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McConnell KM, Shen MJ. The need for multilevel supportive care infrastructure for cancer caregivers. Cancer 2024; 130:1913-1915. [PMID: 38567689 DOI: 10.1002/cncr.35303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Communication with cancer caregivers occurs in the broader multilevel context of oncology care. Improving communication with caregivers requires changes across multiple levels of this context.
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Affiliation(s)
- Kelly M McConnell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Attieh S, Kilpatrick K, Chênevert D, Pomey MP, Loiselle CG. Measuring Team Functioning During the COVID-19 Pandemic: Perspectives of Cancer Care Team Members. J Multidiscip Healthc 2024; 17:2623-2633. [PMID: 38828266 PMCID: PMC11141571 DOI: 10.2147/jmdh.s448985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
Background In a public health crisis such as COVID-19, cancer teams face significant challenges including acute work disruptions, rapid shifts in clinical practice, and burnout. Within this context, it is crucial to explore team functioning from the perspectives of multiple stakeholders. Objective This quantitative pilot study aimed to 1) measure perceptions of multi-stakeholders on key indicators of team functioning (Team Effectiveness, TE, and Team Relational Coordination, TRC) during COVID-19 and its transition, and 2) document whether patient perceptions of TE/TRC are significantly associated with their cancer care experiences. Methods A descriptive design with repeated measures was used. Through convenience sampling, participants were recruited from two outpatient cancer clinics at a large university-affiliated hospital, in Montréal, Qc, Canada. Sixty-six participants (ie, 13 healthcare professionals, 40 patients, 6 informal caregivers, and 7 volunteers) completed e-measures at T1 (years 2021-2022) and n = 44 at T2 (year 2023). Results At T1, participants reported high perceptions of Team Effectiveness (scale 1 to 6) M = 4.47; SD = 0.7 (Mdn = 4.54; IQR: 4.06-5) and Relational Coordination (scale 1 to 5) M = 3.77; SD = 0.77 (Mdn = 3.81; IQR: 3.12-4.38) with no significant differences in perceptions across the four groups. At T2, no significant changes in TE/TRC perceptions were found. At both time points, patient perceptions of TE/TRC were significantly correlated with positive cancer care experiences (Spearman rank correlation rs ranging from 0.69 and 0.83; p < 0.01). Conclusion To our knowledge, this is the first study documenting perceptions of cancer team functioning amidst the pandemic as reported by multiple stakeholders. Significant relationships between patient perceptions of TE/TRC and their cancer care experiences underscore the importance of including patients' views in team functioning processes. Future work should rely on larger sample sizes to further explore key elements of optimal team functioning.
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Affiliation(s)
- Samar Attieh
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Denis Chênevert
- Department of Human Resources Management, HEC Montréal, Montréal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montréal, QC, Canada
- Centre d’excellence sur le partenariat avec les patients et le public, Montréal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Carmen G Loiselle
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Segal Cancer Center, Jewish General Hospital, Montréal, Canada
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3
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Parina R, Emamaullee J, Ahmed S, Kaur N, Genyk Y, Raashid Sheikh M. Impact of Medicaid Expansion on Surgical Care and Outcomes for Hepatobiliary Malignancies. Am Surg 2024; 90:829-839. [PMID: 37955410 DOI: 10.1177/00031348231216492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND As part of the Patient Protection and Affordable Care Act, some states expanded Medicaid eligibility to adults with incomes below 138% of the federal poverty line. While this resulted in an increased proportion of insured residents, its impact on the diagnosis and treatment of hepatopancreaticobiliary (HPB) cancers has not been studied. STUDY DESIGN The National Cancer Database (NCDB) from 2010 to 2017 was used. Patients diagnosed with HPB malignancies in states which expanded in 2014 were compared to patients in non-expansion states. Subset analyses of patients who underwent surgery and those in high-risk socioeconomic groups were performed. Outcomes studied included initiation of treatment within 30 days of diagnosis, stage at diagnosis, care at high volume or academic center, perioperative outcomes, and overall survival. Adjusted difference-in-differences analysis was performed. RESULTS A total of 345,684 patients were included, of whom 55% resided in non-expansion states and 54% were diagnosed with pancreatic cancer. Overall survival was higher in states with Medicaid expansion (HR .90, 95% CI [.88-.92], P < .01). There were also better postoperative outcomes including 30-day mortality (.67 [.57-.80], P < .01) and 30-day readmissions (.87 [.78-.97], P = .02) as well as increased likelihood of having surgery in a high-volume center (1.42 [1.32-1.53], P < .01). However, there were lower odds of initiating care within 30 days of diagnosis (.77 [.75-.80], P < .01) and higher likelihood of diagnosis with stage IV disease (1.09 [1.06-1.12], P < .01) in expansion states. CONCLUSION While operative outcomes and overall survival from HPB cancers were better in states with Medicaid expansion, there was no improvement in timeliness of initiating care or stage at diagnosis.
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Affiliation(s)
- Ralitza Parina
- Department of Surgery, Keck Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Juliet Emamaullee
- Department of Surgery, Keck Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Saif Ahmed
- Department of Surgery, Keck Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Navpreet Kaur
- Department of Surgery, Keck Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Yuri Genyk
- Department of Surgery, Keck Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Mohd Raashid Sheikh
- Department of Surgery, Keck Medical Center, University of Southern California, Los Angeles, CA, USA
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Marshall AL, Masselink LE, Kouides PA, Davies FE, Farooqui A, Nagalla S, Herrera A, Mortier N, Brodsky R, Erikson CE. Advanced practice providers in hematology: actionable findings from national paired APP and physician surveys. Blood Adv 2024; 8:1179-1189. [PMID: 38127271 PMCID: PMC10910059 DOI: 10.1182/bloodadvances.2023011927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
ABSTRACT Advanced practice providers (APPs) are critical to the hematology workforce. However, there is limited knowledge about APPs in hematology regarding specialty-specific training, scope of practice, challenges and opportunities in APP-physician interactions, and involvement with the American Society of Hematology (ASH). We conducted APP and physician focus groups to elucidate major themes in these areas and used results to inform development of 2 national surveys, 1 for APPs and 1 for physicians who work with APPs. The APP survey was distributed to members of the Advanced Practitioner Society of Hematology and Oncology, and the physician survey was distributed to physician members of ASH. A total of 841 APPs and 1334 physicians completed the surveys. APPs reported most hematology-specific knowledge was obtained via on-the-job training and felt additional APP-focused training would be helpful (as did physicians). Nearly all APPs and physicians agreed that APPs were an integral part of their organizations and that physician-APP collaborations were generally positive. A total of 42.1% of APPs and 29.3% of physicians reported burnout, and >50% of physicians felt that working with APPs had reduced their burnout. Both physicians and APPs reported interest in additional resources including "best practice" guidelines for APP-physician collaboration, APP access to hematology educational resources (both existing and newly developed resources for physicians and trainees), and greater APP integration into national specialty-specific professional organizations including APP-focused sessions at conferences. Professional organizations such as ASH are well positioned to address these areas.
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Affiliation(s)
- Ariela L. Marshall
- Division of Hematology Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Leah E. Masselink
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | | | - Faith E. Davies
- Pearlmutter Cancer Center, New York University Langone Health, New York, NY
| | - Azam Farooqui
- Department of Hematology and Oncology, Ironwood Cancer & Research Centers, Chandler, AZ
| | | | - Alex Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA
| | - Nicole Mortier
- Sickle Cell Disease Clinical Trials Network, ASH Research Collaborative, Washington, DC
| | - Robert Brodsky
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clese E. Erikson
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
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Cheng Z, Johar A, Nilsson M, Schandl A, Lagergren P. Cancer-related fatigue trajectories up to 5 years after curative treatment for oesophageal cancer. Br J Cancer 2024; 130:628-637. [PMID: 38135716 PMCID: PMC10876982 DOI: 10.1038/s41416-023-02551-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Whether cancer-related fatigue develops differently after curative-intended oesophageal cancer treatment and the related modifiable factors are unclear. METHODS This population-based and longitudinal cohort included 409 oesophageal cancer patients who underwent curative oesophagectomy in 2013-2020 in Sweden. The main outcome was cancer-related fatigue trajectories with measurements at 1, 1.5, 2, 2.5, 3, 4 and 5 years postoperatively by validated EORTC QLQ-FA12 questionnaire, and analysed using growth mixture models. Weighted logistic regressions provided odds ratios (OR) with 95% confidence intervals (95% CI) for underlying sociodemographic, clinical, and patient-reported outcome factors in relation to the identified trajectories. RESULTS Two distinct overall cancer-related fatigue trajectories were identified: low level of persistent fatigue and high level of increasing fatigue, with 64% and 36% of patients, respectively. The odds of having high level of fatigue trajectory were increased by Charlson comorbidity index (≥ 2 versus 0: OR = 2.52, 95% CI 1.07-5.94), pathological tumour Stage (III-IV versus 0-I: OR = 2.52, 95% CI 1.33-4.77), anxiety (OR = 7.58, 95% CI 2.20-26.17), depression (OR = 15.90, 95% CI 4.44-56.93) and pain (continuous score: OR = 1.02, 95% CI 1.01-1.04). CONCLUSIONS Long-term trajectories with high level of increasing cancer-related fatigue and the associated modifiable factors were identified after oesophageal cancer treatment. The results may facilitate early identification and targeted intervention for such high-risk patients.
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Affiliation(s)
- Zhao Cheng
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Asif Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Schandl
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Dickson NR, Beauchamp KD, Perry TS, Roush A, Goldschmidt D, Edwards ML, Blakely LJ. Real-world use and clinical impact of an electronic patient-reported outcome tool in patients with solid tumors treated with immuno-oncology therapy. J Patient Rep Outcomes 2024; 8:23. [PMID: 38416270 PMCID: PMC10899997 DOI: 10.1186/s41687-024-00700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Utilization of electronic patient-reported outcome (ePRO) tools to monitor symptoms in patients undergoing cancer treatment has shown clinical benefits. Tennessee Oncology (TO) implemented an ePRO platform in 2019, allowing patients to report their health status online. We conducted a real-world, multicenter, observational, non-interventional cohort study to evaluate utilization of this platform in adults with solid tumors who initiated immuno-oncology (IO) therapy as monotherapy or in combination at TO clinics. METHODS Patients initiating IO therapy prior to platform implementation were included in a historical control (HC) cohort; those initiating treatment after implementation were included in the ePRO cohort, which was further divided into ePRO users (platform enrollment ≤ 45 days from IO initiation) and non-users. Data were extracted from electronic medical records; patients were followed for up to 6 months (no minimum follow up). Outcomes included patient characteristics, treatment patterns, duration of therapy (DoT), and overall survival (OS). RESULTS Data were collected for 538 patients in the HC and 1014 in the ePRO cohort; 319 in the ePRO cohort were ePRO users (uptake rate 31%). Baseline age was higher, more patients had stage IV disease at diagnosis, and more received monotherapy (82 vs 52%, respectively) in the HC vs the ePRO cohort. Median follow-up was 181.0 days (range 0.0-182.6) in the HC and 175.0 (0.0-184.0) in the ePRO cohort. Median DoT of index IO regimen was 5.1 months (95% confidence interval [CI], 4.4-NE) in the HC cohort vs not estimable (NE) in the ePRO cohort. Multivariable regression adjusting for baseline differences confirmed lower risk of treatment discontinuation in the ePRO vs HC cohort: hazard ratio (HR) 0.83 (95% CI, 0.71-0.97); p < 0.05. The estimated 6-month OS rate was 65.5% in the HC vs 72.4% in the ePRO cohort (p < 0 .01). Within the ePRO cohort, DoT of index IO regimen and OS did not differ between users and non-users. In ePRO users, patient platform use was durable over 6 months. CONCLUSION Improvements in DoT and OS were seen after ePRO platform implementation. Conclusions are limited by challenges in separating the impact of platform implementation from other changes affecting outcomes.
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Affiliation(s)
- Natalie R Dickson
- Tennessee Oncology, 2004 Hayes Street - 8th Floor, Nashville, TN, 37203, USA
| | | | | | - Ashley Roush
- Tennessee Oncology, 2004 Hayes Street - 8th Floor, Nashville, TN, 37203, USA
| | | | | | - L Johnetta Blakely
- Tennessee Oncology, 2004 Hayes Street - 8th Floor, Nashville, TN, 37203, USA.
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Attieh S, Loiselle CG. Cancer Care Team Functioning during COVID-19: A Narrative Literature Review and Synthesis. Curr Oncol 2024; 31:335-349. [PMID: 38248107 PMCID: PMC10814830 DOI: 10.3390/curroncol31010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Amid pandemics, health care teams face unprecedented challenges, requiring significant efforts to sustain optimal functioning and navigate rapid practice changes. It is therefore crucial to identify factors affecting team functioning in these contexts. The present narrative review more specifically summarizes the literature on key elements of cancer teams' functioning during COVID-19. The search strategy involved four main databases (i.e., Medline OVID, EMBASE, PsycINFO, and CINAHL), as well as Google Scholar, from January 2000 to September 2022. Twenty-three publications were found to be relevant. Each was read thoroughly, and its content summarized. Across publications, three key themes emerged: (1) swiftly adopting virtual technology for communication and interprofessional collaboration, (2) promoting team resilience, and (3) encouraging self-care and optimizing team support. Our findings underscore key team functioning elements to address in future pandemics. More research is needed to document the perspectives of broader-based team members (such as patients and lay carers) to inform more comprehensive evidence-based team functioning guidelines.
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Affiliation(s)
- Samar Attieh
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
| | - Carmen G. Loiselle
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada;
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3T2, Canada
- Segal Cancer Center, CIUSSS Centre-Ouest, Montreal, QC H3T 1E2, Canada
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Chukwu OA, Nnogo CC, Essue B. Task shifting to nonphysician health workers for improving access to care and treatment for cancer in low- and middle-income countries- a systematic review. Res Social Adm Pharm 2023; 19:1511-1519. [PMID: 37659923 DOI: 10.1016/j.sapharm.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Cancer is a complex global health issue overburdening health systems especially in low- and middle-income countries (LMICs). This burden is becoming more severe and complex as the global shortage of cancer care workforce persists. Since task shifting offers an alternative to address workforce shortages, a systematic review with the following research question was carried out: What is the scope of roles and tasks shifted to nonphysician health workers in improving access to cancer control services? The aim of this review is to critically identify, appraise and present evidence on how task shifting could be integrated and scaled to expand access to quality cancer control services in LMICs. OBJECTIVE The aim of this review is to critically identify, appraise and present evidence on how task shifting could be integrated and scaled to expand access to quality cancer control services in LMICs. METHODS Four databases were searched - CINAHL, EMBASE, MEDLINE and SCOPUS from inception to October 15, 2022, and included all studies that reported task shifting of cancer control services to nonphysician health workers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines was followed to report the review process. Risk of bias was assessed using the National Heart, Lung, and Blood Institute quality assessment scale. The studies were summarized using narrative synthesis. A meta-analysis could not be carried out because the review only assessed the scope of roles that were shifted to nonphysician health workers and because of the heterogeneity in the characteristics of the studies included in the review. RESULTS The search identified 170 articles out of which 16 were included in the review. Three studies were randomized controlled trials, four were cluster randomized trials, while 9 were cross-sectional. Tasks were shifted to primary healthcare workers, nurses, and community health workers. Tasks shifted included screening, patient education, and diagnostic procedures. Evidence from the studies showed that the quality and effectiveness of tasks performed were comparable, and in some cases, better than usual care. CONCLUSIONS Findings showed that tasks in certain areas of cancer control services such as screening, education, and diagnosis can be shifted to nonphysician health workers and that it could be effective in improving access to certain cancer control services. Therefore, this review has shown that task shifting could be an effective strategy in addressing current workforce shortages in cancer care and that there is a need to examine the care required along the cancer continuum to better understand which interventions can most effectively be shifted to more advanced health professionals such as pharmacists to improve access to cancer control services in LMICs.
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Affiliation(s)
- Otuto Amarauche Chukwu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada.
| | | | - Beverley Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
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Villalobos A, Chambers DA. Advancing the science of integrating multiple interventions by blending and bundling. JNCI Cancer Spectr 2023; 7:pkad070. [PMID: 37707597 PMCID: PMC10587993 DOI: 10.1093/jncics/pkad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/15/2023] Open
Abstract
Cancer prevention and control research has produced a variety of effective interventions over the years, though most are single disease focused. To meet the Cancer Moonshot goal to reduce the cancer death rate by 50% by 2047, it may be necessary to overcome the limitations of siloed interventions that do not meet people's multiple needs and limitations in system capacity to deliver the increasing number of interventions in parallel. In this article, we propose integrating multiple evidence-based interventions as a potential solution. We define 2 types of integrated interventions, blended and bundled, and provide examples to illustrate each. We then offer a schematic and outline considerations for how to assemble blended or bundled interventions including looking at the intervention need or opportunity along the cancer continuum as well as co-occurring behaviors or motivations. We also discuss delivery workflow integration considerations including social-ecological level(s), context or setting, implementer, and intended beneficiary. Finally, in assembling integrated interventions, we encourage consideration of practice-based expertise and community and/or patient input. After assembly, we share thoughts related to implementation and evaluation of blended or bundled interventions. To conclude the article, we present multiple research opportunities in this space. With swift progress on these research directions, cancer prevention and control interventionists and implementation scientists can contribute to achieving the promise of the reignited Cancer Moonshot.
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Affiliation(s)
- Aubrey Villalobos
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Liu R, Weldon CB, Linehan E, Gordon N, Abbe T, Hennings M, James H, Katzel J, Ng C, Tomita M, Velotta JB, Ossowski S, Sakoda LC, Sprague SL, Dowling A, Beringer K, Ravelo A, Yu E, Trosman JR. Fostering a High-Functioning Team in Cancer Care Using the 4R Oncology Model: Assessment in a Large Health System and a Blueprint for Other Institutions. JCO Oncol Pract 2023; 19:e125-e137. [PMID: 36178937 PMCID: PMC10166419 DOI: 10.1200/op.22.00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/20/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation, which threatens care quality, affects patient outcomes, and strains the oncology workforce. We assessed whether the 4R Oncology model for team-based interdependent care delivery and patient self-management affected team functioning in a large community-based health system. METHODS 4R was deployed at four locations in breast and lung cancers and assessed along four characteristics of high-functioning teams: recognition as a team internally and externally; commitment to an explicit shared goal; enablement of interdependent work to achieve the goal; and engagement in regular reflection to adapt objectives and processes. RESULTS We formed an internally and externally recognized team of 24 specialties committed to a shared goal of delivering multidisciplinary care at the optimal time and sequence from a patient-centric viewpoint. The team conducted 40 optimizations of interdependent care (22 for breast, seven for lung, and 11 for both cancers) at four points in the care continuum and established an ongoing teamwork adaptation process. Half of the optimizations entailed low effort, while 30% required high level of effort; 78% resulted in improved process efficiency. CONCLUSION 4R facilitated development of a large high-functioning team and enabled 40 optimizations of interdependent care along the cancer care continuum in a feasible way. 4R may be an effective approach for fostering high-functioning teams, which could contribute to improving viability of the oncology workforce. Our intervention and taxonomy of results serve as a blueprint for other institutions motivated to strengthen teamwork to improve patient-centered care.
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Affiliation(s)
- Raymond Liu
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Christine B. Weldon
- Center for Business Models in Healthcare, Glencoe, IL
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Elizabeth Linehan
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Nancy Gordon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Thea Abbe
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Marti Hennings
- Department of Hematology Oncology, The Permanente Medical Group, Modesto, CA
| | - Henie James
- Department of Hematology Oncology, The Permanente Medical Group, Oakland, CA
| | - Jed Katzel
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Chun Ng
- Department of Hematology Oncology, The Permanente Medical Group, Modesto, CA
| | - Megumi Tomita
- Department of Hematology Oncology, The Permanente Medical Group, Modesto, CA
| | - Jeffrey B. Velotta
- Department of Hematology Oncology, The Permanente Medical Group, Oakland, CA
| | - Stephanie Ossowski
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Lori C. Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Anna Dowling
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Kimberly Beringer
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | | | - Elaine Yu
- Genentech, Inc, South San Francisco, CA
| | - Julia R. Trosman
- Center for Business Models in Healthcare, Glencoe, IL
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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11
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Liu B, Kent EE, Dionne-Odom JN, Alpert N, Ornstein KA. A national profile of health-focused caregiving activities prior to a new cancer diagnosis. J Geriatr Oncol 2022; 13:454-461. [PMID: 34801426 PMCID: PMC9058151 DOI: 10.1016/j.jgo.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Little is known about how unpaid family caregivers may already be engaged in caregiving activities prior to their care recipient's cancer diagnosis. We examined pre-cancer diagnosis caregiving patterns and their association with caregiving strain. METHODS We conducted a population-based analysis of 2011-2017 National Health and Aging Trends Study (NHATS) linked with the National Study of Caregiving (NSOC) and Medicare claims data. Latent class analysis was used to examine patterns of 16 health-focused caregiving tasks (e.g., tracking medications, making appointments) of family caregivers assisting adults ≥65 years prior to an incident cancer diagnosis. High caregiving strain was defined as a total score ≥ 85th percentile of 6 caregiving strain items (e.g., financial difficulty, no time for self). Association between caregiving patterns and strain were examined using multivariable logistic regression, adjusting for care recipient and caregiver characteristics. RESULTS An estimated 4.2 million caregivers cared for older adults prior to care recipients' new cancer diagnoses during 2011-2017. They engaged in a median of four health-focused caregiving activities. Nearly 1-in-5 (18.7%) pre-cancer caregivers had high caregiving strain. Caregivers were classified into 3 health-focused caregiving activity classes: Low-level (41.2%), Moderate-coordination (29.3%), and High-intensity (29.4%). Higher caregiving activity was associated with higher caregiving strain (adjusted odds ratio (aOR) = 3.85, 95% CI: 2.34-6.33). Caregivers in the High-intensity class had the highest caregiving strain (39.9%), and included more spouses (28.1% vs <18%). CONCLUSION One-third of U.S. caregivers who help older adults prior to their cancer diagnoses are already highly strained and engaged in high-level health-focused caregiving tasks. Oncology clinicians should assess the capacity and strain of family caregivers who may already be supporting patients with new cancer diagnoses and refer caregivers to additional supportive care services.
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Affiliation(s)
- Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, United States of America
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States of America; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Katherine A Ornstein
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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12
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Green J, Wright H, Seely D, Legacy M, Anderson M, Armstrong H, Martell C, Soles S, Balneaves LG. A survey of multidisciplinary healthcare providers utilizing the KNOWintegrativeoncology.org educational platform. BMC Complement Med Ther 2022; 22:118. [PMID: 35484545 PMCID: PMC9047465 DOI: 10.1186/s12906-022-03601-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Although the vast majority of cancer patients use natural health products (NHPs), 59% of oncology healthcare providers (HCP) report not receiving any education on NHPs. KNOWintegrativeoncology.org (KNOW) is a web-based educational platform that provides up-to-date evidence on NHPs used in cancer care with a user-friendly interface. KNOW is a database of human studies systematically gathered from MEDLINE and EMBASE. We surveyed HCPs before and after accessing KNOW to identify their information needs regarding NHPs in cancer care, their preferred way to receive information, barriers they face accessing NHP information, and to obtain feedback on the website. Methods Recruitment was done through Beaumont Health Systems, the Society for Integrative Oncology, and the Andrew Weil Centre for Integrative Medicine, University of Arizona. HCPs who consented completed an initial survey and then a follow-up survey after being given access to KNOW for 4–6 weeks. Participants were required to access KNOW at least three times before completion of the follow-up survey. Results A total of 65 participants completed the initial survey, with 60% (n = 39) from the conventional medical community, 33% (n = 21) from the integrative medicine community, and 7% (n = 5) from the research community. The majority of participants (82%; n = 53) preferred educational websites to email updates, podcasts/webinars, in-house experts, PubMed searches and smartphone apps. The most common barriers identified to accessing information on NHPs were time, accessibility at point-of-care, and credibility of sources. A high number of participants were lost to follow up, with 18 participants demographically representative of the initial sample of 65 completing the follow-up survey. Half (n = 9) of participants stated accessing the KNOW website changed their clinical practice. Close to 90% (n = 16) reported they would recommend KNOW to a colleague. Conclusion Oncology HCPs reported preferring to use, and already relying on, numerous web-based educational platforms to gather information on NHPs, with time, accessibility, and credibility being common barriers to obtaining information. Our study findings highlight the promise of the KNOW web-based educational platform in reducing barriers to accessing up-to-date information on NHPs in busy cancer care settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03601-5.
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Affiliation(s)
- Jen Green
- Emcura Integrative Clinic, Bloomfield Twp, Bloomfield Hills, MI, USA
| | | | - Dugald Seely
- Patterson Institute for Integrative Oncology Research, CCNM, Toronto, ON, Canada.,The Centre for Health Innovation, Ottawa, ON, Canada
| | - Mark Legacy
- Patterson Institute for Integrative Oncology Research, CCNM, Toronto, ON, Canada.,The Centre for Health Innovation, Ottawa, ON, Canada
| | | | | | | | - Sarah Soles
- Integrated Health Clinic, Fort Langley, Langley, BC, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada.
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13
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Vaz-Luis I, Di Meglio A, Havas J, El-Mouhebb M, Lapidari P, Presti D, Soldato D, Pistilli B, Dumas A, Menvielle G, Charles C, Everhard S, Martin AL, Cottu PH, Lerebours F, Coutant C, Dauchy S, Delaloge S, Lin NU, Ganz PA, Partridge AH, André F, Michiels S. Long-Term Longitudinal Patterns of Patient-Reported Fatigue After Breast Cancer: A Group-Based Trajectory Analysis. J Clin Oncol 2022; 40:2148-2162. [PMID: 35290073 PMCID: PMC9242405 DOI: 10.1200/jco.21.01958] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Fatigue is recognized as one of the most burdensome and long-lasting adverse effects of cancer and cancer treatment. We aimed to characterize long-term fatigue trajectories among breast cancer survivors. METHODS We performed a detailed longitudinal analysis of fatigue using a large ongoing national prospective clinical study (CANcer TOxicity, ClinicalTrials.gov identifier: NCT01993498) of patients with stage I-III breast cancer treated from 2012 to 2015. Fatigue was assessed at diagnosis and year 1, 2, and 4 postdiagnosis. Baseline clinical, sociodemographic, behavioral, tumor-related, and treatment-related characteristics were available. Trajectories of fatigue and risk factors of trajectory-group membership were identified by iterative estimates of group-based trajectory models. RESULTS Three trajectory groups were identified for severe global fatigue (n = 4,173). Twenty-one percent of patients were in the high-risk group, having risk estimates of severe global fatigue of 94.8% (95% CI, 86.6 to 100.0) at diagnosis and 64.6% (95% CI, 59.2 to 70.1) at year 4; 19% of patients clustered in the deteriorating group with risk estimates of severe global fatigue of 13.8% (95% CI, 6.7 to 20.9) at diagnosis and 64.5% (95% CI, 57.3 to 71.8) at year 4; 60% were in the low-risk group with risk estimates of 3.6% (95% CI, 2.5 to 4.7) at diagnosis and 9.6% (95% CI, 7.5 to 11.7) at year 4. The distinct dimensions of fatigue clustered in different trajectory groups than those identified by severe global fatigue, being differentially affected by sociodemographic, clinical, and treatment-related factors. CONCLUSION Our findings highlight the multidimensional nature of cancer-related fatigue and the complexity of its risk factors. This study helps to identify patients with increased risk of severe fatigue and to inform personalized interventions to ameliorate this problem.
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Affiliation(s)
- Ines Vaz-Luis
- Gustave Roussy, Medical Oncology, Villejuif, France.,INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Antonio Di Meglio
- Gustave Roussy, Medical Oncology, Villejuif, France.,INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Julie Havas
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Mayssam El-Mouhebb
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Pietro Lapidari
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Daniele Presti
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Davide Soldato
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Barbara Pistilli
- Gustave Roussy, Medical Oncology, Villejuif, France.,INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Agnes Dumas
- Universite de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | | | | | | | | | - Sarah Dauchy
- Gustave Roussy, Supportive Care, IPLESP, Paris, France
| | | | | | | | | | - Fabrice André
- Gustave Roussy, Medical Oncology, Villejuif, France.,INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, INSERM, University Paris-Saclay, Villejuif, France.,Equipe labellisée Ligue Contre le Cancer, Villejuif, France
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14
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Mariotto AB, Enewold L, Parsons H, Zeruto CA, Yabroff KR, Mayer DK. Workforce Caring for Cancer Survivors in the United States: Estimates and Projections of Utilization. J Natl Cancer Inst 2022; 114:837-844. [PMID: 35171249 DOI: 10.1093/jnci/djac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/15/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aims to quantify the extent and diversity of the cancer care workforce, beyond medical oncologists, to inform future demand, as the number of cancer survivors is expected to grow in the US. METHODS SEER-Medicare data was used to evaluate healthcare utilization of cancer survivors diagnosed between 2000-2014 and enrolled in fee-for-service Medicare Parts A and B and 65 years or older in 2008-2015. We calculated percentage of cancer survivors who saw each clinician specialty and their average annual number of visits in each phase of care. We projected the national number of individuals receiving care and number of annual visits by clinician specialty and phase of care through 2040. RESULTS Cancer survivors had higher care utilization in the first year after diagnosis and last year of life phases. During the initial year after cancer diagnosis, most survivors were seen for cancer-related care by a medical oncologist (59.1%), primary care provider (55.9%) and/or other cancer-treating physicians (42.2%). The percentage of survivors with cancer-related visits to each specialty declined after the first year after diagnosis, plateauing after year 6-7. However, at 10 or more years after diagnosis, about 20% of cancer survivors had visits to medical oncologists and an average of 4 visits a year. CONCLUSIONS Cancer survivors had higher care utilization in the first year after diagnosis and last year of life. High levels of care utilization across specialty in all phases of care has important implications for models of survivorship care coordination and workforce planning.
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Affiliation(s)
- Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
| | - Lindsey Enewold
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
| | - Helen Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, US
| | | | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, US
| | - Deborah K Mayer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US.,School of Nursing, University of North Carolina Chapel Hill, Chapel Hill, NC, US.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, US
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15
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Rocque GB, Wheeler SB, Griggs J. Growing the Next Generation of Oncology Researchers and Oncologists. JCO Oncol Pract 2022; 18:559-561. [PMID: 35157513 PMCID: PMC9377688 DOI: 10.1200/op.21.00873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gabrielle B Rocque
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL.,University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL.,O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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16
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Tetzlaff ED, Hylton HM, Ruth KJ, Hasse Z, Hall MJ. Changes in Burnout Among Oncology Physician Assistants Between 2015 and 2019. JCO Oncol Pract 2022; 18:e47-e59. [PMID: 34292762 PMCID: PMC8757962 DOI: 10.1200/op.21.00051] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Burnout has significant implications for the individual provider, the oncology workforce, and the quality of care for patients with cancer. The primary aim of this study was to explore temporal changes in burnout among physician assistants (PAs) in oncology in 2019 compared with 2015. METHODS Oncology PAs were surveyed to assess for burnout using the Maslach Burnout Inventory according to the same cross-sectional design of the study performed in 2015. Comparison between oncology PAs in 2015 and 2019 in the prevalence of burnout and personal and professional characteristics was performed. RESULTS Two hundred thirty-four participants completed the full-length survey. The participants in 2015 and 2019 were similar in age (41.8 v 40.3 years), sex (88.8% v 86.3% female), number of years as a PA in oncology (9.6 v 10), and percentage involved in academic practice (55.2% v 59.2%). There was a significant increase in burnout in 2019 compared with 2015 with 48.7% of PAs reporting at least one symptom of burnout compared with 34.8% (odds ratio for burnout, 2019 v 2015 = 1.92 [95% CI, 1.40 to 2.65], P < 0.001). The odds of burnout remained higher in 2019 compared with 2015 when adjusted for age, sex, relationship status, practice setting, subspecialty, practice type, and hours worked. Factors associated with burnout in both 2015 and 2019 include the percentage of time spent on patient care, collaborative physician relationship, number of hours worked, and satisfaction with compensation. No new factors associated with burnout emerged in 2019 that were not identified in 2015. CONCLUSION The rate of burnout of oncology PAs has significantly increased. Burnout in oncology PAs is multifactorial, and the increase cannot be easily explained. Additional research is needed to better define the drivers of PA burnout.
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Affiliation(s)
- Eric D. Tetzlaff
- Fox Chase Cancer Center, Philadelphia, PA,Eric D. Tetzlaff, MHS, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111; e-mail:
| | - Heather M. Hylton
- Association of Physician Assistants in Oncology, Altamonte Springs, FL
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17
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Jung A, Kay SS, Robinson JL, Sheppard BB, Mayer DK. Large-scale North American cancer survivorship surveys: 2011-2019 update. J Cancer Surviv 2021; 16:1236-1267. [PMID: 34734367 DOI: 10.1007/s11764-021-01111-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE There are gaps in our knowledge to provide quality cancer care to the growing numbers of survivors. Leveraging existing data to answer survivorship research questions is one approach to address these gaps. Therefore, the purpose of this paper is to replicate and expand a previous report of existing cancer survivorship survey data. METHODS We conducted a trifold search strategy for relevant surveys and data sets to (1) determine the extent to which cancer survivors are being surveyed, (2) determine the topics being covered in these surveys, and (3) create a compendium of information about these surveys and data sets, so researchers can conduct additional analyses. RESULTS Thirty-five surveys were identified and included in this report; most were longitudinal studies (71%) in adult cancer survivors (91%). The domains addressed in these surveys were general medical characteristics, medical conditions, costs, employment, symptoms and/or side effects, psychosocial factors and coping, perceived quality of care, and health behaviors. CONCLUSIONS Existing data are available for researchers to explore new knowledge to enhance cancer survivorship quality care. This is an opportunity to fully utilize existing data to answer survivorship questions in a cost effective manner. IMPLICATIONS FOR CANCER SURVIVORS Survivors should be encouraged to participate in research studies as these data can close the gap in our knowledge and care of this growing population.
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Affiliation(s)
- Ahrang Jung
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7460, USA
| | | | - Jennifer L Robinson
- Department of Behavioral and Community Health, University of Maryland at College Park, College Park, MD, 20742-2611, USA
| | | | - Deborah K Mayer
- School of Nursing, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7460, USA.
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18
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Turchi GP, Dalla Riva MS, Orrù L, Pinto E. How to Intervene in the Health Management of the Oncological Patient and of Their Caregiver? A Narrative Review in the Psycho-Oncology Field. Behav Sci (Basel) 2021; 11:99. [PMID: 34356716 PMCID: PMC8301046 DOI: 10.3390/bs11070099] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/22/2023] Open
Abstract
Starting from statistical data derived from the oncological field, some articles have highlighted the importance of communication in the patient-caregiver dyad and have considered the various roles involved in a cancer diagnosis situation. Thus, the question of how to intervene in terms of "quality of life" from the time of diagnosis to the recovery or death of a cancer patient, beyond the sanitary and physical dimensions, has become relevant. Therefore, the present narrative review aims to offer an overview of the state of the art in terms of the psychological treatment modalities of cancer patients, from the diagnosis to the post-surgery period. A total of 67 articles were collected and analyzed, in relation to (1) psychological constructs employed in the oncological field, (2) intervention models and (3) quality of life and well-being measurement and evaluation tools. We described these articles, differentiating between those focusing on the role of (1) the patient, (2) the caregiver, (3) the patient-caregiver dyad and (4) healthcare professional roles. The oncological diagnosis and its repercussions in the lives of the patient and caregiver were explored and critical aspects that emerged from the literature were highlighted. In conclusion, the analysis allowed some considerations about the need to define research protocols and useful management strategies for increasing the overall health of patients with cancer diagnoses and the people who surround them.
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Affiliation(s)
- Gian Piero Turchi
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padua, 35131 Padua, Italy; (G.P.T.); (M.S.D.R.); (L.O.)
| | - Marta Silvia Dalla Riva
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padua, 35131 Padua, Italy; (G.P.T.); (M.S.D.R.); (L.O.)
| | - Luisa Orrù
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padua, 35131 Padua, Italy; (G.P.T.); (M.S.D.R.); (L.O.)
| | - Eleonora Pinto
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology, 35128 Padua, Italy
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Frosch ZAK, Illenberger N, Mitra N, Boffa DJ, Facktor MA, Nelson H, Palis BE, Bekelman JE, Shulman LN, Takvorian SU. Trends in Patient Volume by Hospital Type and the Association of These Trends With Time to Cancer Treatment Initiation. JAMA Netw Open 2021; 4:e2115675. [PMID: 34241630 PMCID: PMC8271360 DOI: 10.1001/jamanetworkopen.2021.15675] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/03/2021] [Indexed: 11/23/2022] Open
Abstract
Importance Increasing demand for cancer care may be outpacing the capacity of hospitals to provide timely treatment, particularly at referral centers such as National Cancer Institute (NCI)-designated and academic centers. Whether the rate of patient volume growth has strained hospital capacity to provide timely treatment is unknown. Objective To evaluate trends in patient volume by hospital type and the association between a hospital's annual patient volume growth and time to treatment initiation (TTI) for patients with cancer. Design, Setting, and Participants This retrospective, hospital-level, cross-sectional study used longitudinal data from the National Cancer Database from January 1, 2007, to December 31, 2016. Adult patients older than 40 years who had received a diagnosis of 1 of the 10 most common incident cancers and initiated their treatment at a Commission on Cancer-accredited hospital were included. Data were analyzed between December 19, 2019, and March 27, 2020. Exposures The mean annual rate of patient volume growth at a hospital. Main Outcomes and Measures The main outcome was TTI, defined as the number of days between diagnosis and the first cancer treatment. The association between a hospital's mean annual rate of patient volume growth and TTI was assessed using a linear mixed-effects model containing a patient volume × time interaction. The mean annual change in TTI over the study period by hospital type was estimated by including a hospital type × time interaction term. Results The study sample included 4 218 577 patients (mean [SD] age, 65.0 [11.4] years; 56.6% women) treated at 1351 hospitals. From 2007 to 2016, patient volume increased 40% at NCI centers, 25% at academic centers, and 8% at community hospitals. In 2007, the mean TTI was longer at NCI and academic centers than at community hospitals (NCI: 50 days [95% CI, 48-52 days]; academic: 43 days [95% CI, 42-44 days]; community: 37 days [95% CI, 36-37 days]); however, the mean annual increase in TTI was greater at community hospitals (0.56 days; 95% CI, 0.49-0.62 days) than at NCI centers (-0.73 days; 95% CI, -0.95 to -0.51 days) and academic centers (0.14 days; 95% CI, 0.03-0.26 days). An annual volume growth rate of 100 patients, a level observed at less than 1% of hospitals, was associated with a mean increase in TTI of 0.24 days (95% CI, 0.18-0.29 days). Conclusions and Relevance In this cross-sectional study, from 2007 to 2016, across the studied cancer types, patients increasingly initiated their cancer treatment at NCI and academic centers. Although increases in patient volume at these centers outpaced that at community hospitals, faster growth was not associated with clinically meaningful treatment delays.
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Affiliation(s)
- Zachary A. K. Frosch
- Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Nicholas Illenberger
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel J. Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Matthew A. Facktor
- Department of Thoracic Surgery, Geisinger Heart Institute, Danville, Pennsylvania
| | - Heidi Nelson
- Cancer Programs, American College of Surgeons, Chicago, Illinois
| | - Bryan E. Palis
- Cancer Programs, American College of Surgeons, Chicago, Illinois
| | - Justin E. Bekelman
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lawrence N. Shulman
- Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - Samuel U. Takvorian
- Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Sun V, Reb A, Debay M, Fakih M, Ferrell B. Rationale and Design of a Telehealth Self-Management, Shared Care Intervention for Post-treatment Survivors of Lung and Colorectal Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:414-420. [PMID: 33415649 PMCID: PMC7994229 DOI: 10.1007/s13187-021-01958-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 05/05/2023]
Abstract
Survivors of lung and colorectal cancer have high post-treatment needs; the majority are older and suffer from greater comorbidities and poor quality of life (QOL). They remain underrepresented in research, leading to significant disparities in post-treatment outcomes. Personalized post-treatment follow-up care and care coordination among healthcare teams is a priority for survivors of lung and colorectal cancer. However, there are few evidence-based interventions that address survivors' post-treatment needs beyond the use of a follow-up care plan. This paper describes the rationale and design of an evidence-informed telehealth intervention that integrates shared care coordination between oncology/primary care and self-management skills building to empower post-treatment survivors of lung and colorectal cancer. The intervention design was informed by (1) contemporary published evidence on cancer survivorship, (2) our previous research in lung and colorectal cancer survivorship, (3) the chronic care self-management model (CCM), and (4) shared post-treatment follow-up care between oncology and primary care. A two-arm, parallel randomized controlled trial will determine the efficacy of the telehealth intervention to improve cancer care delivery and survivor-specific outcomes. ClinicalTrials.gov Identifier: NCT04428905.
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Affiliation(s)
- Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, CA, USA.
- Department of Surgery, City of Hope, Duarte, CA, USA.
| | - Anne Reb
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Marc Debay
- Department of Family Medicine, University of California, Riverside, CA, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Betty Ferrell
- Department of Population Sciences, City of Hope, Duarte, CA, USA
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Friend PJ. Graduate Nursing Education: Selecting the Right Program to Match Career Goals. Clin J Oncol Nurs 2020; 24:613-616. [PMID: 33216047 DOI: 10.1188/20.cjon.613-616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Practicing nurses are returning to school to further their education. There is a growing demand for nurses with advanced degrees to meet the needs of an expanding population of patients living with cancer. However, there are many different graduate nursing degree and program options, and several considerations should be taken into account when selecting a degree and a school. Discerning career goals is key to making the best decisions.
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Oncology Pharmacists Can Reduce the Projected Shortfall in Cancer Patient Visits: Projections for Years 2020 to 2025. PHARMACY 2020; 8:pharmacy8010043. [PMID: 32197351 PMCID: PMC7151692 DOI: 10.3390/pharmacy8010043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/24/2022] Open
Abstract
Based on the projected need for a larger oncology care workforce, we estimated the patient care visits and care activities that Board Certified oncology pharmacists (BCOPs) could contribute to oncology care from 2020–2025. Using projected counts for BCOPs through 2025, we estimated that 2.9–4.1 million 30-min BCOP patient visits were possible at 50% workforce capacity. BCOPs’ clinical activities overlapped strongly with those of nurse practitioners (NPs) and physician assistants (PAs) in patient education and treatment management. BCOPs could help reduce provider stress and burnout concerns by spreading these activities across a broader set of providers. BCOPs were more active than NPs and PAs in clinical trials research. Recent advances in immunotherapy, pharmacogenetics, pharmacogenomics, and oral oncolytic agents make the medication-focused training of OPs particularly useful to care teams. Comparison also showed that BCOPs were less active in providing follow-up visits and prescribing. Fulfilling the projected BCOP numbers through 2025 will require continued growth in Postgraduate Year 2 (PGY2) oncology pharmacy resident programs and on-the-job training programs. Our review of the trends in cancer incidence, mortality, and survivorship suggest a sustained need for the activities of BCOPs and other oncology care providers.
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