ECCO Essential Requirements for Quality Cancer Care: Primary care

Optimizing the integration of family physicians into cancer survivorship care in the BC Interior: a mixed methods study of physicians' opinions and experiences

PURPOSE

With cancer diagnoses increasing worldwide and the number of cancer survivors rising, family physicians are being increasingly relied upon to provide post-cancer treatment care and/or survivorship care. This mixed-method study explores and evaluates barriers and facilitators to optimizing family physician-led survivorship care in the largely rural Interior of British Columbia (BC), Canada.

METHODS

A mixed-method approach consisting of quantitative surveys and qualitative interviews was utilized to explore family physician and oncologist perspectives on the current state of survivorship care for breast, lung, prostate, and colorectal cancers within the BC Interior.

RESULTS

Concerns about family physician knowledge in some aspects of survivorship care were identified by both groups, with mixed responses regarding geographical factors, resources, and communication networks. Success was dependent on information from oncologists with more common cancer sites fitting the model better. There was significant concern for individuals with no family physician. Five frequently discussed facilitators were identified: (1) providing accessible survivorship guidelines, (2) standardized discharge summaries (i.e., survivorship care plans), (3) clear points-of-contact at cancer care centers, (4) more educational opportunities, and (5) compatible electronic supports between care providers.

CONCLUSIONS

Overall, the model of family physician-led survivorship care was supported by family physicians and oncologists within the BC Interior, although success was dependent on several factors. Identifying the perspectives of physicians directly involved in the survivorship care pathway will be instrumental in developing and implementing solutions that will succeed within the BC Interior and similar regions. Implication to for Cancer Survivors We hope that the improvements to interprofessional cooperation driven by our research may improve the quality and continuity of care received by cancer survivors in British Columbia and beyond.  IMPLICATION TO CANCER SURVIVORS: We hope that the improvements to interprofessional cooperation driven by our research may improve the quality and continuity of care received by cancer survivors in British Columbia and beyond.

Utilisation of Chronic Disease and Mental Health Management Services and Cardioprotective Medication Prescriptions in Primary Care for Patients With Cardiovascular Diseases and Cancer: A Cross-Sectional Study

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors. Mental health is considered an important risk factor affecting the treatment of cardiovascular disease. However, little is known about the use of secondary prevention strategies for CVD in patients with both cancer and CVD. This study aimed to compare the utilisation of primary care chronic disease management plans, mental health care and guideline-indicated cardioprotective medications among CVD patients with and without cancer.

METHODS

Retrospective cross-sectional study utilising clinical data of patients with CVD from 50 Australian primary care practices. Outcomes included the use of chronic disease management plans, mental health care, guideline-indicated cardioprotective medications and influenza vaccination. Logistic regression, accounting for demographic and clinical covariates and clustering effects by practices, was used to compare the two groups.

RESULTS

Of the 15,040 patients with CVD, 1,486 patients (9.9%) concurrently had cancer. Patients with cancer, compared to those without, were older (77.6 vs 71.8 years, p<0.001), more likely to drink alcohol (62.6% vs 55.7%, p<0.001), have lower systolic (130.3±17.8 vs 132.5±21.1 mmHg, p<0.001) and diastolic (72.2±11 vs 75.3±34 mmHg, p<0.001) blood pressure. Although suboptimal for both groups, patients with cancer were significantly more likely to have general practice management plans (GPMPs) (51.4% vs 43.2%, p<0.001), coordination of team care arrangements (TCAs) (46.2% vs 37.0%, p<0.001), have a review of either GPMP or TCA (42.8% vs 34.7%, p<0.001), have a mental health treatment consultation (15.4% vs 10.5%, p=0.004) and be prescribed blood pressure-lowering medications (70.1% vs 66.0%, p=0.002). However, there were no statistical differences in the prescription of lipid-lowering or antiplatelet medications. After adjustments for covariates and multiple testing, patients with cancer did not show a difference in GPMPs, TCAs, and a review of either, but were more likely to receive mental health treatment consultations than those without cancer (odds ratio 1.76; 95% confidence interval 1.42-2.19).

CONCLUSIONS

Less than half of patients with CVD had a GPMP, TCA or review of either. Although those patients with cancer were more likely to receive these interventions, still around half the patients did not. Medicare-funded GPMPs, TCAs and a review of either GPMP or TCA were underutilised, and future studies should seek to identify ways of improving access to these services.

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

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.

Oncofertility awareness among primary care physicians in India

BACKGROUND

Primary care physicians not only coordinate referrals to oncology services but can play a crucial role in successful fertility preservation referrals in cancer-diagnosed patients. Hence, it is important to assess their knowledge and attitudes towards fertility preservation.

METHODS

An eighteen-item oncofertility survey was administered to primary care physicians between May 2019 to September 2020.  Results: A total of forty-six responses were received and analysed. About 60% of primary care physicians did not have adequate knowledge about available fertility preservation options and only 26-32% were aware of international guidelines recommending fertility preservation in cancer patients.  Conclusions: Imparting awareness and knowledge of fertility preservation and its options to primary care physicians could enable an integrated cancer care model while also facilitating successful oncofertility referrals in countries like India.

Cancer Care Continuum Research and Educational Innovation: Are Academic Internists Keeping up with Population Trends?

Academic internists play a unique role in conducting innovative research, developing educational curricula, and influencing policy. As the population of patients living with and beyond cancer is expected to reach 22 million by 2030, it is essential for academic internists to lead innovative research in clinical care and medical education across the cancer care continuum. We characterized cancer-related topics presented at the 2015-2019 annual meetings of the Society of General Internal Medicine, a national organization of over 3,000 academic general internists. We analyzed all scientific (n = 3,437), Innovation in Medical Education (n = 756), and Innovation in Clinical Practice (n = 664) abstracts for content across the cancer continuum: prevention, screening, diagnosis, treatment, survivorship, and palliative/end-of-life care (P/EOL). Of 3,437 scientific abstracts, 304 (8.8%) related to cancer. Prevention, screening, diagnosis, treatment, survivorship, and P/EOL were addressed in 52 (17.1%), 145 (47.7%), 18 (5.9%), 57 (18.8%), 12 (4.0%), and 29 (9.5%) of scientific abstracts, respectively. Some addressed multiple phases, and 6 were classified as "other." Breast (mean = 18.2, SD = 4.66), colorectal (mean = 12.8, SD = 3.11), and lung (mean = 8.2, SD = 2.29) cancers were most presented in scientific abstracts per year. Five (0.66%) of the 756 Innovation in Medical Education abstracts and 41 (6.2%) of the 665 Innovation in Clinical Practice abstracts addressed cancer. Similarly, they primarily focused on screening and prevention. To lead innovation in clinical care, education, and policy across the cancer continuum and prepare the future workforce, academic internists should expand their focus to later phases, particularly survivorship and P/EOL.

Indigenous Australians' Experiences of Cancer Care: A Narrative Literature Review

To provide the latest evidence for future research and practice, this study critically reviewed Indigenous peoples' cancer care experiences in the Australian healthcare system from the patient's point of view. After searching PubMed, CINAHL and Scopus databases, twenty-three qualitative studies were included in this review. The inductive approach was used for analysing qualitative data on cancer care experience in primary, tertiary and transitional care between systems. Three main themes were found in healthcare services from Indigenous cancer care experiences: communication, cultural safety, and access to services. Communication was an important theme for all healthcare systems, including language and literacy, understanding of cancer care pathways and hospital environment, and lack of information. Cultural safety was related to trust in the system, privacy, and racism. Access to health services was the main concern in transitional care between healthcare systems. While some challenges will need long-term and collective efforts, such as institutional racism as a downstream effect of colonisation, cultural training for healthcare providers and increasing the volume of the Indigenous workforce, such as Indigenous Liaison Officers or Indigenous Care Coordinators, could effectively address this inequity issue for Indigenous people with cancer in Australia in a timely manner.

Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review

BACKGROUND

Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from observational studies conducted in high income countries on PAs' competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care.

METHOD

A rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009-2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation.

RESULTS

From 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs' competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis.

CONCLUSION

This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs' roles, including outcomes of the diagnostic process.

Current Trends in the Quality Assessment of Colorectal Cancer Practice and Treatment in South Korea during 2012-2017

Purpose

Colorectal cancer (CRC) is increasing in South Korea due to westernized eating habits and regular health check-ups. The Korean Health Insurance Review and Assessment Service (HIRA) has conducted a national quality assessment of the treatment of CRC. This study examined the quality assessment report of the Korean HIRA and analyzed the status of practice pattern and the epidemiology of CRC in South Korea.

Materials and Methods

The number of subjects was determined based on the number of surgical procedures in each institution during 2012–2017. The institution types were classified according to the number of beds and the composition of oncologic specialists. Twenty-one indicators for diagnosis, chemotherapy, radiotherapy, surgery, pathology, and mortality were analyzed and the inter-institutional variation for each indicator was calculated.

Results

Among 21 evaluation indices, indicators related to medical records, receipt of chemotherapy with a high coefficient of variation of ≥ 0.1% were improved over 6 years until the survey in 2017. In the analysis of indices affecting surgical mortality, the regional lymph node resection and examination rate (p=0.022) showed a negative correlation with surgical mortality. Hospitalization stay (p < 0.001) and hospitalization cost (p=0.002) were positively correlated with surgical mortality.

Conclusion

This study showed that the treatment quality and examination status for CRC in South Korea were appropriate for improving relevant medical records, receipt of chemotherapy, maintaining the quality of treatment, and mortality. These analyses could be the basis for developing an improved quality assessment program worldwide.

The requirements of a specialist breast centre

This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.