie psychosozialen Langzeit- und Spätfolgen vorzubeugen bzw. diese zu minimieren, die Mortalität zu senken sowie die Lebensqualität von Patienten zu verbessern. Die Evidenz zur Wirksamkeit von SCP hinsichtlich der Verbesserung patientenberichteter Endpunkte ist bislang nicht eindeutig. Die Bereitstellung von maßgeschneiderten Informationen sowie von risikomodifizierenden und bedarfsorientierten Angeboten auf der Basis einer Risikostratifizierung wird als zentraler Bestandteil bei der Implementierung von SCP angesehen. Dabei nimmt die Förderung von Selbstmanagement- und Gesundheitskompetenzen der Patienten, insbesondere vor dem Hintergrund der Zunahme von digitalen Gesundheitsanwendungen, einen hohen Stellenwert ein.
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Affiliation(s)
- Anja Mehnert-Theuerkauf
- Abteilung für Medizinische Psychologie und Medizinische Soziologie Universitätsklinikum Leipzig, Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland.
| | - Peter Esser
- Abteilung für Medizinische Psychologie und Medizinische Soziologie Universitätsklinikum Leipzig, Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
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34
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Lai-Kwon J, Kelly B, Lane S, Biviano R, Bartula I, Brennan F, Kivikoski I, Thompson J, Dhillon HM, Menzies A, Long GV. Feasibility, acceptability, and utility of a nurse-led survivorship program for people with metastatic melanoma (MELCARE). Support Care Cancer 2022; 30:9587-9596. [PMID: 36136246 PMCID: PMC9492451 DOI: 10.1007/s00520-022-07360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/10/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) and targeted therapy (TT) have improved the survival of people with metastatic melanoma. We assessed the feasibility, acceptability, and utility of a novel model of nurse-led, telehealth-delivered survivorship care (MELCARE) for this survivor group. METHODS People ≥ 18 years diagnosed with unresectable stage III or stage IV melanoma who were ≥ 6 months post initiation of ICI/TT with a radiological response suggestive of a long-term response to ICI/TT were recruited from a specialist melanoma centre in Australia. All participants received MELCARE, a nurse-led survivorship program involving two telehealth consultations 3 months apart, needs assessment using the Distress Thermometer (DT) and Problem List, and creation of a survivorship care plan. Feasibility, acceptability, and utility were assessed using rates of consent and study completion, time taken to complete each component of MELCARE, the Acceptability of Intervention Measure (AIM), and a customised utility survey. RESULTS 31/54 (57%) people consented. Participants were male (21, 68%), with a median age of 67 (range: 46-82). Eleven (35%) were receiving/had received ipilimumab and nivolumab and 27 (87%) had ceased treatment. Feasibility was demonstrated with 97% completing MELCARE. Utility was demonstrated on a customised survey and supported by a reduction in the mean DT score (initial: 5.6, SD: 2.9; follow-up: 1.5, SD: 1.2). Acceptability was demonstrated on 3/4 AIM items. CONCLUSION MELCARE was feasible and acceptable with high levels of utility. However, the consent rate was 57% indicating some people do not require support. Future studies should consider MELCARE's optimal timing, resourcing, and cost-effectiveness.
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Affiliation(s)
| | - Brooke Kelly
- Melanoma Patients Australia, Varsity Lakes, Australia
| | - Sarah Lane
- Melanoma Institute Australia, Sydney, Australia
| | | | - Iris Bartula
- Melanoma Institute Australia, Sydney, Australia ,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | | | | | - Haryana M. Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia ,Psycho-Oncology Cooperative Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Alexander Menzies
- Melanoma Institute Australia, Sydney, Australia ,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,Royal North Shore Hospital, Sydney, Australia ,Mater Hospital, Sydney, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, Sydney, Australia ,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,Royal North Shore Hospital, Sydney, Australia ,Mater Hospital, Sydney, Australia
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