1
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Moraitis AM, Seven M, Sirard J, Walker RR. Clinical Relevance and Implementation Considerations of Physical Activity in Young Adult Cancer Survivorship: An Expert Consensus Study. J Adolesc Young Adult Oncol 2022. [PMID: 36269579 DOI: 10.1089/jayao.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Elevated survival rates in young adult cancer survivors (YACS) are accompanied by high morbidity levels resulting in an array of unmet needs limiting full life potential. Physical activity (PA) improves physical, psychological, and social aspects of health after a cancer diagnosis. There are no standardized PA guidelines tailored to YACS. Therefore, there is a critical need to understand areas of clinical relevance/agreement on PA use and implementation in young adult (YA) survivorship care. Aim: To identify expert consensus areas on the assessment, prescription, and implementation of PA in YA survivorship care; identify areas of clinical relevance and endorsement of PA as a health optimization strategy in YA survivorship care. Methods: A four-round modified Delphi study of international multidisciplinary experts (Round I/II n = 18; Round III n = 57, Round IV n = 45) in exercise oncology, symptom management, survivorship care, youth cancer care was conducted. Qualitative content analysis, descriptive statistics (% agreement, standard deviation, mean), and inter-rater reliability (Kappa) were calculated. Results: Experts reached a consensus on clinical providers needed to assess, refer, and provide PA interventions, the need for guidelines, and essential care delivery system components to foster the integration of PA integration in YA survivorship care as a health optimization activity. Conclusions/Implications: Cancer care integration models should optimize the unique preferences, strengths, and developmental stage of YA affected by cancer. The study adds to the existing literature on multidisciplinary teams needed to provide clinical expertise and organizational support to foster PA integration into YA survivorship care.
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Affiliation(s)
| | - Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - John Sirard
- Department of Kinesiology and Commonwealth Honors College, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - Rachel Rae Walker
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
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2
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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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3
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Moraitis AM, Seven M, Sirard J, Walker R. Expert Consensus on Physical Activity Use for Young Adult Cancer Survivors' Biopsychosocial Health: A Modified Delphi Study. J Adolesc Young Adult Oncol 2021; 11:459-469. [PMID: 34935468 DOI: 10.1089/jayao.2021.0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Cancer treatment impacts young adults' (YA) biological and psychosocial health, with over >50% reporting unmet needs. Physical activity (PA) offers symptom mitigation, risk reduction, and critical independence to YA (age 18-39 years) affected by cancer. When tailored to YA, PA guidelines can facilitate PA integration into survivorship care. However, no current expert consensus on PA use in YA exists. Aim: To describe expert consensus and opinions on the application of PA as a biopsychosocial health promotion strategy for YA cancer survivors, guided by the Revised Symptom Management Theory. Methods: A four-round modified Delphi study was conducted with international multidisciplinary experts (round I/II, n = 18; round III, n = 57; round IV, n = 45) in exercise oncology, symptom management, survivorship care, and adolescent-YA cancer care. Qualitative content analysis, descriptive statistics (% agreement, SD, mean), and inter-rater reliability (Kappa) were calculated. Results: Experts reached a consensus on the following: PA should be integrated into YA cancer care as part of supportive oncology to mitigate symptoms of fatigue, cardiometabolic health, muscle mass loss, altered body composition, and anxiety/depression; PA improves functional capacity and wellbeing; at all points on the care continuum YA should be asked if they would like guidance on PA use; PA interventions should be tailored for personal facilitators, barriers, and motivations, to maximize survivorship adaptations. Conclusion/Implication: The results of this study identified areas of expert consensus that warrant PA implementation in YA survivorship care to guide future research and clinical endeavors.
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Affiliation(s)
- Ann Marie Moraitis
- College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Memnun Seven
- College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - John Sirard
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Rachel Walker
- College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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4
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Fardell JE, Wakefield CE, De Abreu Lourenco R, Signorelli C, McCarthy M, McLoone J, Osborn M, Gabriel M, Anazodo A, Alvaro F, Lockwood L, Walwyn T, Skeen J, Tillemans R, Cohn RJ. Long-term health-related quality of life in young childhood cancer survivors and their parents. Pediatr Blood Cancer 2021; 68:e29398. [PMID: 34606168 DOI: 10.1002/pbc.29398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 08/24/2021] [Accepted: 09/11/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Few studies have investigated the health-related quality of life (HRQoL) of young childhood cancer survivors and their parents. This study describes parent and child cancer survivor HRQoL compared to population norms and identifies factors influencing child and parent HRQoL. METHODS We recruited parents of survivors who were currently <16 years, and >5 years postdiagnosis. Parents reported on their child's HRQoL (Kidscreen-10), and their own HRQoL (EQ-5D-5L). Parents rated their resilience and fear of cancer recurrence and listed their child's cancer-related late effects. RESULTS One hundred eighty-two parents of survivors (mean age = 12.4 years old and 9.7 years postdiagnosis) participated. Parent-reported child HRQoL was significantly lower than population norms (48.4 vs. 50.7, p < .009). Parents most commonly reported that their child experienced sadness and loneliness (18.1%). Experiencing more late effects and receiving treatments other than surgery were associated with worse child HRQoL. Parents' average HRQoL was high (0.90) and no different to population norms. However 38.5% of parents reported HRQoL that was clinically meaningfully different from perfect health, and parents experienced more problems with anxiety/depression (43.4%) than population norms (24.7%, p < .0001). Worse child HRQoL, lower parent resilience, and higher fear of recurrence was associated with worse parent HRQoL. CONCLUSIONS Parents report that young survivors experience small but significant ongoing reductions in HRQoL. While overall mean levels of HRQoL were no different to population norms, a subset of parents reported HRQoL that was clinically meaningfully different from perfect health. Managing young survivors' late effects and improving parents' resilience through survivorship may improve HRQoL in long-term survivorship.
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Affiliation(s)
- Joanna E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Maria McCarthy
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute (MCRI), Melbourne, Victoria, Australia
| | - Jordana McLoone
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Michael Osborn
- Paediatric Haematology/Oncology, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Frank Alvaro
- John Hunter Children's Hospital, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Liane Lockwood
- Oncology Service Group, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Thomas Walwyn
- Perth Children's Hospital, School of Paediatrics & Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jane Skeen
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Ramon Tillemans
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
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- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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5
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Casillas JN, Schwartz LF, Gildner JL, Crespi CM, Ganz PA, Kahn KL, Stuber ML, Bastani R, Morales S, Quintana K, Gonzalez A, Casas E, Barboa E. Engaging Latino Adolescent and Young Adult (AYA) Cancer Survivors in Their Care: Piloting a Photonovela Intervention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:971-980. [PMID: 32333369 PMCID: PMC10132777 DOI: 10.1007/s13187-020-01724-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Latino adolescent and young adult (AYA) cancer survivors represent a growing population given the changing demographics in the USA. They experience significant healthcare disparities and barriers that warrant age-specific and culturally appropriate interventions to improve their clinical and psychosocial outcomes. This single-arm pilot study evaluated a novel intervention - a photonovela - on its ability to educate Latino AYA survivors and their family members and engage them in survivorship care. Ninety-seven participants (Latino AYA survivors and their family members) were recruited for this study. Three surveys assessing survivorship care confidence, cancer stigma, and survivorship care knowledge were administered to families before they received the photonovela, after the intervention, and at a booster phone call session. Mixed effects models were used to evaluate differences in scores at the three time points while accounting for repeated measures and family clustering. Results show that the photonovela was effective in improving survivorship care confidence and knowledge of Latino AYA survivors and their families. This pilot study indicates that the photonovela has potential to be a useful intervention for improving confidence and knowledge regarding the need to seek survivorship care for Latino AYA cancer survivors.
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Affiliation(s)
- Jacqueline N Casillas
- Department of Pediatrics, Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, A2-410 MDCC, Los Angeles, CA, 90095, USA.
- Center for Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, 90095, USA.
| | - Lindsay F Schwartz
- Department of Pediatrics, Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, A2-410 MDCC, Los Angeles, CA, 90095, USA
| | | | - Catherine M Crespi
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, 90095, USA
| | - Patricia A Ganz
- Center for Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, 90095, USA
- Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, 90095, USA
| | - Katherine L Kahn
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, 90095, USA
| | - Margaret L Stuber
- Department of Psychiatry, David Geffen School of Medicine at UCLA, Resnick Neuropsychiatric Hospital, Los Angeles, CA, 90095, USA
| | - Roshan Bastani
- Center for Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, 90095, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, 90095, USA
| | - Sonia Morales
- Division of Pediatric Hematology/Oncology, Children's Hospital of Orange County, Orange, CA, 92868, USA
| | - Karla Quintana
- Padres Contra El Cáncer (PADRES), Toluca Lake, CA, 91602, USA
| | - Amri Gonzalez
- Padres Contra El Cáncer (PADRES), Toluca Lake, CA, 91602, USA
| | - Esther Casas
- Padres Contra El Cáncer (PADRES), Toluca Lake, CA, 91602, USA
| | - Elvia Barboa
- Padres Contra El Cáncer (PADRES), Toluca Lake, CA, 91602, USA
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6
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McLoone J, Wakefield CE, Taylor N, Johnston K, Sansom-Daly UM, Cohen J, O'Brien TA, Cohn RJ, Signorelli C. The COVID-19 pandemic: Distance-delivered care for childhood cancer survivors. Pediatr Blood Cancer 2020; 67:e28715. [PMID: 32970366 DOI: 10.1002/pbc.28715] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Jordana McLoone
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ursula M Sansom-Daly
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jennifer Cohen
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,CanTeen, Sydney, New South Wales, Australia
| | - Tracey A O'Brien
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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7
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Pham Q, Hearn J, Gao B, Brown I, Hamilton RJ, Berlin A, Cafazzo JA, Feifer A. Virtual care models for cancer survivorship. NPJ Digit Med 2020; 3:113. [PMID: 32923690 PMCID: PMC7468136 DOI: 10.1038/s41746-020-00321-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
Virtual care models for cancer survivorship are needed to support patients living with the chronic effects of cancer treatment, while increasing health system capacity. Characteristics that may be critical to their success have not been adequately studied. This scoping review summarizes previous efforts to virtualize survivorship care to inform future innovations in the field. Four databases were searched for articles published before January 2020, and 24 articles that met selection criteria were included in this analysis. Rationale for pursuing virtual models of care shared two common objectives: (1) the need for sustainable survivorship care, and (2) the opportunity to improve survivorship outcomes. Breast cancer (N = 10) and prostate cancer (N = 4) were the most targeted cancers for virtual survivorship care. The implemented technologies included web platforms (N = 15), telephone calls (N = 12), and smartphone or tablet applications (N = 5). A variety of healthcare professionals were effectively involved in the provision of virtual care. Future virtual care models may benefit from integrating with existing health systems and services, repurposing common technologies, involving allied health professionals, and engaging patients and caregivers from diverse communities in the design of virtual services.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jason Hearn
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL Canada
| | - Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Ian Brown
- Division of Urology, Niagara Health, Niagara, ON Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON Canada
- Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, ON Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON Canada
| | - Joseph A. Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Andrew Feifer
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON Canada
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8
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Signorelli C, Wakefield CE, Johnston KA, Fardell JE, McLoone JK, Brierley MEE, Schaffer M, Thornton-Benko E, Girgis A, Wallace WH, Cohn RJ, _ _. Re-Engage: A Novel Nurse-Led Program for Survivors of Childhood Cancer Who Are Disengaged From Cancer-Related Care. J Natl Compr Canc Netw 2020; 18:1067-1074. [DOI: 10.6004/jnccn.2020.7552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/18/2020] [Indexed: 11/17/2022]
Abstract
Background:Survivors of childhood cancer often experience treatment-related chronic health conditions. Survivorship care improves survivors’ physical and mental health, yet many are disengaged from care. Innovative models of care are necessary to overcome patient-reported barriers to accessing survivorship care and to maximize survivors’ health.Methods:We piloted a novel survivorship program, called “Re-engage,” a distance-delivered, nurse-led intervention aiming to engage, educate, and empower survivors not receiving any cancer-related care. Re-engage involves a nurse-led consultation delivered via telephone/online to establish survivors’ medical history and needs. Participants completed questionnaires at baseline, 1 month postintervention, and 6-month follow-up.Results:A total of 27 survivors who had not accessed survivorship care in the last 2 years participated (median age, 31 years; interquartile range [IQR], 27–39 years); of which, 82% were at high-risk for treatment-related complications. Participation in Re-engage was high (75%) and there was no attrition once survivors enrolled. At 1 month postintervention, 92% of survivors reported that Re-engage was “beneficial,” which all survivors reported at 6-month follow-up. Survivors’ overall satisfaction with their care increased from 52% before Re-engage to 84% at 1 month postintervention. Survivors’ mean self-efficacy scores remained similar from baseline to 1 month postintervention (b = −0.33, 95% CI, −1.31 to 0.65), but increased significantly from baseline to 6-month follow-up (b = 1.64, 95% CI, 0.28–3.00). At 6-month follow-up, 73% of survivors showed an increase in health-related self-efficacy compared with baseline.Conclusions:Re-engage is a highly acceptable and feasible intervention and promotes health-related self-efficacy, which is integral to survivors being advocates for their own health. Further empirical work is needed to evaluate the long-term efficacy of Re-engage.Trial registration:ACTRN12618000194268
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Affiliation(s)
- Christina Signorelli
- 1Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- 2School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
| | - Claire E. Wakefield
- 1Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- 2School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
| | - Karen A. Johnston
- 1Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- 2School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
| | - Joanna E. Fardell
- 1Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- 2School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
| | - Jordana K McLoone
- 1Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- 2School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
| | - Mary-Ellen E. Brierley
- 1Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- 2School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
| | - Maria Schaffer
- 1Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- 2School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Afaf Girgis
- 4Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Sydney, NSW, Australia; and
| | - W. Hamish Wallace
- 5Department of Hematology/Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Richard J. Cohn
- 1Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- 2School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
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9
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Signorelli C, Wakefield CE, Fardell JE, Brierley ME, Darlington AS, Williamson J, Downie P, Cohn RJ. Perceptions of future health and cancer risk in adult survivors of childhood cancer: Implications for engagement in follow-up care. Cancer 2019; 125:1008-1009. [PMID: 30624781 DOI: 10.1002/cncr.31934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Christina Signorelli
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Mary-Ellen Brierley
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | | | - Jane Williamson
- Victorian Paediatric Integrated Cancer Service, Melbourne, Victoria, Australia
| | - Peter Downie
- Victorian Paediatric Integrated Cancer Service, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia.,Children's Cancer Centre, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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10
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Berry-Stoelzle M, Parang K, Daly J. Rural Primary Care Offices and Cancer Survivorship Care: Part of the Care Trajectory for Cancer Survivors. Health Serv Res Manag Epidemiol 2019; 6:2333392818822914. [PMID: 30719488 PMCID: PMC6348493 DOI: 10.1177/2333392818822914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 11/21/2022] Open
Abstract
Background: A cancer diagnosis is a monumental event in a patient’s life and with the number of cancer survivors increasing; most of these patients will be taken care of by a primary care provider at some point after their cancer therapy. The purpose of this study is to identify primary care physician’s needs to care for a patient who has had cancer. Methods: A cross-sectional survey of the physician members of the Iowa Research Network was conducted. The survey was designed to measure physician confidence in cancer survivor’s care, office strategies regarding cancer survivorship care, and resources available for patients with cancer. Two hundred seventy-four Iowa Research Network members were invited to participate in this survey. Results: Eighty-two physicians (30%) completed the questionnaire with 96% reporting that they are aware of their patient’s cancer survivorship status. Seventy-one physicians reported they were aware of cancer survivorship status by an oncologist sending a note to the office, 68 being diagnosed in their office, 61 by the patient keeping the office apprised, and 15 receiving a survivorship care plan. Physicians reported the top changes in a cancer survivor’s physical health as fatigue (81%) and pain (59%). Sixty-two physicians reported not feeling confident for managing chemobrain, cardiotoxicity (71%), and skin changes (35%). Male physicians were significantly more confident managing patients’ skin changes (P = .049) and musculoskeletal disturbances than female physicians (P = .027), while female physicians were significantly more confident managing early-onset menopause than male physicians (P = .027). Conclusion: Most respondents are aware of their patients who are cancer survivors and are mostly confident in the care they provide for them related to long-term effects and side effects of cancer therapies with limited receipt of cancer survivorship care plans.
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Affiliation(s)
| | - Kim Parang
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
| | - Jeanette Daly
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
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