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Aleshchenko E, Apfelbacher C, Baust K, Calaminus G, Droege P, Glogner J, Horenkamp-Sonntag D, Ihle P, Kaatsch P, Klein M, Kloppe T, Kuepper-Nybelen J, Langer T, Luepkes C, Marschall U, Meier I, Merzenich H, Spix C, Swart E, Trocchi P. VersKiK: Study protocol of an observational registry-based study on the current state of follow-up care and adherence to follow-up guidelines after cancer in childhood or adolescence. Cancer Epidemiol 2023; 87:102469. [PMID: 37806118 DOI: 10.1016/j.canep.2023.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND This article describes the study design of the quantitative part of the VersKiK study, The primary objectives of this study are to examine the occurrence of late effects in survivors of childhood or adolescent cancer (module 1), investigate health-related vulnerabilities and medical service utilization within this survivor group (modules 1 and 3), and assess the alignment between documented follow-up care for cardiological and audiological late effects with guideline recommendations, along with evaluating the extent of adherence among paediatric cancer survivors (module 3). METHODS This is a non-interventional retrospective observational cohort study. It is based on stochastically linked insurance claims data from approximately 150,000 statutory insured persons with information concerning around 25,000-30,000 cancer survivors recorded in the German Childhood Cancer Register (GCCR). To explore adherence to selected follow-up guidelines, intention to treat treatment data from clinical study groups for particular diagnostic entities will be additionally included. DISCUSSION The growing group of survivors after cancer in childhood and adolescence is representing a special population with an increasing demand for life-long healthcare services through relative high probability of late effects. Currently, there is a limited evidence in Germany on utilization of corresponding medical services and adherence to follow-up guidelines. With this study design, we are aiming to address these gaps and, consequently, suggest improvements to existing follow-up guidelines and follow-up care provision in Germany.
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Affiliation(s)
- E Aleshchenko
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany.
| | - C Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany
| | - K Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - G Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - P Droege
- Health Services and Quality Research, Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - J Glogner
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | | | - P Ihle
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - P Kaatsch
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - M Klein
- DAK-Gesundheit, Hamburg, Germany
| | - T Kloppe
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | - J Kuepper-Nybelen
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - T Langer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - C Luepkes
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | | | - I Meier
- Techniker Krankenkasse (TK), Hamburg, Germany
| | - H Merzenich
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - C Spix
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - E Swart
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany
| | - P Trocchi
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany
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Schlairet MC, Heddon MA, Randolph J. Predicting Survivorship Appointment Nonattendance in a Community Cancer Center: A Machine-Learning Approach. West J Nurs Res 2023; 45:607-617. [PMID: 37085980 DOI: 10.1177/01939459231165749] [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: 04/23/2023]
Abstract
Understanding and predicting cancer survivors' health care utilization is critical to promote quality care. The consultative system of survivorship care uses a onetime consultative appointment to transition patients from active treatment into survivorship follow-up care. Knowledge of attributes associated with nonattendance at this essential appointment is needed. An ability to predict patients with a likelihood of nonattendance would be of value to practitioners. Unfortunately, traditional data modeling techniques may not be useful in working with large numbers of variables from electronic medical record platforms. A variety of machine-learning algorithms were used to develop a model for predicting 843 survivors' nonattendance at a comprehensive community cancer center in the southeastern United States. A parsimonious model resulted in a k-fold classification accuracy of 67.3% and included three variables. Practitioners may be able to increase utilization of follow-up care among survivors by knowing which patient groups are more likely to be survivorship appointment nonattenders.
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Affiliation(s)
- Maura C Schlairet
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, USA
| | - Mary Ann Heddon
- Clinical Trials Program, Pearlman Cancer Center of South Georgia Medical Center, Valdosta, GA, USA
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, USA
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Alchin JE, Signorelli C, McLoone JK, Wakefield CE, Fardell JE, Johnston K, Cohn RJ. Childhood Cancer Survivors' Adherence to Healthcare Recommendations Made Through a Distance-Delivered Survivorship Program. J Multidiscip Healthc 2022; 15:1719-1734. [PMID: 35983228 PMCID: PMC9380825 DOI: 10.2147/jmdh.s363653] [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: 02/25/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Ongoing survivorship care allows childhood cancer survivors the opportunity to address treatment-related health problems and improve their quality of life. However, many survivors do not adhere to their healthcare professionals’ recommendations and the factors supporting their adherence remain unclear. Patients and Methods Long-term childhood cancer survivors completed the “Re-engage” program, which assessed survivors’ heath needs and provided individualised recommendations for health interventions and surveillance developed by an expert multi-disciplinary team (MDT). We measured survivors’ recall of, and adherence to, their individualised healthcare recommendations at one and six months post-intervention. We conducted a series of univariate negative binomial regressions to investigate factors associated with the total number of recommendations that were correctly recalled and adhered to. Results We analysed the data of 25 childhood cancer survivors who participated in Re-engage (mean age = 31.9 years). On average, survivors were provided with 6.6 recommendations (range = 1–11). Survivors accurately recalled receiving 3.0 recommendations at one month post-intervention and 1.9 at six months. Survivors had adhered to an average of 1.3 recommendations by six-month follow-up. In total, 56% of participants reported that they did not adhere to any recommendations. By six-month follow-up, greater adherence to MDT recommendations was associated with having a history of a second cancer (B = 1.391; 95% confidence interval [CI], 0.686 to 2.097; p < 0.001) and reporting a greater level of worry about late effects (B = 1.381; 95% CI, 0.494 to 2.269; p = 0.002). Conclusion Survivors reported sub-optimal levels of adherence and demonstrated limited recall of their healthcare recommendations. Effective communication of recommendations and clear discussion of barriers limiting adherence, coupled with late effects education, may be critical to ensure that survivors engage with their recommendations, to improve their quality of life and health outcomes. Trial Registration Number ACTRN12618000194268.
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Affiliation(s)
- Joseph Elliot Alchin
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jordana Kathleen McLoone
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Claire Elizabeth Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Joanna Elizabeth Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
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Phelan M, Hayashi SS, Sauerburger K, Henry J, Wu N, Hayashi RJ. Prevalence of hearing screening failures in low-risk childhood cancer survivors. Pediatr Blood Cancer 2022; 69:e29437. [PMID: 34854541 PMCID: PMC8712396 DOI: 10.1002/pbc.29437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/30/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND We sought to estimate the frequency of hearing screening failures in pediatric cancer survivors at low risk for hearing loss and evaluate the feasibility of administering screenings in this population. PROCEDURE Survivors in the St. Louis Children's Hospital Late Effects Clinic were recruited. Eligibility included (a) diagnosis of a pediatric cancer treated without platinum chemotherapy or cranial radiation, (b) at least 6 months from completion of therapy, (c) between the ages of 7 and 18 years, (d) cognitively/behaviorally able to participate, and (e) English speaking. Behavioral hearing screenings from 1000 to 8000 Hz were performed by trained personnel using a calibrated audiometer. A failed screen was defined by a participant not responding to two or more of the three screening attempts for at least one frequency in at least one ear. RESULTS One hundred nine patients met eligibility criteria with 78 enrolled (71.5%). Diagnoses included leukemia (57.7%), sarcoma (11.5%), Wilms tumor (14.1%), lymphoma (12.8%), and other solid tumors (3.9%). The median age was 13.2 years (Q1-Q3: 9.6-15.4) and the median time from treatment completion was 3.7 years (Q1-Q3: 2.3-7.4). Eighteen patients (23%) failed the hearing screen (95% CI: 14%-34%). No demographic or treatment-related variables were significantly correlated to screening failure. Six screen failures (33%) underwent formal audiology assessments, with three demonstrating unilateral hearing loss: two conductive and one sensorineural. CONCLUSIONS A significant fraction of pediatric cancer survivors at low risk for hearing loss failed hearing screening. Broader use of hearing screening should be considered.
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Affiliation(s)
- Meghan Phelan
- Program in Audiology and Communication Sciences, Washington University School of Medicine
| | | | - Kara Sauerburger
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine
| | - Jennifer Henry
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine
| | - Ningying Wu
- Siteman Cancer Center, Washington University School of Medicine
| | - Robert J. Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine
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Gandy KC, De Nigris FB, Frugé E, Okcu MF, Schwartz DD. "Why We Keep Coming Back": Family and Provider Perspectives on Factors Influencing Long-term Follow-up for Pediatric Cancer Survivorship Care. J Pediatr Hematol Oncol 2022; 44:e176-e184. [PMID: 34133376 DOI: 10.1097/mph.0000000000002239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The majority of childhood cancer survivors do not follow-up for long-term risk-based screening for recurrent illness and treatment late effects, despite a high prevalence of secondary morbidities. The primary aim of this study was to investigate factors that influence long-term follow-up for survivorship care, from the perspectives of providers, patients, and caregivers. MATERIALS AND METHODS A semistructured interview was designed to elicit stakeholder perspectives on factors that facilitate or impede routine clinic visits after completion of cancer therapy. Results were analyzed using a qualitative framework method. RESULTS Providers, patients, and caregivers identified a wide range of factors that might influence long-term follow-up for care. All respondents noted the importance of efficient clinical operations, resources such as parking, provider behaviors, rapport/attachment, and patient/family logistics. Compared with patients/caregivers, providers more frequently mentioned institutional operations, their own education and skills, patient/family understanding and motivation, and interpersonal processes such as communication style. Families more frequently mentioned clinic environment, and patients more frequently noted the importance of having a family member present, something neither providers nor caregivers reported. CONCLUSIONS Providers, patients, and patient caregivers have different perspectives regarding factors that may influence follow-up for long-term survivorship care. Understanding these differences can help inform efforts to improve follow-up.
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Affiliation(s)
- Kellen C Gandy
- Section of Hematology-Oncology, Department of Pediatrics
| | | | - Ernest Frugé
- Section of Hematology-Oncology, Department of Pediatrics
| | - Mehmet F Okcu
- Section of Hematology-Oncology, Department of Pediatrics
| | - David D Schwartz
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Milam J, Freyer DR, Miller KA, Tobin J, Wojcik KY, Ramirez CN, Ritt-Olson A, Thomas SM, Baezconde-Garbanati L, Cousineau M, Modjeski D, Gupta S, Hamilton AS. Project Forward: A Population-Based Cohort Among Young Adult Survivors of Childhood Cancers. JNCI Cancer Spectr 2021; 5:pkab068. [PMID: 34585063 PMCID: PMC8462512 DOI: 10.1093/jncics/pkab068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/18/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Childhood cancer survivors (CCS) face increased risk of morbidity and are recommended to receive lifelong cancer-related follow-up care. Identifying factors associated with follow-up care can inform efforts to support the long-term health of CCS. Methods Eligible CCS (diagnosed between 1996 and 2010) identified through the Los Angeles County Cancer Surveillance Program responded to a self-report survey that assessed demographic, clinical, health-care engagement, and psychosocial risk and protective factors of recent (prior 2 years) cancer-related follow-up care. Weighted multivariable logistic regression was conducted to identify correlates of care. All statistical tests were 2-sided. Results The overall response rate was 44.9%, with an analytical sample of n = 1106 (54.2% Hispanic; mean [SD] ages at survey, diagnosis, and years since diagnosis were 26.2 [4.9], 11.6 [5.4], and 14.5 [4.4] years, respectively). Fifty-seven percent reported a recent cancer-related visit, with lower rates reported among older survivors. Having insurance, more late effects, receipt of a written treatment summary, discussing long-term care needs with treating physician, knowledge of the need for long-term care, having a regular source of care, and higher health-care self-efficacy were statistically significantly associated with greater odds of recent follow-up care, whereas older age, Hispanic or Other ethnicity (vs non-Hispanic White), and years since diagnosis were associated with lower odds of recent care (all Ps < .05). Conclusions Age and ethnic disparities are observed in receipt of follow-up care among young adult CCS. Potential intervention targets include comprehensive, ongoing patient education; provision of written treatment summaries; and culturally tailored support to ensure equitable access to and the utilization of care.
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Affiliation(s)
- Joel Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Departments of Medicine and Epidemiology and Biostatistics, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - David R Freyer
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica Tobin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Katherine Y Wojcik
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, WA, USA
| | - Cynthia N Ramirez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Cousineau
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Denise Modjeski
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sapna Gupta
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Perceived Health among Adolescent and Young Adult Survivors of Childhood Cancer. ACTA ACUST UNITED AC 2021; 28:825-836. [PMID: 33562251 PMCID: PMC7985790 DOI: 10.3390/curroncol28010080] [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: 11/28/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
Survivors of childhood cancer (SCCs) are at increased risk of late effects, which are cancer- and treatment-related side-effects that are experienced months to years post-treatment and encapsulate a range of physical, cognitive and emotional problems including secondary malignancies. Perceived health can serve as an indicator of overall health. This study aims to (1) understand how a patient reported outcome (PRO) of perceived health of SCCs compares to controls who have not had a cancer diagnosis and (2) examine the relationships between perceived health and demographic and clinical variables, and health behavior. A total of 209 SCCs (n = 113 (54.10%) males; median age at diagnosis = 6.50 years; median time off treatment = 11.10 years; mean age at study = 19.00 years) were included. SCCs completed annual assessments as part of Long-Term Survivor Clinic appointments, including a question on perceived health answered on a five-point Likert scale. Data were collected retrospectively from medical charts. Perceived health of SCCs was compared to a control group (n = 836) using data from the 2014 Canadian Community Health Survey. Most SCCs (67%) reported excellent or very good health. The mean perceived health of SCCs (2.15 ± 0.91) was not statistically different from population controls (2.10 ± 0.87). Pain (B = 0.35; p < 0.001), physical activity (B = −0.39; p = 0.013) and concerns related to health resources (B = 0.59; p = 0.002) were significant predictors of perceived health. Factors shown to influence SCCs’ perceived health may inform interventions. Exploration into how SCCs develop their conception of health may be warranted.
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Park BK, Kim JY, Rogers VE. Development and Usability Evaluation of a Facebook-Based Intervention Program for Childhood Cancer Patients: Mixed Methods Study. J Med Internet Res 2020; 22:e18779. [PMID: 32720897 PMCID: PMC7420636 DOI: 10.2196/18779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/22/2020] [Accepted: 06/11/2020] [Indexed: 01/23/2023] Open
Abstract
Background Childhood cancers previously considered to be incurable now have 5-year survival rates up to 84%. Nevertheless, these patients remain at risk of morbidity and mortality from therapy-related complications. Thus, patient education and self-management strategies for promoting a healthy lifestyle are of tantamount importance for improving short- and long-term health outcomes. A Facebook-based “Healthy Teens for Soaam” (a Korean term for childhood cancers) program was developed to help improve knowledge and self-management practices of teens with cancer related to their disease and treatment. Objective The two-fold purpose of this usability study was (1) to describe the process of developing an 8-week Facebook-based intervention program for teens with cancer, and (2) to evaluate its usability to refine the program. Methods Multiple phases and methods were employed to develop and evaluate the usability of the program. Study phases included: (1) needs assessment through focus group interviews and qualitative content analysis, (2) development of module content, (3) expert review and feedback on module content, (4) Facebook-based program development, (5) usability evaluation by heuristic evaluation, (6) usability evaluation by targeted end-user testing, and (7) modification and final version of the program. Usability of the final version was confirmed through feedback loops of these phases. Results Based on 6 focus group discussion sessions, it was determined that teens with cancer were interested in seeing stories of successful childhood cancer cases and self-management after discharge, and preferred multimedia content over text. Therefore, each Facebook module was redesigned to include multimedia materials such as relevant video clips tailored for teens. Usability assessed by heuristic evaluation and user testing revealed several critical usability issues, which were then revised. Potential end users tested the final program and perceived it to be usable and useful for teens with cancer. Conclusions To our knowledge, “Healthy Teens for Soaam” is the first Facebook-based intervention program for teens with cancer. We actively worked with current childhood cancer patients and survivors to develop and improve this program, achieved good usability, and met the expressed needs and preferences of target end users. This 8-week Facebook-based educational program for teens with cancer, developed as the first step of an upcoming intervention study, will be useful for improving knowledge and self-management strategies of teens.
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Affiliation(s)
- Bu Kyung Park
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Valerie E Rogers
- School of Nursing (retired), University of Maryland Baltimore, Baltimore, MD, United States
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Zabih V, Kahane A, O'Neill NE, Ivers N, Nathan PC. Interventions to improve adherence to surveillance guidelines in survivors of childhood cancer: a systematic review. J Cancer Surviv 2019; 13:713-729. [PMID: 31338733 DOI: 10.1007/s11764-019-00790-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Many survivors of childhood cancer are at high risk of late effects of their cancer therapy, including cardiac toxicity and subsequent malignant neoplasms (SMN). Current North American guidelines recommend periodic surveillance for these late effects. We conducted a systematic review of the literature to estimate rates of adherence to recommended surveillance and summarize studies evaluating interventions intended to increase adherence. METHODS We searched MEDLINE, Embase, Web of Science, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and September 2018 that reported adherence to surveillance for cardiac toxicity and SMN (breast and colorectal cancer) and interventions implemented to improve completion of recommended testing. Risk of bias was assessed using relevant Cochrane checklists. Due to heterogeneity and overlapping study populations, we used narrative synthesis to summarize the findings. This review was registered in PROSPERO: CRD42018098878. RESULTS Thirteen studies met our inclusion criteria for assessing adherence to surveillance, while five assessed interventions to improve rates of surveillance. No studies met criteria for low risk of bias. Completion of recommended surveillance was lowest for colorectal cancer screening (11.5-30.0%) followed by cardiomyopathy (22.3-48.1%) and breast cancer (37.0-56.5%). Factors such as patient-provider communication, engagement with the health care system, and receipt of information were consistently reported to be associated with higher rates of surveillance. Of five randomized controlled trials aimed at improving surveillance, only two significantly increase completion of recommended testing-one for echocardiography and one for mammography. Both involved telephone outreach to encourage and facilitate these tests. CONCLUSION The majority of childhood cancer survivors at high risk of cardiac toxicity or SMN do not receive evidence-based surveillance. There is paucity of rigorous studies evaluating interventions to increase surveillance in this population. IMPLICATIONS FOR CANCER SURVIVORS Robust trials are needed to assess whether tailored interventions, designed based on unique characteristics and needs of each survivor population, could improve adherence.
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Affiliation(s)
- Veda Zabih
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | | | | | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Reynolds K, Spavor M, Brandelli Y, Kwok C, Li Y, Disciglio M, Carlson LE, Schulte F, Anderson R, Grundy P, Giese-Davis J. A comparison of two models of follow-up care for adult survivors of childhood cancer. J Cancer Surviv 2019; 13:547-557. [PMID: 31250352 DOI: 10.1007/s11764-019-00774-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 06/03/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Few studies have compared follow-up-care models for adult survivors of childhood cancer (ASCCs), though choice of model could impact medical test adherence, and health-related quality of life (QOL). This study compared two follow-up-care models, cancer-center-based versus community-based, for ASCCs in Alberta, Canada, to determine which model would demonstrate greater ASCC adherence to guideline-recommended medical screening tests for late effects, QOL, physical symptoms, and adherence to yearly follow-up. METHODS ASCC discharged to a community model (over 15 years) and those with comparable birth years (1973-1993) currently followed in a cancer center model were recruited via direct contact or multimedia campaign. Chart review identified chemotherapeutic and radiation exposures, and required medical late effect screening tests. ASCCs also completed questionnaires assessing QOL, physical symptoms, and follow-up behavior. RESULTS One hundred fifty-six survivors participated (community (n = 86); cancer center (n = 70)). Primary analysis indicated that cancer center ASCCs guideline-recommended total test adherence percentage (Mdn = 85.4%) was significantly higher than the community model (Mdn = 29.2%, U = 3996.50, p < 0.0001). There was no significant difference in QOL for cancer center ASCCs (M = 83.85, SD = 20.55 versus M = 77.50, SD = 23.94; t (154) = 1.77, p = 0.078) compared to community-based ASCCs. Cancer center-based ASCCs endorsed from 0.4-7.1% fewer physical symptom clusters, and higher adherence to follow-up behavior in comparisons using effect sizes without p values. CONCLUSION This study highlights the cancer center model's superiority for adherence to exposure-based medical late effect screening guidelines, cancer-specific follow-up behaviors, and the reporting of fewer physical complaints in ASCCs. IMPLICATIONS FOR CANCER SURVIVORS ASCCs followed in a cancer center model likely benefit from earlier late-effects detection and opportunities for early intervention.
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Affiliation(s)
- K Reynolds
- Long Term Survivor's Clinic, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Spavor
- Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada.
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Y Brandelli
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - C Kwok
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Y Li
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada
| | - M Disciglio
- Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada
| | - L E Carlson
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada
| | - F Schulte
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Division of Medical Science, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - R Anderson
- Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Oncology, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada
| | - P Grundy
- Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - J Giese-Davis
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada
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11
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Daly A, Lewis RW, Vangile K, Masker KW, Effinger KE, Meacham LR, Mertens AC. Survivor clinic attendance among pediatric- and adolescent-aged survivors of childhood cancer. J Cancer Surviv 2018; 13:56-65. [PMID: 30560348 DOI: 10.1007/s11764-018-0727-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/04/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Childhood cancer survivors need regular, risk-adapted, long-term survivor care. This retrospective study describes the proportion of survivors seen for an initial survivor clinic visit within a large pediatric oncology program. METHODS Patients diagnosed with non-central nervous system childhood malignancies from 2007 to 2012 were followed from the time of survivor clinic eligibility (2 years following completion of therapy) through their initial survivor clinic visit or end of study. Demographic, cancer-related, and logistical factors related to clinic attendance were examined using Kaplan-Meier curves and Cox proportional regressions. RESULTS Eligible survivors were 53.0% male, 51.5% non-Hispanic white, and 30.9% survivors of leukemia. Among the 866 eligible survivors for this study, 610 (70.4%) completed their initial visit. After controlling for sex and time eligible, survivors who received surgery only (aHR 0.04 (0.02, 0.08)) or radiation only (0.24 (0.15, 0.39)) and who had Medicaid (0.77 (0.64, 0.92)) were significantly less likely to have an initial visit as were those of black or other/mixed race and those who lived > 25 mi from the clinic (p < 0.01). Survivors aged 6-11 years or 12-17 years at eligibility were significantly more likely to complete an initial visit as compared to those aged 2-5 years (1.55 (1.24, 1.93) and 1.44 (1.14, 1.83), respectively). CONCLUSIONS Nearly a third of survivors were not seen in a pediatric survivor clinic despite the importance of survivor care. These results identify populations at risk for not pursuing long-term survivorship care. IMPLICATIONS FOR CANCER SURVIVORS Failure to transition to pediatric survivor care may lead to lifelong non-engagement and incorrect perceptions about future health.
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Affiliation(s)
- Ashley Daly
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Division of Behavioral Health, Idaho Department of Health and Welfare, Boise, ID, USA
| | | | - Kristen Vangile
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Karen Wasilewski Masker
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, 4th Floor, Atlanta, GA, 30322, USA
| | - Karen E Effinger
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, 4th Floor, Atlanta, GA, 30322, USA
| | - Lillian R Meacham
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, 4th Floor, Atlanta, GA, 30322, USA
| | - Ann C Mertens
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, 4th Floor, Atlanta, GA, 30322, USA.
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12
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Baenziger J, Roser K, Mader L, Christen S, Kuehni CE, Gumy-Pause F, Tinner EM, Michel G. Can the theory of planned behavior help explain attendance to follow-up care of childhood cancer survivors? Psychooncology 2018; 27:1501-1508. [PMID: 29473254 DOI: 10.1002/pon.4680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Childhood cancer survivors are at high risk for late effects. Regular attendance to long-term follow-up care is recommended and helps monitoring survivors' health. Using the theory of planned behavior, we aimed to (1) investigate the predictors of the intention to attend follow-up care, and (2) examine the associations between perceived control and behavioral intention with actual follow-up care attendance in Swiss childhood cancer survivors. METHODS We conducted a questionnaire survey in Swiss childhood cancer survivors (diagnosed with cancer aged <16 years between 1990 and 2005; ≥5 years since diagnosis). We assessed theory of planned behavior-related predictors (attitude, subjective norm, perceived control), intention to attend follow-up care, and actual attendance. We applied structural equation modeling to investigate predictors of intention, and logistic regression models to study the association between intention and actual attendance. RESULTS Of 299 responders (166 [55.5%] females), 145 (48.5%) reported attending follow-up care. We found that subjective norm, ie, survivors' perceived social pressure and support (coef = 0.90, P < 0.001), predicted the intention to attend follow-up; attitude and perceived control did not. Perceived control (OR = 1.58, 95%CI:1.04-2.41) and intention to attend follow-up (OR = 6.43, 95%CI:4.21-9.81) were positively associated with attendance. CONCLUSIONS To increase attendance, an effort should be made to sensitize partners, friends, parents, and health care professionals on their important role in supporting survivors regarding follow-up care. Additionally, interventions promoting personal control over the follow-up attendance might further increase regular attendance.
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Affiliation(s)
- Julia Baenziger
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Luzius Mader
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Salome Christen
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Fabienne Gumy-Pause
- Department of Pediatrics, Onco-Hematology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Eva Maria Tinner
- Division of Pediatric Hematology/Oncology, University Children's Hospital Bern, Bern, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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