Improved models of care for cancer survivors

Key Updates in Testicular Cancer: Optimizing Survivorship and Survival

Testicular cancer is a rare but highly curable malignancy, predominantly affecting young men. Advances in multimodal therapy, including cisplatin-based chemotherapy, radiotherapy, and surgical interventions, have resulted in excellent cancer-specific survival. However, with improved survival rates, long-term health consequences and survivorship issues have emerged as critical concerns. Testicular cancer survivors (TCSs) are at risk of adverse health outcomes, including endocrine dysfunction, cardiovascular disease, secondary malignancies, chemotherapy-induced neuropathy, and psychosocial challenges. Endocrine disturbances such as hypogonadism and infertility require careful monitoring, while cardiovascular risks necessitate long-term preventive strategies. Survivors also face an elevated risk of secondary malignancies, necessitating tailored follow-up. Recent advances in the de-escalation of therapy, particularly for stage II seminoma and metastatic germ cell tumors, aim to balance oncologic efficacy with minimizing toxicity. This review discusses the evolving landscape of testicular cancer survivorship, the impact of treatment-related complications, and contemporary management strategies, emphasizing a multidisciplinary approach to optimize long-term outcomes and quality of life.

Indolent lymphoma: addressing the needs of survivors

Over the past two decades, there has been a continuous improvement in outcome for patients with indolent lymphoma (iNHL) resulting in a gradual accumulation of survivors. While life expectancy in the current era approaches that of the lymphoma-free population, patients continue to experience lifelong complications of the disease and its treatment affecting general health, emotional, psychological and social wellbeing, relationships, employment, finances, and fitness. Contemporary care models while suited to the management of lymphoma are often lacking when it comes to identification and management of these additional needs. Given improvements in physical survival achieved over the past decades, it is timely for us to focus on other issues affecting patient wellbeing including immunodeficiency and infection, second cancers, cardiovascular disease, bone health, psychological wellbeing, and sexual health. Many of these aspects are in the domain of the primary care physician; however, there is limited guidance on how these issues should be addressed. It is now time for us to engage our patients, their caregivers, and other healthcare providers in care aspects beyond the lymphoma diagnosis, so they can anticipate a rich and full life, free from both direct and indirect consequences of the lymphoma diagnosis.

Quality cancer survivorship care: a modified Delphi study to define nurse capabilities

PURPOSE

To establish capabilities required by nurses to deliver quality cancer survivorship care in Australia.

METHODS

A two-round online modified Delphi involving Australian cancer nurses. Initial domains and capability statements were based on the Quality of Cancer Survivorship Care Framework and supplemented by national and international nursing frameworks. In Round 1 (R1), experts categorised the applicability of 53 capabilities for cancer nurses, across eight domains, in relation to Australian National Professional Development Framework for Cancer Nursing (EdCaN) groups: 'All', 'Many', 'Some', and 'Few' nurses, or not relevant. In Round 2 (R2), experts rated agreement with capabilities allocated to the nurse groups. A priori consensus was set at ≥ 80%.

RESULTS

Surveys were distributed to 51 experts, with a response rate of 92% (47/51) for R1 and 75% (38/51) for R2. Following R1, ten capabilities were added, resulting in 63 capabilities for R2 to establish consensus allocation to EdCaN groupings. Fifty-seven capabilities reached consensus; four capabilities were moved from 'many' to 'some' nurses; one capability was moved from 'some' to 'few' nurses; and one capability was retained in 'all' nurses following Delphi feedback and research team discussion.

CONCLUSIONS

Sixty-three capabilities across eight cancer survivorship care domains were identified and allocated to different nursing groupings. This study provides important foundational work by identifying the capabilities of cancer nurses to deliver quality cancer survivorship care in Australia.

IMPLICATIONS FOR CANCER SURVIVORS

The identification of clearly defined capabilities may improve the quality of cancer survivorship care through the enrichment and standardisation of educational curricula and continuing professional education, and through improved workforce planning.

A scoping review exploring cancer survivorship in Africa: 2011 to 2024

PURPOSE

The scope of cancer survivorship in Africa remains largely unexplored. This scoping review aims to describe current survivorship-related factors and care delivery characteristics in Africa, and to provide insights that can inform a more systematic integration of survivorship care into the broader cancer care continuum.

METHODS

Four databases (PubMed, Embase, Web of Science: Core, CINAHL Plus) were searched for journal articles and grey literature published from 2011 to August 2024 in English. Articles were included if they focused on post-treatment care for African cancer survivors. Covidence® was utilised for screening and data collection. Microsoft Excel was used for data cleaning and analysis.

RESULTS

A total of 9417 articles were screened and 181 included. The number of studies per year grew from 6 (2011) to 32 (2023). These comprised 71 conference abstracts and 110 journal articles conducted in 19 African countries. The study methodologies utilised include 97 quantitative, 42 qualitative, 25 programme descriptions, and 18 mixed methods. Childhood survivorship was the focus for 40 studies. Psychosocial effects of cancer and its treatment were discussed in 104 studies.

CONCLUSIONS

Interest in post-treatment cancer survivorship and related care is increasing across Africa. While significant research has explored the physical and psychosocial effects of cancer, there remains a critical need for studies focused on care coordination, targeted interventions, and strategies to improve quality-of-life outcomes for survivors.

IMPLICATIONS FOR CANCER SURVIVORS

The overall scope of post-treatment cancer survivorship care in Africa primarily centres on psychosocial outcomes, with limited emphasis on care coordination. This underscores the need for further research and the development of context-relevant, feasible, and integrated care models within African health systems.

Understanding experiences of optimal survivorship care: findings from a population-based study of cancer survivors

BACKGROUND

Multiple frameworks describing optimal cancer survivorship care recommend the development of systems to monitor delivery of quality care. This study reports the experiences of cancer survivorship care in Australia and examines associations with patient-level sociodemographic and clinical characteristics.

METHODS

People aged ≥ 16 years, with any cancer receiving cancer care in a Victorian public hospital in 2018, were invited to complete a survey assessing care experiences. Seven items assessed follow-up care experiences with optimal care indicated by the response: 'Yes, definitely received', and sub-optimal care by responses 'Yes, I think so', 'No', and 'Not sure'. A composite score was derived with optimal care defined as positive experiences on the majority of items. Sociodemographic and clinical factors associated with optimal care were examined using multivariable logistic regression.

RESULTS

Of the 4998 (47% response rate) respondents, 3555 were receiving follow-up care. The item most respondents indicated receiving optimal care was 'receiving information about schedule of tests/check-ups' (73%), with optimal care least likely to be reported for the item 'receiving information about new symptoms needing investigation' (44%). Based on our composite measure, only 40% had optimal survivorship care overall. Those more likely to report optimal survivorship care were male, from lower socioeconomic advantage areas, reported excellent health, diagnosed with breast, prostate, lung or a haematological cancer, and diagnosed less recently.

CONCLUSIONS

Large numbers of Australian cancer survivors report sub-optimal survivorship care, with experiences varying by some sociodemographic and clinical characteristics. Understanding reasons for differences can provide insight into strategies to ameliorate variations.

Supporting wellness after cancer treatment for women from Chinese, Vietnamese, and Arabic backgrounds: a qualitative study of healthcare provider views

INTRODUCTION

Over one million Australians live with a cancer diagnosis, with nearly a quarter speaking a language other than English. Cancer survivors from culturally and linguistically diverse (CALD) backgrounds often face significant unmet needs during survivorship, including navigating the healthcare system and accessing culturally appropriate support. For example, Chinese- and Vietnamese-speaking survivors report physical and psychosocial impacts, compounded by limited availability and access to tailored information on symptom management and recurrence prevention. This study aimed to explore healthcare providers' perspectives on designing supportive care programs for women cancer survivors from Vietnamese, Arabic, and Chinese-speaking backgrounds, focusing on culturally appropriate content, delivery formats, and barriers and facilitators to engagement.

METHOD

Thirteen healthcare providers experienced in cancer survivorship and supportive care for CALD women participated in semi-structured interviews. Participants were recruited from healthcare settings in Western Sydney, a culturally diverse region, using purposive sampling to ensure diverse professional perspectives. Interviews were guided by an advisory committee, audio-recorded, transcribed verbatim, and analyzed thematically using NVivo.

RESULTS

Three key areas were identified: program content, delivery preferences, and barriers/enablers. A holistic approach addressing physical, emotional, and social dimensions was recommended, incorporating culturally tailored guidance on diet, exercise, and mindfulness. Non-hospital, community-based settings were favored for accessibility and comfort, with a stepped-care model offering varying levels of support based on individual needs. Challenges included language barriers, privacy concerns, and logistical issues, while facilitators encompassed culturally sensitive outreach, community partnerships, and bilingual facilitators. Participants emphasized the importance of low-cost programs with flexible delivery formats.

CONCLUSIONS

This study provides valuable insights from healthcare providers on the design of culturally and linguistically tailored supportive care programs for women cancer survivors from Vietnamese-, Arabic-, and Chinese-speaking backgrounds. Providers emphasized the importance of a holistic approach addressing physical, emotional, and social needs, with delivery in accessible, community-based settings. Key recommendations included culturally sensitive outreach, bilingual facilitators, and flexible, low-cost program options to overcome barriers such as language, privacy concerns, and logistical challenges. These programs have the potential to advance health equity by improving survivorship experiences and outcomes for culturally diverse women.

The role of general practice to address the supportive care needs of Australian cancer survivors: a qualitative study

Background Cancer survivors have a broad range of supportive care needs that are not consistently managed in general practice. Understanding the barriers primary healthcare providers face in providing high quality supportive care is crucial for improving the delivery of supportive care in general practice. Methods This Australian qualitative study involved semi-structured interviews with general practitioners (n =9), practice nurses (n =8), and a community liaison worker employed in general practice (n =1), to explore barriers and facilitators to identifying and managing supportive care for cancer survivors. Data were thematically analysed to develop recurring themes related to the identification and provision of supportive care. Results Four major themes were developed: identification of supportive care needs, time and provision of supportive care, challenges in supportive care for diverse populations, and desire for more information. Improved education; enhanced communication across all levels of healthcare, including centralised access to patient information; and greater knowledge of available services were highlighted as facilitators to the management of supportive care for cancer survivors. Conclusions Targeted efforts to support the facilitators identified here can contribute to more effective management of supportive care for diverse cancer survivor populations to improve the overall quality of care and health outcomes for these individuals.

"I Became the Messenger Between the Hospitals": A Study on the Journeys of People With Cancer Using the Critical Incident Technique

INTRODUCTION

Patients with serious conditions face complex, long-lasting patient journeys involving multiple healthcare providers. Research shows that these journeys are frequently perceived as fragmented, with significant challenges in communication and information flow. However, there is limited knowledge about the organisational and informational aspects linked to good and poor experiences. This study investigated critical factors in cancer journeys, focusing on communication and the informational and organisational elements shaping patient experiences.

METHODS

The critical incident technique was used to identify positive and negative factors in cancer patient journeys. People with cancer and their next-of-kin were recruited through Norway's national cancer organisation. Patient episodes were collected from 41 participants via digital workshops combined with questionnaires and supplemented by in-depth interviews. Critical incidents were extracted using specific analytical criteria.

RESULTS

A total of 187 critical incidents were identified, including 81 positive and 106 negative. Content analysis revealed 12 categories of incidents. Positive incidents were linked to effective communication, timely information, and well-coordinated care, particularly through cancer pathways. Negative incidents often involved communication delays, insensitive information delivery, and poor coordination among healthcare providers. Notably, around 40% of the negative incidents stemmed from fragmented health services or a lack of progress, often forcing patients to act as messengers.

CONCLUSION

By examining critical experiences, this study highlights key areas for improving cancer care. Timely information and clinical empathy when delivering sensitive diagnoses are essential. Healthcare providers must coordinate services more effectively to prevent patients from intervening to ensure care progress.

PATIENT OR PUBLIC CONTRIBUTION

Patients' stories formed the core data. The public contributed to recruitment, while patient feedback informed the workshop design.

Core elements and principles of nutrition models of care for people with cancer: A scoping review

BACKGROUND AND AIMS

The development and implementation of evidence-based cancer nutrition models of care into clinical practice is challenging and pragmatic guidance is lacking. This scoping review aimed to identify the core elements and principles of nutrition models of care for people with cancer.

METHODS

MEDLINE Complete, CINAHL and Embase were systematically searched between 1 January 2003-8 November 2023. Studies were eligible for inclusion and data extraction if they reported on the implementation or evaluation of a nutrition model of care for adults with any cancer diagnosis. The protocol was prospectively registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/RQVHJ) on 7 November 2023.

RESULTS

The search identified 4599 papers, 28 studies met inclusion criteria. Studies were primarily conducted in Australia (71.4 %), within a hospital (96.4 %), metropolitan setting (89.3 %) and with various cancer diagnoses. Most studies described a nutrition screening process and 50 % used a valid and reliable assessment tool. Studies described provision of direct care by the dietitian (n = 26), primarily conducted in the outpatient setting (n = 26) and lesser in the inpatient setting (n = 12), and frequently face-to-face (n = 25) [phone (n = 14), telehealth (n = 3)]. Ten core elements were identified that underpinned the models of care including: timely care driven by a care pathway, protocol or clinic (100.0 %); nutrition expertise and leadership (100.0 %); flexible and integrated (100.0 %); with multi-directional communication (96.4 %); accessible (92.9 %); stratified by risk (89.3 %); multidisciplinary engagement (85.7 %); across different care time-points and settings (85.7 %); supported by training/education (50.0 %) and data integration (25.0 %).

CONCLUSIONS

Nutrition expert-led cancer nutrition models of care literature was primarily limited to metropolitan, hospital settings and many lacked valid nutrition assessment tools. Ten core elements were identified that underpinned nutrition care, with the most utilised being: timely care driven by a care pathway, protocol or clinic; nutrition expert-led; flexible and integrated; with multi-directional communication; accessible; and stratified by risk. There is great potential for an evidence-based model of nutrition care to improve the implementation and embedding of high-quality nutrition elements into the cancer pathway.

Clinician's guide: expert insights on the use of CDK4/6 inhibitors in patients with early breast cancer

The introduction of the cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors abemaciclib and ribociclib to the adjuvant setting marks a significant advancement in the treatment of hormone-receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer (HR+, HER2- EBC). Despite significant strides in early detection and treatment, many patients continue to face the risk of disease recurrence, highlighting the need for more effective adjuvant therapies. These CDK4/6 inhibitors, combined with adjuvant endocrine therapy, have shown promising efficacy in reducing recurrence rates while maintaining a manageable safety profile, as evidenced by the monarchE and NATALEE trials. This paper explores the integration of adjuvant CDK4/6 inhibitors into clinical practice, focusing on disease-free survival and safety outcomes. Key considerations in selecting between abemaciclib and ribociclib are discussed, including patient risk profiles, efficacy and safety profiles, treatment duration, and individual patient preferences. In addition, we discuss managing adverse events to prevent premature discontinuation, with strategies that include dose holds, dose reductions, proactive symptom management, and patient education. The paper also highlights strategies to enhance patient medication adherence and the involvement of multidisciplinary care teams to support treatment delivery. As research continues to evolve, additional follow-ups of the monarchE and NATALEE trials and future trials will further refine patient selection and treatment sequencing, ultimately improving outcomes and enhancing the quality of life for patients with HR+, HER2- EBC.

The Role of Sociodemographic Characteristics and Social Determinants of Health in Influencing the Perceived Quality of Patient-Provider Communication

Background: Patient-centered communication is a critical process in high-quality healthcare that emphasizes the reciprocal sharing of information between providers and patients to ensure care aligns with the patient's needs, preferences, and personal values. A significant challenge arises from the healthcare provider's time constraints during clinical encounters and the lack of adequate training on how to adopt a patient-centered communication style that addresses patient concerns, making it difficult to foster an environment conducive to shared decision making. These issues are further exacerbated by cultural and language barriers, along with low levels of health literacy and social determinants of health (SDoHs), which complicate efforts to deliver patient-centered care. Objective: This study examined quality criteria for patient-provider communication (PPC) and their associations with sociodemographic characteristics and SDoHs on housing, transportation, and food insecurity. Methods: This retrospective cross-sectional study analyzed data from the 2022 Health Information National Trends Survey (HINTS-6) national dataset. Associations between PPC and sociodemographic variables were tested using the chi-squared test. Binary logistic regression was carried out to examine the association between three PPC criteria and each of the sociodemographic characteristics and patient comfort in disclosing information on SDoHs. Results: Bivariate analyses showed statistically significant associations for age, occupation status, marital status, Hispanic origin, and race across all three PPC criteria. Significant associations were reported for education and income for the two criteria related to being given the chance to ask questions and being involved in healthcare decisions. Finally, significant associations were reported for all PPC criteria and patient comfort levels in discussing SDoHs. Conclusions: Findings from this paper provide insight for enhancing the quality of PCC in underserved populations, particularly when it comes to informing the design of evidence-based cervical cancer screening interventions which are culturally centered around the patients' needs and that integrate PPC as a foundational component.

[Determinants in the quality of life of breast cancer survivors]

OBJECTIVES

To measure the quality of life of women breast cancer (BC) survivors and to detect differences according to clinical and sociodemographic variables.

DESIGN

Cross-sectional observational study from May to August 2024.

PLACEMENT

Spain.

PARTICIPANTS

Women BC survivors, selected by non-probabilistic purposive sampling, from the database of the Spanish Association Against Cancer.

MAIN MEASUREMENTS

Self-administered form that included the validated Quality of Life in Adult Cancer Survivors questionnaire along with a series of questions referring to clinical and sociodemographic variables. A descriptive analysis was performed and the mean scores of the scale domains were compared by Student's t-test and one-factor analysis of variance.

RESULTS

A total of 1293 women participated. The total score of the Quality of Life in Adult Cancer Survivors and most of its domains decreased significantly as both the age of the BC survivors and the time elapsed since completion of primary treatment increase. In addition, participants who were receiving hormone treatment reported worse quality of life at the time of the interview. The concern that a family member will be diagnosed with cancer is very frequent and remains constant for almost all groups.

CONCLUSIONS

Differences among BC survivors highlight the need for personalized comprehensive care, helping professionals and patients to make informed decisions, reducing oncologic impact and improving quality of life in the short and long term.

Late effects of the treatment of childhood cancer

Excellent progress has been made in the last few decades in the cure rates of pediatric malignancies, with more than 80% of children with cancer who have access to contemporary treatment being cured. However, the therapies responsible for this survival can also produce adverse physical and psychological long-term outcomes, referred to as late effects, which appear months to years after the completion of cancer treatment. Research has shown that 60% to 90% of childhood cancer survivors (CCSs) develop one or more chronic health conditions, and 20% to 80% of survivors experience severe or life-threatening complications during adulthood. Therefore, understanding the late side effects of such treatments is important to improve the health and quality of life of the growing population of CCSs.

Detection of potential complications in cancer survivors after chemotherapy and development of a regional care network: the PASCA feasibility study

Complications are often poorly identified and managed in cancer survivors after treatment and restoring their initial quality of life remains a challenge, particularly in a context of unequal access to care nationwide. The PASCA "Parcours de Santé au cours du Cancer [in English: healthcare pathways with cancer]" feasibility study was conducted in the Léon Bérard Comprehensive Cancer Center (Lyon, France) to assess the feasibility of a complications detection program, in cancer survivors who have received intensive chemotherapy. An initial network of physicians and healthcare professionals was also set up to facilitate medical referrals after detection. The study had a high recruitment rate (83.8%) and an adherence rate of 43%. In our analysis population (n = 98), 8% presented de novo dermatological, cardiological, and pneumological complications. Of these, 42 completed all program visits. Among them, the number of patients who developed a ≥ grade 2 complication increased between the first and last visits in: nephrology (+13.9%), overweight/obesity (+12.5%), endocrinology (+8.3%) and cardiology (+5.6%). Patient satisfaction was high (68%). The results supported the feasibility of a complication detection program and highlighted the presence of de novo complications at the first visit, as well as an increase in the number of patients developing complication in four areas between the first and last visit. In the future, after-treatment programs could be improved by increasing the motivation of the referring oncologists and patients, improving communication and by adapting the follow-up visits to take into consideration the constraints and profiles of the cancer survivors.

Care That Fits: Optimizing Value-Based Care for Acute Kidney Injury Survivors

Acute kidney injury (AKI) survivors are at risk for substantial adverse outcomes, and the post-AKI setting is a source of high health care utilization. Kidney health is often not prioritized after discharge from an AKI hospitalization and can be complicated by patient and process-related barriers. Improving kidney care for AKI survivors has the potential to improve outcomes, though data on which care models are optimal for this population are lacking. Care models utilized in other patient populations, as well as prior trials of AKI survivor clinics, can provide insight as to how these models could be implemented in the post-AKI setting to improve outcomes in a cost-effective way. Potential care models range on a spectrum from the least specialized, most highly scalable, and cost-effective options, such as patient engagement programs and home health, to more generally accessible models including allied health-driven models, and primary care-embedded programs, to highly specialized and less scalable options, such as nephrology-led survivor clinics. Each has potential applications and limitations in the post-AKI setting. Ongoing studies that incorporate elements of multiple care models may have the most promise to improve value-based care in the care of AKI survivors.

Survivorship clinic attendance improves completion but not timeliness of cardiac surveillance post anthracyclines

BACKGROUND

Anthracycline induced cardiomyopathy (AIC) is an important complication of cancer management. Recent findings showed that with early identification and intervention, AIC may be fully or partially reversible. European society of cardiology (ESC) guidelines recommend a risk-stratified monitoring approach, including transthoracic echocardiogram (TTE) for all patients within 12 months post-treatment.

AIM

Investigate the impact of a survivorship clinic on TTE follow up for AIC.

METHODS

Over a 5 year span, 235 patients with haematological malignancies received anthracycline chemotherapy ≥ 250mg/m2. The electronic medical records of these patients were reviewed. TTE outcomes were compared between survivorship and non-survivorship patients.

RESULTS

Survivorship patients received TTE in 88.6% of cases, whereas non-survivorship patients received TTE in 30.9% of cases. In survivorship patients, TTE was indicated for asymptomatic screening in 92.3% of cases. In non-survivorship patients the majority of TTE were for symptom investigation (78.0%). Chi-squared analysis found these results to be statistically significant (p value < 0.05).

DISCUSSION

Survivorship patients are nearly three times more likely to receive TTE monitoring for AIC. However, due to delayed clinic referral/attendance, only 36.4% received TTE within 1 year of treatment completion, in line with ESC guidelines.

CONCLUSION

Survivorship clinics improve TTE monitoring for AIC, allowing early identification and potential intervention. However, reliance on this model alone may risk inadequate surveillance for patients who do not attend and delays in referral/attendance may impact monitoring timeliness.

Co-Design and Evaluation Protocol for the RECOVER Model of Care After Childhood Cancer Treatment

Background: Advances in diagnosis and treatment have significantly increased survival rates for childhood cancer, leading to a growing population of long-term survivors. However, these survivors face substantial physical and psychological sequelae that affect both the child and their family. We developed the RECOVER model of care to support childhood cancer survivors as they transition from the end of their planned treatment to survivorship, addressing the broader health and wellness needs beyond medical surveillance. The primary objectives are to assess the feasibility and acceptability of the RECOVER model of care in routine paediatric oncology practice. Secondary objectives include evaluating preliminary efficacy outcomes and identifying factors that influence the successful adoption and integration of the model. Methods: The study comprises a Type 2 Hybrid Implementation/Effectiveness non-randomised controlled trial to compare historical and prospective data. Quantitative data will assess feasibility, reach, effectiveness, adoption, maintenance, and implementation. The qualitative component will assess end-user acceptability and appropriateness through focus groups, surveys, and interviews. Quantitative and qualitative results will be integrated during the interpretation phase to provide complementary insights into the interconnected contextual factors that facilitate the model uptake. Discussion: The RECOVER model of care aims to offer a robust approach to survivorship care, facilitating the continuous monitoring and management of long-term and late effects in childhood cancer survivors. This model has the potential to significantly improve the quality of life and health outcomes for this vulnerable population by addressing their comprehensive needs in a timely and systematic manner.

Models of care and associated targeted implementation strategies for cancer survivorship support in Europe: a scoping review protocol

INTRODUCTION

Cancer and its treatments can lead to a wide range of side-effects that can persist long after treatments have ended. Across Europe, survivorship care is traditionally hospital-based specialist-led follow-up, leading to gaps in supportive care. Improved screening, diagnosis and treatment increase survival rates. With more individuals living with, through and beyond cancer, the predominance of the hospital-based specialist model is unsustainable, costly and resource-intensive. An understanding of what alternative Models of Care are available and the barriers and facilitators to their implementation is a first step towards enhancing supportive care across the cancer journey. The aim of this scoping review is to source and synthesise information from studies evaluating patient-oriented models of cancer survivorship supportive care for adults in Europe.

METHODS AND ANALYSIS

The scoping review will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Review Extension guidelines and will be guided by a six-stage methodological framework. A search strategy has been developed according to the Population, Concept and Context structure and will be applied to seven databases. A targeted search of grey literature will be completed. All identified records will be screened using predefined eligibility criteria by at least two researchers and undergo full-text review for inclusion. Data pertaining to the conceptualisation, evaluation and implementation of sourced Models of Care will be extracted.

ETHICS AND DISSEMINATION

As there is no primary data, ethical approval is not required. This review will be conducted as part of the EU COST Action CA21152-Implementation Network Europe for Cancer Survivorship Care. The protocol and subsequent scoping review will be published in a peer-reviewed journal. The Action involves representatives from most countries across Europe which will assist with the dissemination of the work to key stakeholders.

The use of selected palliative medicine scales by family doctors in Poland, preliminary online study and its potential impact on knowledge dissemination

BACKGROUND

This study addresses the limited knowledge among Polish family doctors of scales for evaluating palliative care patients and their ability to assess symptoms using those scales. The aim was to identify the potential advantages and disadvantages for implementing this type of tools.

METHODS

A Computer-Assisted Web Interview (CAWI) was conducted among primary health care doctors. The survey assessed knowledge and usage of selected medical scales (KPS, ECOG, NRS, Barthel, Katz, ESAS, and a non-existent scale for bias check) in the daily practice of family physicians in relation to palliative care patients.

RESULTS

The study analysed responses from 706 doctors, revealing significant gaps in their knowledge and practical application of the scales. It presented lack of familiarity and inappropriate application of 4 out of 6 scales. Over 66% of surveyed doctors couldn't identify the appropriate tool for assessing the quality of life of patients with heart failure, and over 76% could not identify the appropriate tool for assessing shortness of breath and constipation. Based on the NRS pain scale this study indicates that knowledge of a scale translates directly to its practical application.

CONCLUSIONS

Appropriate educational activities should be provided to support GPs in broadening their knowledge and in using selected scales. Further studies need to be performed not only in the area of tools validation but simultaneously on how to disseminate the usage of those tools.

Trajectories of Supportive Care Needs for People Who Travel to Receive Cancer Treatment: A Longitudinal Study in Australia

OBJECTIVE

To describe trajectories of change in unmet supportive care needs over a two-year period among people diagnosed with cancer and assess whether these trajectories vary as a function of sociodemographic and clinical characteristics.

METHODS

This analysis used data from a longitudinal study of people in Queensland, Australia who travelled largely from regional and remote areas to metropolitan centres to receive cancer care (N = 784). Supportive care needs were measured at baseline, then at 3-, 12-, and 24-month post-baseline across five domains ('psychological', 'physical and daily living', 'health systems and information', 'patient care and support', 'sexuality') using the Supportive Care Needs Survey-Short Form. Latent Curve Growth Analysis was performed to examine trajectories of change in unmet needs and assess whether these trajectories were influenced by participant characteristics.

RESULTS

Significant linear slopes indicated a modest decrease in unmet supportive care needs for all domains, except sexuality. For most domains, significant variance in intercepts but not slopes indicated individual differences in needs at baseline but not in trajectories over time. At baseline, the proportion of unmet needs was highest for the 'physical and daily living' (M = 44.2%, SD = 39.1%) and 'psychological' domains (M = 37.8%, SD = 36.3%). Unmet needs at baseline were consistently higher among participants who were younger, had a higher education level, and who reported poorer QoL.

CONCLUSIONS

The proportion of unmet supportive care needs reported by people living with cancer may decrease over time, largely irrespective of sociodemographic and clinical characteristics. Despite this, unmet needs remain prevalent, particularly for physical and psychological support.

Cancer center-based follow-up among pediatric and adolescent/young adult cancer survivors: the role of a community-based organization and the social determinants of health

PURPOSE

Adherence to survivorship care is suboptimal among pediatric and adolescent/young adult (AYA) cancer survivors. We evaluated predictors of cancer center-based follow-up among pediatric/AYA cancer survivors, with an emphasis on social determinants of health (SDOH).

METHODS

This retrospective cohort study used electronic health record data at an academic medical center to identify patients aged 0-29 years at last cancer treatment who completed treatment 2010-2019. Cancer center-based follow-up was defined by oncology or survivorship clinic visits through 12/31/2022. Multivariate logistic regression models (overall, ages 0-19 [pediatric], 20-29 [YA]) evaluated the association of demographics, clinical/treatment characteristics, and SDOH (insurance type, distance to cancer center, area deprivation index) with clinic attendance. Further modeling accounted for the service area of a community-based organization (CBO) that supports families of children with cancer.

RESULTS

A total of 2210 survivors were included (56% pediatric, 44% YA; 66% non-White). Cancer center-based follow-up decreased from 94% 1-year post-treatment to 35% at > 5-7 years. In adjusted analysis, AYAs had the lowest follow-up (5-7 years post-treatment: OR 0.25 [0.15-0.41] for age 25-29; OR 0.25 [0.16-0.41] for age 20-24; OR 0.32 [0.20-0.52] for age 15-19). Survivors residing within the CBO service area were twice as likely to follow-up (OR 2.10 [1.34-3.29]).

CONCLUSIONS

Among a diverse population, AYA survivors were vulnerable to loss to follow-up. Other SDOH were not consistently associated with follow-up. Support from a CBO may partly explain these findings.

IMPLICATIONS FOR CANCER SURVIVORS

CBOs may strengthen survivorship follow-up within medically underserved communities. More research is needed to understand community support in survivorship.

Are digital psychological interventions for psychological distress and quality of life in cancer patients effective? A systematic review and network meta-analysis

BACKGROUND

Many cancer patients experience psychological distress and/or poor quality of life during or after their cancer treatment, yet they face multiple barriers to accessing psychological support. Digital psychological interventions represent a promising approach for addressing these barriers, however their comparative effectiveness remains uncertain.

METHODS

Nine databases were searched for randomized controlled trials (RCTs) from inception to July 2024. The primary outcomes were psychological distress and quality of life, and the secondary outcomes were measures of depression, anxiety, insomnia, fatigue, and fear of cancer recurrence in this study.

RESULTS

One hundred and thirty-six RCTs with 23,154 participants were identified. Of these interventions, three types-digitally-delivered cognitive behavioral therapy (CBT), health education, and virtual reality therapy (VRT)-demonstrated significant reductions in psychological distress compared to non-active controls. Digital CBT, narrative interventions, and VRT significantly improved quality of life compared to non-active controls. For depression, both digital CBT and VRT were superior to the non-active control group. Regarding anxiety, CBT, psychoeducation, and VRT outperformed the non-active control group. In terms of fatigue, CBT, psychoeducation, VRT, and multi-component interventions all showed enhanced efficacy compared to the non-active control group. However, only CBT exhibited significantly superior effectiveness in alleviating insomnia compared to non-active controls. Similarly, only mindfulness-based interventions significantly reduced fear of cancer recurrence compared to the non-active control condition.

CONCLUSIONS

Our results suggest that digital CBT and VRT are highly promising options for reducing psychological distress and enhancing the quality of life among cancer patients; further high-quality randomized controlled trials involving diverse populations are essential to validate these findings.

Co-Design of the Structured Personalised Assessment for Reviews After Cancer (SPARC) Intervention

INTRODUCTION

An increasing number of people are living beyond cancer with unmet health needs. The aim of this study was to co-design a digital intervention to improve health outcomes for people who have completed potentially curative treatment for cancer.

METHODS

Two co-design workshops were held with patients, clinicians (including oncologists, general practitioners and nurses), digital/computing science experts and third-sector representatives. At workshop one, problems and gaps in care were identified and intervention ideas were generated. At workshop two, a prototype intervention was discussed and refined.

RESULTS

The workshops were attended by 43 people in total: 26 at event one and 23 at event two (six attended both events). Patients valued relationship-based care and felt supported during hospital treatment. Patients 'fell off a cliff' after discharge, and there was consensus that more could be done in primary care to support those living beyond cancer. It was proposed that cancer reviews could be integrated into UK primary care chronic disease management activities. A digital form, the 'Structured Personalised Assessment for Reviews after Cancer' (SPARC) tool, was developed to support asynchronous consultations that would cover the breadth of problems and health promotion activities required for high-quality primary care for cancer. SPARC could also identify those without problems who do not require review.

CONCLUSION

SPARC has been co-designed to support brief but comprehensive cancer review consultations between primary care clinicians and their patients. SPARC aligns with best practice guidelines. The next step is to evaluate SPARC with patients and in general practices.

PATIENT AND PUBLIC CONTRIBUTION

Patient and stakeholder engagement was at the centre of this research study. Cancer organisations such as 'CLAN' cancer support, Prostate Cancer Scotland and Cancer Research UK helped us to engage with patients. The Aberdeen University Institute of Applied Health Science Patient Public Involvement group were also instrumental in sense-checking and improving the materials for the second workshop. We plan to involve our patient and carer partners in designing the next stages of our research (including study materials, processes and methods) so that they will be at the centre of evaluating the intervention that they have been instrumental in designing.

Patterns of Survivorship Follow-Up Care Among Patients With Breast Cancer: A Retrospective Population-Based Cohort Study in Ontario, Canada, Between 2006 and 2016

PURPOSE

Many cancer survivors have ongoing follow-up with their oncologist(s), despite evidence that this care can be competently managed by primary care and transitioning well survivors could relieve growing pressure on cancer care systems. We analyzed population-based administrative data from Ontario, Canada, to examine rates of transition to primary care-led follow-up care during the survivorship phase, including clinical and demographic predictors associated with being transitioned.

METHODS

We conducted a retrospective cohort study to describe the patterns of survivorship follow-up care among all patients with breast cancer in Ontario from 2006 to 2016. Data were derived from the Ontario Cancer Registry and other linked data sets. We defined the survivorship phase of care beginning at 2 years after initial diagnosis. Logistic regression was used to explore factors potentially prognostic of no oncology visits in each of the years after survivorship.

RESULTS

Our survivorship cohort was composed of 71,719 patients with breast cancer, 42% of whom were considered to have transitioned from oncology to primary care 2 years after diagnosis. Although the number of patients having oncology visits diminished over time, a quarter of the cohort continued being seen in year 5 of survivorship. Regression analysis found older age, early cancer stage, living farther from a cancer center, not receiving radiation or chemotherapy, and high well-being to be associated with transitioning to primary care.

CONCLUSION

Our findings contribute to the development of low-risk profiles among survivors to inform optimal transition from oncology to primary care. Further research examining qualitative perspectives from oncologists, cancer survivors, and primary care is also required to illuminate other sentinel factors to be considered when transitioning during follow-up.

Needs Assessment to Guide the Development of a Pediatric Survivorship Program to Promote the Physical and Psychological Well-being of Children After Cancer Treatment

BACKGROUND

Studies have provided insights into the major challenges and needs of young children who survive cancer. Many such challenges are related to a lack of support during the patient's transition back to normal life. Survivorship programs are designed to help survivors cope with potential late effects of treatment and to provide psychosocial support. However, there is not yet a survivorship program in Hong Kong that provides young survivors with continuous care.

OBJECTIVES

To explore the challenges and needs faced by pediatric cancer survivors during their transition from patient to survivor and to guide the development of the survivorship program.

METHODS

A qualitative descriptive design utilizing purposive sampling was used. Semistructured interviews were conducted with 30 pediatric cancer survivors aged between 9 and 18 years, along with their parents/caregivers, as well as 5 pediatric cancer oncology nurses and 3 pediatric oncologists.

RESULTS

The interviews yielded 4 overarching themes: (1) challenges in school reintegration, (2) concerns relating to physical and psychological well-being, (3) lack of social support and adaptation difficulties, and (4) needs for supportive care services.

CONCLUSION

The findings provide insights into the needs of pediatric cancer survivors, their parents, and other key stakeholders. These insights suggest that a pediatric cancer survivorship program should be established in Hong Kong as an essential component of the continuum of cancer care.

IMPLICATIONS FOR PRACTICE

Survivor clinic care should be enhanced to provide continuous support for children who have completed medical treatment and their caregivers, incorporating the perspectives of all stakeholders.

Leveraging artificial intelligence-mediated communication for cancer prevention and control and drug addiction: A systematic review

OBJECTIVE

To conduct a systematic review on Artificial Intelligence-Mediated Communication (AIMC) behavioral interventions in cancer prevention/control and substance use.

METHODS

Eight databases were searched from 2017 to 2022 using the Population Intervention Control Outcome Study (PICOS) framework. We synthesized findings of AIMC-based interventions for adult populations in cancer prevention/control or substance use, applying SIGN Methodology Checklist 2 for quality assessments and reviewing retention and engagement.

RESULTS

Initial screening identified 187 studies; seven met inclusion criteria, involving 2768 participants. Females comprised 67.6% (n = 1870). Mean participant age was 42.73 years (SD = 7.00). Five studies demonstrated significant improvements in substance use recovery, physical activity, genetic testing, or dietary habits.

CONCLUSIONS

AIMC shows promise in enhancing health behaviors, but further exploration is needed on privacy risks, biases, safety concerns, chatbot features, and serving underserved populations.

IMPLICATIONS

There is a critical need to foster comprehensive fully powered studies and collaborations between technology developers, healthcare providers, and researchers. Policymakers can facilitate the responsible integration of AIMC technologies into healthcare systems, ensuring equitable access and maximizing their impact on public health outcomes.

Multilevel factors influence the use of a cardiovascular disease assessment tool embedded in the electronic health record in oncology care

Digital health tools are positive for delivering evidence-based care. However, few studies have applied rigorous frameworks to understand their use in community settings. This study aimed to identify implementation determinants of the Automated Heart-Health Assessment (AH-HA) tool within outpatient oncology settings as part of a hybrid effectiveness-implementation trial. A mixed-methods approach informed by the Consolidated Framework for Implementation Research (CFIR) examined barriers and facilitators to AH-HA implementation in four NCI Community Oncology Research Program (NCORP) practices participating in the WF-1804CD AH-HA trial. Provider surveys were analyzed using descriptive statistics. Interviews with providers (n = 15) were coded using deductive (CFIR) and inductive codes by trained analysts. The CFIR rating tool was used to rate each quote for (i) valence, defined as a positive (+) or negative (-) influence, and (ii) strength, defined as a neutral (0), weak (1), or strong (2) influence on implementation. All providers considered discussing cardiovascular health with patients as important (61.5%, n = 8/13) or somewhat important (38.5%, n = 5/13). The tool was well-received by providers and was feasible to use in routine care among cancer survivors. Providers felt the tool was acceptable and usable, had a relative advantage over routine care, and had the potential to generate benefits for patients. Common reasons clinicians reported not using AH-HA were (i) insufficient time and (ii) the tool interfering with workflow. Systematically identifying implementation determinants from this study will guide the broader dissemination of the AH-HA tool across clinical settings and inform implementation strategies for future scale-up hybrid trials.

Long-term behavioral symptom clusters among survivors of early-stage breast cancer: Development and validation of a predictive model

BACKGROUND

Fatigue, cognitive impairment, anxiety, depression, and sleep disturbance are cancer-related behavioral symptoms that may persist years after early-stage breast cancer, affecting quality of life. We aimed to generate a predictive model of long-term cancer-related behavioral symptoms clusters among breast cancer survivors 4 years after diagnosis.

METHODS

Patients with early-stage breast cancer were included from the CANcer TOxicity trial (ClinicalTrials.gov identifier NCT01993498). Our outcome was the proportion of patients reporting cancer-related behavioral symptoms clusters 4 years after diagnosis (≥3 severe symptoms). Predictors, including clinical, behavioral, and treatment-related characteristics; Behavioral Symptoms Score (BSS; 1 point per severe cancer-related behavioral symptom at diagnosis); and a proinflammatory cytokine (interleukin 1b; interleukin 6; tumor necrosis factor α) genetic risk score were tested using multivariable logistic regression, implementing bootstrapped augmented backwards elimination. A 2-sided P less than .05 defined statistical significance.

RESULTS

In the development cohort (n = 3555), 642 patients (19.1%) reported a cluster of cancer-related behavioral symptoms at diagnosis, and 755 (21.2%) did so 4 years after diagnosis. Younger age (adjusted odds ratio for 1-year decrement = 1.012, 95% confidence interval [CI] = 1.003 to 1.020), previous psychiatric disorders (adjusted odds ratio vs no = 1.27, 95% CI = 1.01 to 1.60), and BSS (adjusted odds ratio ranged from 2.17 [95% CI = 1.66 to 2.85] for BSS = 1 vs 0 to 12.3 [95% CI = 7.33 to 20.87] for BSS = 5 vs 0) were predictors of reporting a cluster of cancer-related behavioral symptoms (area under the curve = 0.73, 95% CI = 0.71 to 0.75). Genetic risk score was not predictive of these symptoms. Results were confirmed in the validation cohort (n = 1533).

CONCLUSION

Younger patients with previous psychiatric disorders and higher baseline symptom burden have greater risk of long-term clusters of cancer-related behavioral symptoms. Our model might be implemented in clinical pathways to improve management and test the effectiveness of risk-mitigation interventions among breast cancer survivors.

Implementation and ethical issues of an eHealth-facilitated integrated care model in stem cell transplantation: A qualitative process evaluation study

Introduction

eHealth-facilitated integrated care models (eICMs) offer promising enhancements to healthcare delivery in stem cell transplantation, but entail implementation and ethical challenges. While qualitative process evaluation methodologies can effectively address such issues through interdisciplinary collaboration, no previous studies have integrated approaches from implementation science and applied ethics into eICM evaluations.

Objective

Exploring an integrated approach to the qualitative process evaluation of a stem cell transplantation eICM (SMILe-ICM), our objectives were threefold: (1) assess the current SMILe-ICM's implementation through stakeholder perceptions; (2) examine relevant ethical issues; and (3) develop strategies to mitigate identified implementation and ethical challenges.

Methods

Semistructured individual interviews were conducted with 12 patients and 3 relatives. Additionally, 8 clinicians in total participated in two focus groups. Data analysis followed an inductive-deductive thematic approach built on interpretative frameworks from implementation science and medical ethics and supported by ethical consultations.

Results

We isolated three main themes, centered on the patient's treatment journey and recovery, to explain patients', their relatives' and clinicians' perceptions regarding the SMILe-ICM. While the SMILe-ICM was generally viewed as valuable, perspectives varied regarding standardized procedures, including eHealth, and care coordination practices. These themes encompass implementation and ethical issues related to individual, intervention, inner setting, and outer setting factors, leading to the development of 17 implementation strategies.

Conclusion

This study provides nuanced insights into patient- and provider-level eICM implementation and ethical challenges. By identifying these issues early, the integrated research design and resulting strategies facilitated well-informed, timely solutions.

Spanish Society of Medical Oncology recommendations for comprehensive assessment and care of cancer survivors' needs

This article reviews the contemporary and inclusive definition of cancer survivorship, including patients with and without disease who have completed or continue to undergo treatment. The Spanish Society of Medical Oncology (SEOM) describes in this article the needs of these patients and outlines a care model based on an estimation of cancer incidence and identification of patient needs, to enable the provision of practical actions to achieve effective care. The objectives of this review are to identify the main effects of cancer on survivors and to establish appropriate ways of measuring these effects, as well as discussing the management of physical, psychological and social, occupational, financial, and other health-related needs. We suggest a multidisciplinary care model and training programs for the different professionals involved in care, and highlight challenges and the future role of the SEOM and health-care policy in ensuring optimum care of cancer survivors.

Profiling current cancer survivorship practices and enhancing survivorship care in public hospitals in Victoria, Australia

PURPOSE

Comprehensive survivorship care involves cancer surveillance, management of post-treatment effects, health promotion and coordination between care sectors. This study aimed to understand current survivorship practices, build awareness and support improved survivorship care in Victoria, Australia.

METHODS

This project had three components: (1) a survey of 20 Victorian clinical sites, assessing elements described in the Victorian Quality Cancer Survivorship Framework; (2) educational webinars for oncology health professionals, to increase survivorship knowledge and awareness; (3) implementation of targeted survivorship care quality initiatives in a sample of health services. Survey, evaluation and outcome data were reported descriptively.

RESULTS

All sites responded to the survey (3 hospitals have a common operating model hence supplied a single response). Most (11/18, 60%) rated their survivorship care as 'developing' and did not have a clear survivorship care policy (13/18, 72%). The provision of post-treatment information was inconsistent, as was the assessment for needs. Most sites do not stratify survivors (< 25% of survivors received stratified care at 13/18 sites, 72%), provide survivorship care plans (< 25% survivors received SCP at 8/18 sites, 44%) and collect limited outcome data. Webinars were well received, with 98% of health professionals reporting improved knowledge and awareness. All seven sites valued targeted implementation support to improve aspects of survivorship care.

CONCLUSIONS

Current Victorian survivorship care appears suboptimal. There was good health professional engagement with educational webinars and with improvement activities.

IMPLICATIONS FOR CANCER SURVIVORS

Results have informed survivorship improvement work, focusing on implementing policy, improving aspects of care delivery and building capability across the state.

Contextual factors that influence adoption and sustainment of self-management support in cancer survivorship care: a practical application of theory with qualitative interviews

BACKGROUND

Self-management support (SMS) is a recommended component of cancer survivorship care that improves health-related quality of life and reduces healthcare utilisation. However, widespread implementation has been difficult to achieve, with a gap in the literature on system-wide implementation efforts. This study examines contextual factors perceived to influence SMS adoption and sustainment in cancer centres in the Republic of Ireland.

METHOD

Semistructured interviews were conducted with 47 key informants from 20 cancer organisations across community and hospital settings. Participants were asked to report the level of adoption and sustainment of SMS at their organisation. This information was used to categorise organisations as low, medium or high implementers. We conducted cross-case analysis following the principles of Framework Analysis. Using the Consolidated Framework for Implementation Research as a menu of constructs, we examined factors influencing adoption and sustainment and variation in levels of implementation.

RESULTS

National policy, external accreditation, external financing opportunities and the presence of champions in organisations are influential early in the implementation process driving adoption. Healthcare provider-led programmes and evidence of SMS improving patient outcomes and aligning with an organisation's priorities are necessary to secure buy-in, particularly among senior leadership. An organisational culture of entrepreneurship enables adoption and sustainment, with resources and a culture supporting staff well-being enabling sustainment.

CONCLUSION

While national policy is a driver, additional factors related to programme attributes and local contextual features such as the presence of champions, organisational readiness and culture influence implementation. The results may be used for future evaluations of SMS implementation in cancer survivorship care and to inform the development of tailored implementation strategies.

A digital and nurse-led support intervention, first year after prostate cancer treatment: a single-arm feasibility study in a Swedish primary care setting

BACKGROUND

The prevalence of patients with prostate cancer is increasing, and the first year after treatment is a vulnerable period for patients as they experience symptoms and unmet needs. Although electronic patient-reported outcomes that focus on patient self-management have demonstrated benefits, evidence is sparse regarding patients with prostate cancer in primary care settings and the role of nurses as a supportive resource. The significant role of primary care in future cancer care is on the agenda. This study aims to test the feasibility of a complex intervention that includes electronic patient-reported outcomes and self-management advice in an app, combined with nurse-led support, in primary care settings during the first year after curative intended prostate cancer treatment.

METHODS

The intervention lasted four weeks and was a single-arm study. Feasibility was assessed by examining the recruitment process, retention rate, adherence to the reporting of symptoms in the app, and acceptability of the intervention. Data was collected through (1) logged data from the app that included patient-reported outcomes and self-management advice, (2) field notes by the nurse, and (3) semi-structured interviews with patients. Descriptive statistics were applied to logged data. The interviews and the field notes were analysed using qualitative content analysis.

RESULTS

The recruitment rate was 55%, yielding 11 patients with high retention as all completed the intervention. Adherence to reporting was 100%, and all functions in the app were used. Individual variation in how patients used the app was found, which was attributed to patients' current needs. In total, 36 health dialogues with the nurse (virtual, face-to-face, telephone) were performed; all first dialogues lasted longer, while follow-ups were shorter. Patients described that the health dialogues covered relevant subjects and that the combination of using the app and health dialogues was tailored and provided supplementary support. No adverse events occurred; however, a few technical difficulties interfered with the intervention, and the patients gave valuable suggestions for improvement. Furthermore, patients suggested that the intervention should start immediately after treatment.

CONCLUSION

As the patients adhered to and accepted the intervention, it was considered feasible. Findings suggest intervention should start directly after treatment ends.

Exploring disparities in post-cancer treatment instructions: an analysis of rural vs. urban breast cancer survivors in Missouri using BRFSS data

BACKGROUND

There are more than 4 million breast cancer survivors in the United States. With continuing improvements in early detection and treatment, the number of breast cancer survivors will only continue to increase. Breast cancer survivors face a lifetime risk of long-term or late-effects from cancer treatments, thus post-cancer treatment care, referred to as survivorship care, is critical. Social determinants of health, including where a breast cancer survivor lives, may impact cancer survivorship care. Our purpose was to evaluate the relationship between rural/urban status and receipt of cancer survivorship care and instructions for Missouri breast cancer survivors using state-level data from a nationwide telephone survey-the Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

Missouri included the BRFSS Cancer Survivorship Module in 2014, 2016, 2018, and 2020. Module items ask cancer survivors about receipt of a "post-cancer-treatment summary" and "follow-up instructions." We hypothesized chances of receipt of both components would differ among four level Rural-Urban Commuting Area (RUCA) Code groups (Rural, Small-Town, Micropolitan, Metropolitan). Data from 430 breast cancer survivors over four survey years were combined and grouped according to RUCA status. Using a logistic model with a multilevel approach (after sampling weights calibration), the relationship between receipt of survivorship instructions and RUCA group was examined.

RESULTS

46% of Missouri breast cancer survivors reported receipt of complete survivorship instructions. Compared to rural breast cancer survivors, micropolitan breast cancer survivors had 5.9 times higher odds of receiving survivorship instructions (p < 0.0001).

CONCLUSIONS

Less than half of respondents reported receiving complete post-cancer treatment instructions. More urban respondents were more likely to receive instructions than their rural counterparts which raises questions about the quality of post-treatment care between rural and urban survivors. A sophisticated and purposeful approach to mitigating potential disparities is warranted. Receipt of cancer survivorship care plans may be impacted by rurality/urbanicity. Clinicians caring for cancer survivors living in rural or urban settings must continue to be diligent with providing personalized survivorship care.

Personalised exercise rehabilitation in cancer survivorship: Findings from a triage and referral feasibility study

PURPOSE

Screening, triage and referral systems are proposed as efficient, needs-based models of cancer rehabilitation. This study aimed to evaluate the feasibility of the PERCS triage and referral system.

METHODS

Utilising a pre-post design, the feasibility of PERCS was evaluated quantitatively in the context of a physiotherapy-led clinic for patients diagnosed with cancer during COVID-19. Assessments at baseline and 12 weeks (T1) included medical, social and physical activity history; patient-reported outcomes and performance-based measures. Following the assessment, the PERCS system allocated participants to one of three exercise pathways.

RESULTS

Sixty-four participants were recruited over 5 months (25.2% recruitment rate; female n = 39; mean age 61.4 (12.4) years). Almost all participants (90.6%) required support to become more physically active. The majority (n = 43, 66%) were referred to community exercise programmes, and n = 15 (23%) required physiotherapy rehabilitation. Five required medical pre-clearance, and one was re-triaged at 1 week. The mean cost per participant for community exercise services was €107.70. At T1, adherence to physical activity guidelines increased for aerobic (44 to 83%) and resistance (13 to 67%) exercise. Improvements were observed in hand grip strength (x̄ 2.59 kg, p = 0.001), 30-s sit-to-stand (x̄ + 3.7 stands, p < 0.001) and 6-min walk test (x̄ + 37.3 m, p = 0.001).

CONCLUSION

PERCS appropriately triaged patients to the right level of exercise and rehabilitation for individual needs. Participants experienced improvements in physical activity and physical functioning metrics.

IMPLICATIONS FOR CANCER SURVIVORS

The PERCS triage and referral system is feasible to complete and may support the effective and patient-centred implementation of exercise into cancer care.

TRIAL REGISTRATION

ClinicalTrials.gov registration: NCT05615285.

Prevalence of cancer survivors in the United States

BACKGROUND

With aging of the population and improvements in diagnosis, treatment, and supportive care, the number of cancer survivors in the United States has increased; updated prevalence estimates are needed.

METHODS

Cancer prevalence on January 1, 2022, was estimated using the Prevalence Incidence Approach Model, utilizing incidence, survival, and mortality. Prevalence by age decade, sex, and time from diagnosis was calculated. The percentage of cancer survivors in the projected US population by age and sex was calculated as the ratio of the sex-specific projected prevalence to the sex-specific projected US population.

RESULTS

There were an estimated 18.1 million US cancer survivors as of January 1, 2022. From 2022 to 2030, the number of US cancer survivors is projected to increase to 21.6 million; by 2040, the number is projected to be 26 million. Long-term survivors are highly prevalent; in 2022, 70% of cancer survivors had lived 5 years or more after diagnosis, and 11% of cancer survivors had lived 25 years or more after diagnosis. Among all US females aged 40-54 years, 3.6% were cancer survivors; among females aged 65-74 years, 14.5% were cancer survivors; among females aged 85 years and older, 36.4% were cancer survivors. Among all US males aged 40-54 years, 2.1% were cancer survivors; among males aged 65-74 years, 16% were cancer survivors; and among those aged 85 years and older, 48.3% were cancer survivors.

CONCLUSIONS

Cancer survivors are growing in number. In the United States, most cancer survivors are long-term and very long-term survivors, representing a substantial proportion of the US population.

A qualitative study of specialist multidisciplinary clinician perspectives on barriers/facilitators to care for children with brain cancer and their families: "We're a little bit different to our adult counterparts"

OBJECTIVES

Children with brain cancer and their families have complex care needs throughout diagnosis, active treatment, long-term survivorship, and the palliative phase of illness. This study aimed to explore the perspectives of Australian specialist clinicians on barriers and facilitators to health care for children with brain cancer and their families.

METHODS

A qualitative approach was taken using semi-structured interviews. Eligible participants were clinicians of any discipline providing care to children with brain cancer and their families in Australia. Interviews were conducted by telephone and asked about perceived strengths and weaknesses in health care and available resources for this population. Qualitative content analysis used a directed approach with inductive refinement.

RESULTS

Eleven clinicians participated, 5 of whom were medical, 3 nursing, and 3 allied health. The overarching theme was that the rarity and diversity of brain tumors in children confers challenges to care that lead to variation in practice. Participants reported having to adapt care from guidelines and patient/family resources designed for adults with brain cancer and children with other cancers, and rely on clinical and research networks. Specialist comprehensive cancer care was generally perceived to offer the best model for accommodating the unique needs of each child/family, but barriers to access were highlighted for children in remote Australia, and long-term follow-up was perceived to be inadequate regardless of where children lived.

SIGNIFICANCE OF RESULTS

Until further brain cancer-specific paediatric guidelines become available, our findings highlight the need for communities of practice to share resources and reduce unwarranted variation.

CONCLUSION

Future research should focus on developing and evaluating guidelines and other resources specific to children with brain cancer, as well as informing suitable models for long-term follow-up care for survivors.

Non-gastrointestinal symptom burden following colorectal cancer treatment-a systematic review

BACKGROUND

Colorectal cancer is one of the most common malignancies worldwide. Improvements in screening and treatment have allowed for earlier detection and longer survival. However, treatments, which may involve surgery, radiotherapy and/or chemotherapy, often lead to patients developing both gastrointestinal and non-gastrointestinal symptoms that can persist long term. This systematic review aims to understand better the non-gastrointestinal symptoms that patients develop after colorectal cancer treatment and how these are identified and assessed through the use of questionnaires.

METHOD

The review was conducted according to PRISMA guidelines. Scopus, PubMed, Web of Science, PsycINFO and Cochrane Library were searched. Eligible studies evaluated the non-gastrointestinal symptoms that patients had developed and continued to have at 12 months or longer after treatment. Studies that were performed on patients who were within 12 months of treatment, who had a recurrent or a secondary cancer, had stage 4 cancer/were palliative or that looked solely at gastro-intestinal symptoms were excluded. Articles were limited to studies on human subjects written in English published between February 2012 and July 2024.

RESULTS

The searches identified 3491 articles. Thirty-seven articles met the inclusion criteria, of which, 33 were quantitative, 2 were qualitative and 2 were mixed methods study designs. Nearly two-thirds (n = 22) were cross-sectional studies, whereas 14 were longitudinal. One study had both a cross-sectional and longitudinal component to it. Most studies were of medium to high quality based on the Newcastle Ottawa Scale (n = 23) and were conducted in 14 countries, the majority of which were performed in the Netherlands (n = 14). The majority of participants in the included studies (n = 30/37) were men. There were also three studies that were performed with only female participants and one study that was performed with male participants only. The age range of research participants across all the studies was 29 to 89 years. Forty-five different validated questionnaires containing 5-125 question items were used to collect information on the side effects and impact of colorectal cancer treatment. Completion rate for questionnaires varied from 30 to 100% (median 63.5%). These determined effects on quality of life, emotional/psychological distress, sexual and urinary dysfunction, neuropathy, fatigue and hip pain.

CONCLUSION

This systematic review highlighted a wide range of longer-term non-gastrointestinal symptoms that frequently adversely affect QoL following treatment. These studies included highlighting the importance of nutrition/diet, physical activity, spirituality and communication in managing these long-term side effects.

A Scoping Review of Group Nutrition Education and Cooking Programs for People Affected by Cancer

BACKGROUND

Group nutrition education and cooking programs for people affected by cancer have the potential to address commonly reported unmet needs for dietary information, as well as provide opportunities for practical and social support.

OBJECTIVE

To report the nutrition-related content, delivery methods, and outcomes measured in group nutrition education and cooking programs for people affected by cancer in the published literature, and describe how these programs were developed, implemented, and evaluated.

METHODS

A scoping review of academic literature is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines. Key terms such as cancer, nutrition education, and cooking were searched across 4 databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, and Web of Science) on June 1, 2023, for records published over the past 10 years. Records were independently screened by 2 reviewers. Data extracted included program participants, components, nutrition-related content, delivery methods, outcomes measured, and information about how the program was developed, implemented, and evaluated.

RESULTS

Of 2,254 records identified, 41 articles met eligibility criteria, reporting on 37 programs. Most programs were designed for adult cancer survivors (89%) and conducted after primary treatment (81%). Four programs invited caregivers to attend. Almost all programs (97%) included a nutrition education component, and more than half (59%) included cooking activities, with a predominant focus on recommendations and practical skills for healthy eating. Most programs were delivered byregistered dietitians and/or nutritionists (54%) and included group discussions (57%) and active involvement in cooking activities (57%) in program delivery. The participant outcomes that were measured covered dietary, psychosocial, clinical, and anthropometric domains. Many programs were developed with cancer survivors, dietitians or nutritionists, and researchers. No studies reported on sustainability of program implementation or overall costs. Programs were evaluated using data from surveys, focus groups, interviews, and field notes, with articles typically reporting on participation rates, reasons for nonparticipation, program acceptability, aspects of the nutrition-related programs valued by participants, and suggestions for improvement.

CONCLUSIONS

Future research should prioritize assessing the effectiveness of these programs for participants. Future development, implementation, and evaluation of these programs should include family members and friends and assess the sustainability of program delivery, including cost-effectiveness.

Primary care physicians' knowledge and confidence in providing cancer survivorship care: a systematic review

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.

Healthcare providers' expected barriers and facilitators to the implementation of person-centered long-term follow-up care for childhood cancer survivors: A PanCareFollowUp study

BACKGROUND

Childhood cancer survivors face high risks of adverse late health effects. Long-term follow-up care for childhood cancer survivors is crucial to improve their health and quality of life. However, implementation remains a challenge. To support implementation of high-quality long-term follow-up care, we explored expected barriers and facilitators for establishing this follow-up care among healthcare providers from four European clinics.

METHODS

A qualitative study was conducted using four focus groups comprising 30 healthcare providers in total. The semi-structured interview guide was developed based on the Grol and Wensing framework. Data was analyzed following a thematic analysis, combining both inductive and deductive approaches to identify barriers and facilitators across the six levels of Grol and Wensing: innovation, professional, patient, social, organizational and economic and political.

RESULTS

Most barriers were identified on the organizational level, including insufficient staff, time, capacity and psychosocial support. Other main barriers included limited knowledge of late effects among healthcare providers outside the long-term follow-up care team, inability of some survivors to complete the survivor questionnaire and financial resources. Main facilitators included motivated healthcare providers and survivors, a skilled hospital team, collaborations with important stakeholders like general practitioners, and psychosocial care facilities, utilization of the international collaboration and reporting long-term follow-up care results to convince hospital managers.

CONCLUSION

This study identified several factors for successful implementation of long-term follow-up care for childhood cancer survivors. Our findings showed that specific attention should be given to knowledge, capacity, and financial issues, along with addressing psychosocial issues of survivors.

Survivorship after adolescent and young adult cancer: models of care, disparities, and opportunities

Survivors of adolescent and young adult (AYA; age 15-39 years at diagnosis) cancer are a growing population with the potential to live for many decades after treatment completion. Survivors of AYA cancer are at risk for adverse long-term outcomes including chronic conditions, secondary cancers, impaired fertility, poor psychosocial health and health behaviors, and financial toxicity. Furthermore, survivors of AYA cancer from racially minoritized and low socioeconomic status populations experience disparities in these outcomes, including lower long-term survival. Despite these known risks, most survivors of AYA cancer do not receive routine survivorship follow-up care, and research on delivering high-quality, evidence-based survivorship care to these patients is lacking. The need for survivorship care was initially advanced in 2006 by the Institute of Medicine. In 2019, the Quality of Cancer Survivorship Care Framework (QCSCF) was developed to provide an evidence-based framework to define key components of optimal survivorship care. In this commentary focused on survivors of AYA cancer, we apply the QCSCF framework to describe models of care that can be adapted for their unique needs, multilevel factors limiting equitable access to care, and opportunities to address these factors to improve short- and long-term outcomes in this vulnerable population.

Eliciting Older Cancer Patients' Preferences for Follow-Up Care to Inform a Primary Healthcare Follow-Up Model in China: A Discrete Choice Experiment

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.

Evaluating the Implementation of Integrated Proactive Supportive Care Pathways in Oncology: Master Protocol for a Cohort Study

BACKGROUND

Supportive care (SC) refers to the prevention and management of complications of cancer and its treatment. While it has long been recognized as an important cancer care delivery component, a high proportion of patients face unaddressed SC needs, calling for innovative approaches to deliver SC.

OBJECTIVE

The objective of this master protocol is to evaluate the implementation of different integrated proactive SC pathways across the cancer care continuum in our institution (Gustave Roussy, Villejuif, France). Pathways studied in this master protocol may occur shortly after diagnosis to prevent treatment-related burden; during treatment to monitor the onset of toxicities and provide timely symptom management; and after treatment to improve rehabilitation, self-management skills, and social reintegration.

METHODS

This study is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. The primary objective is to evaluate the impact of SC pathways on patients' distress and unmet needs after 12 weeks, measured by the National Comprehensive Cancer Network's Distress Thermometer and Problem List. Secondary objectives will focus on the pathways (macrolevel) and each SC intervention (microlevel), evaluating their reach (administrative data review of the absolute number and proportion of clinical and sociodemographic characteristics of patients included in the pathways); short-term and long-term efficacy through their impact on quality of life (EQ-5D-5L and the 30-item European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire) and symptom burden (MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and 22-item European Organization for Research and Treatment of Cancer Sexual Health Questionnaire); adoption by patients and providers (administrative data review of SC referrals and attendance or use of SC strategies); barriers to and leverage for implementation (surveys and focus groups with patients, providers, and the hospital organization); and maintenance (cost-consequence analysis). Pilot evaluations with a minimum of 70 patients per pathway will be performed to generate mean Distress Thermometer scores and SDs informing the calculation of formal sample size needed for efficacy evaluation (cohorts will be enriched accordingly).

RESULTS

The study was approved by the ethics committee, and as of February 2024, a total of 12 patients were enrolled.

CONCLUSIONS

This study will contribute toward innovative models of SC delivery and will inform the implementation of integrated SC pathways of care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06479057; https://clinicaltrials.gov/study/NCT06479057.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/52841.

Healthcare professionals' knowledge, understanding and confidence to manage chronic pain after cancer treatment: A UK survey

INTRODUCTION

Healthcare professionals are vital in preparing people living with and beyond cancer about the risks of chronic pain after cancer treatment. To do so, healthcare professionals need to be knowledgeable and confident about chronic pain after cancer treatment, yet little is known about their understanding or confidence of this common long-term and late side effect of cancer treatment.

AIM

To identify healthcare professionals' knowledge and understanding of chronic pain after cancer treatment and consider how confident they are to inform, listen and signpost people living with and beyond cancer to appropriate information and support.

METHOD

A cross sectional online survey was distributed to healthcare professionals in the UK via cancer and primary care networks, cancer alliances and social media. The survey consisted of four domains: 1) knowledge and understanding, 2) information and support, 3) confidence and 4) barriers. Quantitative data were analysed with descriptive statistics and free text comments were analysed using qualitative content analysis.

RESULTS

Healthcare professionals reported limited knowledge and understanding of chronic pain after cancer treatment. Healthcare professionals lacked confidence to talk to people about chronic pain after cancer treatment and viewed their lack of knowledge as a barrier. Additional barriers included 'Limited service provision', 'Conflict between services', 'Not my role' and 'Challenges in diagnosing chronic pain in cancer survivors'.

CONCLUSION

Chronic pain after cancer can be a significant issue for those living with and beyond cancer, yet healthcare professionals report limited knowledge of it or understanding of the impact. More education is needed to increase healthcare professionals' knowledge and confidence in chronic pain after cancer treatment.

EBCC-14 manifesto: Addressing disparities in access to innovation for patients with metastatic breast cancer across Europe

The European Breast Cancer Council (EBCC) traditionally identifies controversies or major deficiencies in the management of patients with breast cancer and selects a multidisciplinary expert team to collaborate in setting crucial principles and recommendations to improve breast cancer care. The 2024 EBCC manifesto focuses on disparities in the care of patients with metastatic breast cancer. There are several reasons for existing disparities both between and within countries. Our recommendations aim to address the stigma of metastatic disease, which has led to significant disparities in access to innovative care regardless of the gross national income of a country. These recommendations are for different stakeholders to promote the care of patients with metastatic breast cancer across Europe and worldwide.

Predictive Performance of Cardiovascular Risk Scores in Cancer Survivors From the UK Biobank

Background

Cardiovascular preventive strategies are guided by risk scores with unknown validity in cancer cohorts.

Objectives

This study aimed to evaluate the predictive performance of 7 established cardiovascular risk scores in cancer survivors from the UK Biobank.

Methods

The predictive performance of QRISK3, Systematic Coronary Risk Evaluation 2 (SCORE2)/Systematic Coronary Risk Evaluation for Older Persons (SCORE-OP), Framingham Risk Score, Pooled Cohort equations to Prevent Heart Failure (PCP-HF), CHARGE-AF, QStroke, and CHA2DS2-VASc was calculated in participants with and without a history of cancer. Participants were propensity matched on age, sex, deprivation, health behaviors, family history, and metabolic conditions. Analyses were stratified into any cancer, breast, lung, prostate, brain/central nervous system, hematologic malignancies, Hodgkin lymphoma, and non-Hodgkin lymphoma. Incident cardiovascular events were tracked through health record linkage over 10 years of follow-up. The area under the receiver operating curve, balanced accuracy, and sensitivity were reported.

Results

The analysis included 31,534 cancer survivors and 126,136 covariate-matched controls. Risk score distributions were near identical in cases and controls. Participants with any cancer had a significantly higher incidence of all cardiovascular outcomes than matched controls. Performance metrics were significantly worse for all risk scores in cancer cases than in matched controls. The most notable differences were among participants with a history of hematologic malignancies who had significantly higher outcome rates and poorer risk score performance than their matched controls. The performance of risk scores for predicting stroke in participants with brain/central nervous system cancer was very poor, with predictive accuracy more than 30% lower than noncancer controls.

Conclusions

Existing cardiovascular risk scores have significantly worse predictive accuracy in cancer survivors compared with noncancer comparators, leading to an underestimation of risk in this cohort.

Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial

PURPOSE

The aim of this study is to assess cost-effectiveness of general practitioner (GP) versus surgeon-led colon cancer survivorship care from a societal perspective.

METHODS

We performed an economic evaluation alongside the I CARE study, which included 303 cancer patients (stages I-III) who were randomised to survivorship care by a GP or surgeon. Questionnaires were administered at baseline, 3-, 6-, 12-, 24- and 36-months. Costs included healthcare costs (measured by iMTA MCQ) and lost productivity costs (SF-HLQ). Disease-specific quality of life (QoL) was measured using EORTC QLQ-C30 summary score and general QoL using EQ-5D-3L quality-adjusted life years (QALYs). Missing data were imputed. Incremental cost-effectiveness ratios (ICERs) were calculated to relate costs to effects on QoL. Statistical uncertainty was estimated using bootstrapping.

RESULTS

Total societal costs of GP-led care were significantly lower compared to surgeon-led care (mean difference of - €3895; 95% CI - €6113; - €1712). Lost productivity was the main contributor to the difference in societal costs (- €3305; 95% CI - €5028; - €1739). The difference in QLQ-C30 summary score over time between groups was 1.33 (95% CI - 0.049; 3.15). The ICER for QLQ-C30 was - 2073, indicating that GP-led care is dominant over surgeon-led care. The difference in QALYs was - 0.021 (95% CI - 0.083; 0.040) resulting in an ICER of 129,164.

CONCLUSIONS

GP-led care is likely to be cost-effective for disease-specific QoL, but not for general QoL.

IMPLICATIONS FOR CANCER SURVIVORS

With a growing number of cancer survivors, GP-led survivorship care could help to alleviate some of the burden on more expensive secondary healthcare services.

Models of survivorship care in patients with head and neck cancer in regional, rural, and remote areas: a systematic review

PURPOSE

Rural people with head and neck cancers (HNC) are likely to experience poorer health outcomes due to limited access to health services, so many benefit from models of care that account for rurality. The aim of this review was to synthesise literature on models of care in this population.

METHODS

Studies were identified using seven databases: PubMed, PsycINFO, Scopus, Embase, CINAHL, Medline, and Web of Science. Studies that tested or reported a model of care in rural HNC survivors were included. Data on characteristics and outcomes of the models were synthesised according to the domains in the Cancer Survivorship Care Quality Framework, and study quality was appraised.

RESULTS

Seventeen articles were included. Eight were randomised controlled trials (seven with a control group and one single-arm study). Three models were delivered online, nine via telehealth, and five in-person. Majority were led by nurses and allied health specialists and most addressed management of physical (n = 9) and psychosocial effects (n = 6), while only a few assessed implementation outcomes such as cost-effectiveness. None evaluated the management of chronic health conditions.

CONCLUSION

Positive outcomes were reported for domains of survivorship care that were measured; however, further evaluation of models of care for rural people with HNC is needed to assess effectiveness across all domains of care.

IMPLICATIONS FOR CANCER SURVIVORS

Rural cancer survivors are a diverse population with unique needs. Alternative models of care such as shared care, or models personalised to the individual, could be considered to reduce disparities in access to care and outcomes.

A multidisciplinary group-based survivorship intervention for those living with multiple myeloma: a feasibility study

BACKGROUND

While multiple myeloma continues to be an incurable cancer, advances in its understanding and management have led to significantly improved survival rates. Survivorship interventions for those living with multiple myeloma remain scarce, despite mounting evidence for multiple unmet support needs among multiple myeloma survivors. The current study aimed to evaluate the feasibility and preliminary effectiveness of a novel multidisciplinary group-based multiple myeloma survivorship intervention.

METHODS

A mixed-method, repeated measures feasibility study was conducted within a routine cancer support service. Seven participants, aged over 18, who had a multiple myeloma diagnosis and were clinically assessed as suitable for the intervention by their haemato-oncologist, attended online for six weekly group sessions of physical exercise and self-management input, completing qualitative, physical and self-report measures at baseline, post-intervention and follow-up.

RESULTS

The intervention was deemed overall feasible, with relatively high uptake, participants describing it as largely acceptable and appropriate and providing recommendations for feasibility-enhancing intervention refinements. Findings regarding the preliminary effectiveness of the intervention were mixed. While qualitative analyses stressed the benefits of the intervention (e.g. peer support, connectedness, improved well-being) and large effect sizes were observed for most physical outcomes, no improvements in self-reported outcomes (i.e. quality of life, fatigue) were reported.

CONCLUSIONS

This study represents the first investigation of a promising novel survivorship intervention for those living with multiple myeloma, highlighting the importance of peer support in particular, on which future clinical trials, aiming to establish the intervention's effectiveness for routine care, will be able to build.