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Stout NL, Alfano CM, Liu R, Dixit N, Jefford M. Implementing a Clinical Pathway for Needs Assessment and Supportive Care Interventions. JCO Oncol Pract 2024; 20:1173-1181. [PMID: 38709984 DOI: 10.1200/op.23.00482] [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: 08/02/2023] [Revised: 02/02/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Despite advances in clinical cancer care, cancer survivors frequently report a range of persisting issues, unmet needs, and concerns that limit their ability to participate in life roles and reduce quality of life. Needs assessment is recognized as an important component of cancer care delivery, ideally beginning during active treatment to connect patients with supportive services that address these issues in a timely manner. Despite the recognized importance of this process, many health care systems have struggled to implement a feasible and sustainable needs assessment and management system. This article uses an implementation science framework to guide pragmatic implementation of a needs assessment clinical system in cancer care. According to this framework, successful implementation requires four steps including (1) choosing a needs assessment tool; (2) carefully considering the provider level, clinic level, and health care system-level strengths and barriers to implementation and creating a pilot system that addresses these factors; (3) making the assessment system actionable by matching needs with clinical workflow; and (4) demonstrating the value of the system to support sustainability.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology Oncology, School of Medicine, West Virginia University Cancer Institute, Morgantown, WV
- Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, WV
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, NY
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Raymond Liu
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Niharika Dixit
- Division of Hematology/Oncology, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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Geng J, Li R, Wang X, Xu R, Liu J, Jiang H, Wang G, Hesketh T. Eliciting Older Cancer Patients' Preferences for Follow-Up Care to Inform a Primary Healthcare Follow-Up Model in China: A Discrete Choice Experiment. THE PATIENT 2024; 17:589-601. [PMID: 38702574 PMCID: PMC11343794 DOI: 10.1007/s40271-024-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Increasing longevity and advances in treatment have increased the cancer burden in the elderly, resulting in complex follow-up care needs; however, in China, little is known about the follow-up care preferences of these patients. This study quantified older cancer patients' preferences for follow-up care and examined the trade-offs they are willing to make to accept an alternative follow-up model. METHODS A discrete choice experiment was conducted among inpatients aged over 60 years with breast, prostate, or colorectal cancer, at two large tertiary hospitals in Nantong, China. Preference weights for follow-up care were estimated using mixed logit analysis. Subgroup analysis and latent class analysis were used to explore preference heterogeneity. RESULTS Complete results were obtained from 422 patients (144 with breast cancer, 133 with prostate cancer, 145 with colorectal cancer), with a mean age of 70.81 years. Older cancer patients stated a preference for follow-up by specialists over primary healthcare (PHC) providers ( β = -1.18, 95% confidence interval -1.40 to -0.97). The provider of follow-up care services was the most valued attribute among patients with breast cancer (relative importance [RI] 37.17%), while remote contact services were prioritized by patients with prostate (RI 43.50%) and colorectal cancer (RI 33.01%). The uptake rate of an alternative care model integrating PHC increased compared with the baseline setting when patients were provided with preferred services (continuity of care, individualized care plans, and remote contact services). CONCLUSION To encourage older cancer patients to use PHC-integrated follow-up care, alternative follow-up care models need to be based on patients' preferences before introducing them as a routine option.
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Affiliation(s)
- Jiawei Geng
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Ran Li
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Insititute of Global Health, University College London, London, UK
| | - Xinyu Wang
- School of Public Health, Nantong University, Nantong, China
| | - Rongfang Xu
- Department of Nursing, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Jibin Liu
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Haiyan Jiang
- Department of Health Management, Affiliated Hospital of Nantong University, Nantong, China
| | - Gaoren Wang
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China.
| | - Therese Hesketh
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China.
- Insititute of Global Health, University College London, London, UK.
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Sussman J, Cerasuolo JO, Pond GR, Bainbridge D, Seow H. Patterns of Survivorship Follow-Up Care Among Patients With Breast Cancer: A Retrospective Population-Based Cohort Study in Ontario, Canada, Between 2006 and 2016. JCO Oncol Pract 2024:OP2300813. [PMID: 39052954 DOI: 10.1200/op.23.00813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/06/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE Many cancer survivors have ongoing follow-up with their oncologist(s), despite evidence that this care can be competently managed by primary care and transitioning well survivors could relieve growing pressure on cancer care systems. We analyzed population-based administrative data from Ontario, Canada, to examine rates of transition to primary care-led follow-up care during the survivorship phase, including clinical and demographic predictors associated with being transitioned. METHODS We conducted a retrospective cohort study to describe the patterns of survivorship follow-up care among all patients with breast cancer in Ontario from 2006 to 2016. Data were derived from the Ontario Cancer Registry and other linked data sets. We defined the survivorship phase of care beginning at 2 years after initial diagnosis. Logistic regression was used to explore factors potentially prognostic of no oncology visits in each of the years after survivorship. RESULTS Our survivorship cohort was composed of 71,719 patients with breast cancer, 42% of whom were considered to have transitioned from oncology to primary care 2 years after diagnosis. Although the number of patients having oncology visits diminished over time, a quarter of the cohort continued being seen in year 5 of survivorship. Regression analysis found older age, early cancer stage, living farther from a cancer center, not receiving radiation or chemotherapy, and high well-being to be associated with transitioning to primary care. CONCLUSION Our findings contribute to the development of low-risk profiles among survivors to inform optimal transition from oncology to primary care. Further research examining qualitative perspectives from oncologists, cancer survivors, and primary care is also required to illuminate other sentinel factors to be considered when transitioning during follow-up.
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Affiliation(s)
- Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Joshua O Cerasuolo
- ICES McMaster, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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4
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Mikesell L, O'Malley DM, Kurtzman RT, Howard J, Bates B, Hemler JR, Fadem SJ, Ferrante JM, Bator A, Hudson SV, Crabtree BF. Identifying priority areas to support primary care engagement in breast cancer survivorship care: A Delphi study. Cancer Med 2024; 13:e7219. [PMID: 38686635 PMCID: PMC11058672 DOI: 10.1002/cam4.7219] [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: 11/16/2023] [Revised: 01/30/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Existing approaches in cancer survivorship care delivery have proven to be insufficient to engage primary care. This study aimed to identify stakeholder-informed priorities to improve primary care engagement in breast cancer survivorship care. METHODS Experts in U.S. cancer survivorship care delivery were invited to participate in a 4-round online Delphi panel to identify and evaluate priorities for defining and fostering primary care's engagement in breast cancer survivorship. Panelists were asked to identify and then assess (ratings of 1-9) the importance and feasibility of priority items to support primary care engagement in survivorship. Panelists were asked to review the group results and reevaluate the importance and feasibility of each item, aiming to reach consensus. RESULTS Respondent panelists (n = 23, response rate 57.5%) identified 31 priority items to support survivorship care. Panelists consistently rated three items most important (scored 9) but with uncertain feasibility (scored 5-6). These items emphasized the need to foster connections and improve communication between primary care and oncology. Panelists reached consensus on four items evaluated as important and feasible: (1) educating patients on survivorship, (2) enabling screening reminders and monitoring alerts in the electronic medical record, (3) identifying patient resources for clinicians to recommend, and (4) distributing accessible reference guides of common breast cancer drugs. CONCLUSION Role clarity and communication between oncology and primary care were rated as most important; however, uncertainty about feasibility remains. These findings indicate that cross-disciplinary capacity building to address feasibility issues may be needed to make the most important priority items actionable in primary care.
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Affiliation(s)
- Lisa Mikesell
- School of Communication and InformationRutgers UniversityNew BrunswickNew JerseyUSA
- Institute for Health, Health Care Policy, and Aging ResearchRutgers UniversityNew BrunswickNew JerseyUSA
| | - Denalee M. O'Malley
- Department of Family MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Rachel T. Kurtzman
- Department of Family MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
- NORC at The University of ChicagoChicagoIllinoisUSA
| | - Jenna Howard
- Department of Family MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Benjamin Bates
- Institute for Health, Health Care Policy, and Aging ResearchRutgers UniversityNew BrunswickNew JerseyUSA
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
- Department of Medicine, Division of General Internal MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Jennifer R. Hemler
- Department of Family MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Sarah J. Fadem
- Department of Family MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Jeanne M. Ferrante
- Institute for Health, Health Care Policy, and Aging ResearchRutgers UniversityNew BrunswickNew JerseyUSA
- Department of Family MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Alicja Bator
- Department of Family MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Shawna V. Hudson
- Institute for Health, Health Care Policy, and Aging ResearchRutgers UniversityNew BrunswickNew JerseyUSA
- Department of Family MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Benjamin F. Crabtree
- Department of Family MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
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Singhal S, Dickerson J, Glover MJ, Roy M, Chiu M, Ellis-Caleo T, Hui G, Tamayo C, Loecher N, Wong HN, Heathcote LC, Schapira L. Patient-reported outcome measurement implementation in cancer survivors: a systematic review. J Cancer Surviv 2024; 18:223-244. [PMID: 35599269 DOI: 10.1007/s11764-022-01216-w] [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: 01/18/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Patient-reported outcome measurements (PROMs) are increasingly used for cancer patients receiving active treatment, but little is known about the implementation and usefulness of PROMs in cancer survivorship care. This systematic review evaluates how cancer survivors and healthcare providers (HCPs) perceive PROM implementation in survivorship care, and how PROM implementation impacts cancer survivors' health outcomes. METHODS We systematically searched PubMed/MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Database of Systematic Reviews from database inception to February 2022 to identify randomized and nonrandomized studies of PROM implementation in cancer survivors. RESULTS Based on prespecified eligibility criteria, we included 29 studies that reported on 26 unique PROMs. The studies were heterogeneous in study design, PROM instrument, patient demographics, and outcomes. Several studies found that cancer survivors and HCPs had favorable impressions of the utility of PROMs, and a few studies demonstrated that PROM implementation led to improvements in patient quality of life (QoL), with small to moderate effect sizes. CONCLUSIONS We found implementation of PROMs in cancer survivorship care improved health outcomes for select patient populations. Future research is needed to assess the real-world utility of PROM integration into clinical workflows and the impact of PROMs on measurable health outcomes. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors accepted PROMs. When successfully implemented, PROMs can improve health outcomes after completion of active treatment. We identify multiple avenues to strengthen PROM implementation to support cancer survivors.
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Affiliation(s)
- Surbhi Singhal
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA.
| | - James Dickerson
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
| | | | - Mohana Roy
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
| | - Michelle Chiu
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Gavin Hui
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Nele Loecher
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Lidia Schapira
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
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Sterba KR, Armeson K, Zapka J, Garrett-Mayer E, Scallion ML, Wall TK, Olsen J, Graboyes EM, Alberg AJ, Day TA. A pilot randomized controlled trial to evaluate a survivorship care planning intervention for head and neck cancer survivor-caregiver dyads. J Cancer Surviv 2024; 18:398-411. [PMID: 35761129 DOI: 10.1007/s11764-022-01227-7] [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: 03/22/2022] [Accepted: 06/14/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE Head and neck cancer (HNC) survivors and caregivers face significant challenges after treatment. This study's objective was to evaluate the effects of a dyadic survivorship care planning (SCP) intervention on survivor and caregiver outcomes. METHODS This randomized controlled trial enrolled HNC survivors and caregivers within 18 months post-treatment, randomized dyads to SCP (one-session with written SCP and follow-up telephone call) or usual care and administered baseline and 6-month surveys. Multivariable linear regression examined intervention effects on depression and unmet needs in dyads and burden on caregiverss and a set of secondary outcomes. Rating scales and open-ended questions assessed acceptability. RESULTS We randomized 89 survivor-caregiver dyads (42 usual care, 47 SCP dyads). Fidelity to SCP was high for most survivorship domains except discussing care barriers (13%). The most commonly discussed referrals included nutrition (83%) and behavioral medicine (38%), but referral uptake was low. The SCP intervention did not improve depression or unmet needs among dyads or burden among caregivers at 6 months relative to usual care (p's > .05). Nurses and dyads rated SCP favorably with > 80% positive ratings for session length and care plan content. Qualitative findings highlighted that SCP helped consolidate complex clinical information and strengthened survivor-caregiver-clinician relationships. CONCLUSIONS An HNC SCP intervention was acceptable but ineffective in improving dyads' outcomes. IMPLICATIONS FOR CANCER SURVIVORS Post-treatment SCP in HNC dyads was ineffective in improving outcomes in survivors and caregivers as delivered in this study. More research is needed to understand how to capitalize on the acceptability of the SCP approach and enhance its effectiveness to support dyads.
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Affiliation(s)
- Katherine R Sterba
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 68 President Street, MSC 955, Charleston, SC, 29425, USA.
| | - Kent Armeson
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 68 President Street, MSC 955, Charleston, SC, 29425, USA
| | - Jane Zapka
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 68 President Street, MSC 955, Charleston, SC, 29425, USA
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 68 President Street, MSC 955, Charleston, SC, 29425, USA
| | - Megan L Scallion
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 68 President Street, MSC 955, Charleston, SC, 29425, USA
| | - Tiffany K Wall
- Department of Otolaryngology-Head and Neck Surgery and Hollings Cancer Center, Medical University of South Carolina, 87 Jonathan Lucas Street MSC 955, Charleston, SC, 29425, USA
| | - Jama Olsen
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 68 President Street, MSC 955, Charleston, SC, 29425, USA
| | - Evan M Graboyes
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 68 President Street, MSC 955, Charleston, SC, 29425, USA
- Department of Otolaryngology-Head and Neck Surgery and Hollings Cancer Center, Medical University of South Carolina, 87 Jonathan Lucas Street MSC 955, Charleston, SC, 29425, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street Room 465, Columbia, SC, 29208, USA
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery and Hollings Cancer Center, Medical University of South Carolina, 87 Jonathan Lucas Street MSC 955, Charleston, SC, 29425, USA
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7
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Hooper J, Jervis N, Morgan L, Beckett V, Hand P, Higgs K, Munir A, Prinn J, Pritchard DM, Sarker D, Srirajaskanthan R, Ellis CB. Neuroendocrine neoplasms: Consensus on a patient care pathway. J Neuroendocrinol 2024; 36:e13380. [PMID: 38471798 DOI: 10.1111/jne.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
People with neuroendocrine neoplasms (NENs) face a multitude of challenges, including delayed diagnosis, low awareness of the cancer among healthcare professionals and limited access to multidisciplinary care and expert centres. We have developed the first patient care pathway for people living with NENs in England to guide disease management and help overcome these barriers. The pathway was developed in two phases. First, a pragmatic review of the literature was conducted, which was used to develop a draft patient care pathway. Second, the draft pathway was then updated following semi-structured interviews with carefully selected expert stakeholders. After each phase, the pathway was discussed among a multidisciplinary, expert advisory group (which comprised the authors and the Deputy Chief Operating Officer, West Suffolk NHS Foundation Trust), who reached a consensus on the ideal care pathway. This article presents the outputs of this research. The pathway identified key barriers to care and highlighted how these may be addressed, with many of the findings relevant to the rest of the UK and international audiences. NENs are increasing in incidence and prevalence in England, compounding pre-existing inequities in diagnosis and disease management. Effective integration of this pathway within NHS England will help achieve optimal, equitable care provision for all people with NENs, and should be feasible within the existing expert multidisciplinary teams across the country.
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Affiliation(s)
| | | | | | - Vivienne Beckett
- Advanced Accelerators Applications (UK & Ireland) Ltd, a Novartis Company, London, UK
| | - Philippa Hand
- London North West University Healthcare NHS Trust, London, UK
| | | | - Alia Munir
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Teaching Hospitals European Neuroendocrine Tumor Society Center of Excellence, Sheffield, UK
| | | | - D Mark Pritchard
- University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool Regional NET Service (European Neuroendocrine Tumor Society Center of Excellence), Liverpool, UK
| | - Debashis Sarker
- Guy's, St Thomas' and King's College Hospitals, King's Health Partners NET Centre (European Neuroendocrine Tumor Society Center of Excellence), London, UK
| | - Raj Srirajaskanthan
- King's College Hospital NHS Foundation Trust, King's Health Partners NET Centre (European Neuroendocrine Tumor Society Center of Excellence), London, UK
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Stout NL, Boatman D, Rice M, Branham E, Miller M, Salyer R. Unmet Needs and Care Delivery Gaps Among Rural Cancer Survivors. J Patient Exp 2024; 11:23743735241239865. [PMID: 38505492 PMCID: PMC10949551 DOI: 10.1177/23743735241239865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Community-based healthcare delivery systems frequently lack cancer-specific survivorship support services. This leads to a burden of unmet needs that is magnified in rural areas. Using sequential mixed methods we assessed unmet needs among rural cancer survivors diagnosed between 2015 and 2021. The Supportive Care Needs Survey (SCNS) assessed 5 domains; Physical and Daily Living, Psychological, Support and Supportive Services, Sexual, and Health Information. Needs were analyzed across domains by cancer type. Survey respondents were recruited for qualitative interviews to identify care gaps. Three hundred and sixty two surveys were analyzed. Participants were 85% White (n = 349) 65% (n = 234) female and averaged 2.03 years beyond cancer diagnosis. Nearly half (49.5%) of respondents reported unmet needs, predominantly in physical, psychological, and health information domains. Needs differed by stage of disease. Eleven interviews identified care gap themes regarding; Finding Support and Supportive Services and Health Information regarding Care Delivery and Continuity of Care. Patients experience persistent unmet needs after a cancer diagnosis across multiple functional domains. Access to community-based support services and health information is lacking. Community based resources are needed to improve access to care for long-term cancer survivors.
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Affiliation(s)
- Nicole L Stout
- Department of Cancer Prevention and Control, School of Medicine, West Virginia University, Morgantown, WV, USA
- Department of Health Policy, Management, and Leadership, School of Public, West Virginia University, Morgantown, WV, USA
| | - Dannell Boatman
- Department of Cancer Prevention and Control, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Madeline Rice
- Division of Physical Therapy, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Emelia Branham
- Division of Physical Therapy, School of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Rachel Salyer
- Department of Internal Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
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Gore C, Lisy K, O'Callaghan C, Wood C, Emery J, Martin A, De Abreu Lourenco R, Schofield P, Jefford M. Colorectal cancer survivors' experiences and views of shared and telehealth models of survivorship care: A qualitative study. Psychooncology 2024; 33:e6265. [PMID: 38072641 DOI: 10.1002/pon.6265] [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: 08/11/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVES The number of colorectal cancer (CRC) survivors is increasing and current models of survivorship care are unsustainable. There is a drive to implement alternative models of care including shared care between general practitioners (GPs) and hospital-based providers. The primary objective of this study was to explore perspectives on facilitators and barriers to shared care. The secondary objective was to explore experiences of telehealth-delivered care. METHOD Qualitative data were collected via semi-structured interviews with participants in the Shared Care for Colorectal Cancer Survivors (SCORE) randomised controlled trial. Interviews explored patient experiences of usual and shared survivorship care during the SCORE trial. In response to the COVID pandemic, participant experiences of telehealth appointments were also explored. Interviews were recorded and transcribed for thematic analysis. RESULTS Twenty survivors of CRC were interviewed with an even number in the shared and usual care arms; 14 (70%) were male. Facilitators to shared care included: good relationships with GPs; convenience of GPs; good communication between providers; desire to reduce public health system pressures. Barriers included: poor communication between clinicians; inaccessibility of GPs; beliefs about GP capacity; and a preference for follow-up care with the hospital after positive treatment experiences. Participants also commonly expressed a preference for telehealth-based follow-up when there was no need for a clinical examination. CONCLUSIONS This is one of few studies that have explored patient experiences with shared and telehealth-based survivorship care. Findings can guide the implementation of these models, particularly around care coordination, communication, preparation, and personalised pathways of care.
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Affiliation(s)
- Claire Gore
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Clare O'Callaghan
- Departments of Psychosocial Cancer Care and Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Colin Wood
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice and Primary Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Martin
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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10
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Jefford M, Emery JD, James Martin A, De Abreu Lourenco R, Lisy K, Grunfeld E, Mohamed MA, King D, Tebbutt NC, Lee M, Mehrnejad A, Burgess A, Marker J, Eggins R, Carrello J, Thomas H, Schofield P. SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer. EClinicalMedicine 2023; 66:102346. [PMID: 38094163 PMCID: PMC10716007 DOI: 10.1016/j.eclinm.2023.102346] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 05/27/2024] Open
Abstract
BACKGROUND SCORE is the first randomised controlled trial (RCT) to examine shared oncologist and general practitioner (GP) follow-up for survivors of colorectal cancer (CRC). SCORE aimed to show that shared care (SC) was non-inferior to usual care (UC) on the EORTC QLQ-C30 Global Health Status/Quality of Life (GHQ-QoL) scale to 12 months. METHODS The study recruited patients from five public hospitals in Melbourne, Australia between February 2017 and May 2021. Patients post curative intent treatment for stage I-III CRC underwent 1:1 randomisation to SC and UC. SC replaced two oncologist visits with GP visits and included a survivorship care plan and primary care management guidelines. Assessments were at baseline, 6 and 12 months. Difference between groups on GHQ-QoL to 12 months was estimated from a mixed model for repeated measures (MMRM), with a non-inferiority margin (NIM) of -10 points. Secondary endpoints included quality of life (QoL); patient perceptions of care; costs and clinical care processes (CEA tests, recurrences). Registration ACTRN12617000004369p. FINDINGS 150 consenting patients were randomised to SC (N = 74) or UC (N = 76); 11 GPs declined. The mean (SD) GHQ-QoL scores at 12 months were 72 (20.2) for SC versus 73 (17.2) for UC. The MMRM mean estimate of GHQ-QoL across the 6 month and 12 month follow-up was 69 for SC and 73 for UC, mean difference -4.0 (95% CI: -9.0 to 0.9). The lower limit of the 95% CI did not cross the NIM. There was no clear evidence of differences on other QoL, unmet needs or satisfaction scales. At 12 months, the majority preferred SC (40/63; 63%) in the SC group, with equal preference for SC (22/62; 35%) and specialist care (22/62; 35%) in UC group. CEA completion was higher in SC. Recurrences similar between arms. Patients in SC on average incurred USD314 less in health costs versus UC patients. INTERPRETATION SC seems to be an appropriate and cost-effective model of follow-up for CRC survivors. FUNDING Victorian Cancer Agency and Cancer Australia.
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Affiliation(s)
- Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Jon D. Emery
- Centre for Cancer Research and Department of General Practice and Primary Care, University of Melbourne, Melbourne, VIC, Australia
| | | | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Eva Grunfeld
- Department of Community and Family Medicine and Ontario Institute for Cancer Research, University of Toronto, Canada
| | - Mustafa Abdi Mohamed
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dorothy King
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Margaret Lee
- Department of Medical Oncology, Western Health, Melbourne, VIC, Australia
| | - Ashkan Mehrnejad
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Adele Burgess
- Olivia Newton John Cancer Centre, Heidelberg, VIC, Australia
| | - Julie Marker
- Primary Care Collaborative Cancer Clinical Trials Group, Centre for Cancer Research and Department of General Practice and Primary Care, University of Melbourne, Melbourne, VIC, Australia
| | - Renee Eggins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Joseph Carrello
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Hayley Thomas
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Penelope Schofield
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Department of Psychology and Iverson Health Innovation Research Institute, Swinburne University, Melbourne, VIC, Australia
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11
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Pang EM, Saynina O, Schapira L, Wise PH, Boynton H, Smith M, Chamberlain LJ, Smith SM. Cancer center-based follow-up among pediatric and adolescent/young adult cancer survivors: the role of a community-based organization and the social determinants of health. J Cancer Surviv 2023:10.1007/s11764-023-01463-5. [PMID: 37792162 DOI: 10.1007/s11764-023-01463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Adherence to survivorship care is suboptimal among pediatric and adolescent/young adult (AYA) cancer survivors. We evaluated predictors of cancer center-based follow-up among pediatric/AYA cancer survivors, with an emphasis on social determinants of health (SDOH). METHODS This retrospective cohort study used electronic health record data at an academic medical center to identify patients aged 0-29 years at last cancer treatment who completed treatment 2010-2019. Cancer center-based follow-up was defined by oncology or survivorship clinic visits through 12/31/2022. Multivariate logistic regression models (overall, ages 0-19 [pediatric], 20-29 [YA]) evaluated the association of demographics, clinical/treatment characteristics, and SDOH (insurance type, distance to cancer center, area deprivation index) with clinic attendance. Further modeling accounted for the service area of a community-based organization (CBO) that supports families of children with cancer. RESULTS A total of 2210 survivors were included (56% pediatric, 44% YA; 66% non-White). Cancer center-based follow-up decreased from 94% 1-year post-treatment to 35% at > 5-7 years. In adjusted analysis, AYAs had the lowest follow-up (5-7 years post-treatment: OR 0.25 [0.15-0.41] for age 25-29; OR 0.25 [0.16-0.41] for age 20-24; OR 0.32 [0.20-0.52] for age 15-19). Survivors residing within the CBO service area were twice as likely to follow-up (OR 2.10 [1.34-3.29]). CONCLUSIONS Among a diverse population, AYA survivors were vulnerable to loss to follow-up. Other SDOH were not consistently associated with follow-up. Support from a CBO may partly explain these findings. IMPLICATIONS FOR CANCER SURVIVORS CBOs may strengthen survivorship follow-up within medically underserved communities. More research is needed to understand community support in survivorship.
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Affiliation(s)
- Emily M Pang
- Stanford University School of Medicine, Stanford, CA, USA
| | - Olga Saynina
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, CA, USA
| | - Lidia Schapira
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | - Paul H Wise
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Heidi Boynton
- Jacob's Heart Children's Cancer Support Services, Watsonville, CA, USA
| | - Mary Smith
- Jacob's Heart Children's Cancer Support Services, Watsonville, CA, USA
| | - Lisa J Chamberlain
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie M Smith
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Stanford University School of Medicine, 750 Welch Rd, Suite 200, Palo Alto, CA, 94304, USA.
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12
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Attai DJ, Katz MS, Streja E, Hsiung JT, Marroquin MV, Zavaleta BA, Nekhlyudov L. Patient preferences and comfort for cancer survivorship models of care: results of an online survey. J Cancer Surviv 2023; 17:1327-1337. [PMID: 35113306 DOI: 10.1007/s11764-022-01177-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/21/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Workforce shortages will impact oncologists' ability to provide both active and survivorship care. While primary care provider (PCP) or survivorship clinic transition has been emphasized, there is little evidence regarding patient comfort. METHODS We developed an online survey in partnership with patient advocates to assess survivors' comfort with PCP or survivorship clinic care and distributed the survey to online, cancer-specific patient communities from June to August 2020. Descriptive and logistic regression analyses were conducted. RESULTS A total of 975 surveys were complete. Most respondents were women (91%) and had private insurance (65%). Thirty-six cancer types were reported. Ninety-three percent had a PCP. Twenty-four percent were comfortable seeing a PCP for survivorship care. Higher odds of comfort were seen among respondents who were Black or had stage 0 cancer; female sex was associated with lower odds. Fifty-five percent were comfortable with a survivorship clinic. Higher odds of comfort were seen with lymphoma or ovarian cancer, > 15 years from diagnosis, and non-US government insurance. Lower odds were seen with melanoma, advanced stage, Medicaid insurance, and one late effect. Preference for PCP care was 87% for general health, 32% for recurrence monitoring, and 37% for late effect management. CONCLUSIONS One quarter of cancer survivors were comfortable with PCP-led survivorship care and about half with a survivorship clinic. Most preferred oncologist care for recurrence monitoring and late-effect management. IMPLICATIONS FOR CANCER SURVIVORS Patient preference and comfort should be considered when developing survivorship care models. Future efforts should focus on facilitating patient-centered transitions to non-oncologist care.
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Affiliation(s)
- Deanna J Attai
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- UCLA Health Burbank Breast Care, 191 S. Buena Vista #415, Burbank, CA, 91505, USA.
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, MA, USA
| | - Elani Streja
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jui-Ting Hsiung
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | | | - Beverly A Zavaleta
- Department of Medicine, Valley Baptist Medical Center - Brownsville, Brownsville, TX, USA
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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Takahashi M. Cancer survivorship care: challenges and opportunities in Japan. Jpn J Clin Oncol 2023; 53:757-763. [PMID: 37279595 DOI: 10.1093/jjco/hyad054] [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: 03/10/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
This article discusses the current international scope and practices of cancer survivorship care and the challenges and opportunities of survivorship care in Japan. Cancer is a common illness in Japan; however, the national cancer control plan focuses only on limited survivorship-related issues, and there is no official national-level survivorship care strategy that addresses the diverse unmet needs of survivors. There is an urgent need to discuss and implement measures for quality survivorship care delivery under the current healthcare system in Japan. The Development of Survivorship Care Coordination Model Research Group, 2022, organized under the National Cancer Center Japan research grant from 2019 to 2022, identified four tasks that are required to realize quality survivorship care: (i) providing education opportunities for survivorship care stakeholders to raise awareness about the concept and the necessity of cancer survivorship care, (ii) providing training opportunities and cancer survivorship care certification for community healthcare providers, (iii) enforcing the economic basis of survivorship care and (iv) creating simpler systems that are organically linked with existing care systems. Collaboration among multiple players is indispensable to developing the philosophy of survivorship care and efficient care delivery. For this purpose, we need a platform where diverse players can participate equally towards the same goal: cancer survivors' optimal wellness.
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Affiliation(s)
- Miyako Takahashi
- Japan Cancer Survivorship Network, Iwate Medical University, The Jikei University School of Medicine, Tokyo, Japan
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14
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Tsuchiya M, Tazaki M, Fujita R, Kodama S, Takata Y. A mixed-method systematic review of unmet care and support needs among Japanese cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01439-5. [PMID: 37531042 DOI: 10.1007/s11764-023-01439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE To synthesize published studies regarding Japanese cancer survivors' needs/unmet needs of care/support, change of unmet needs over time, and preferred care/support providers. METHODS A mixed-method systematic review was conducted. MEDLINE, PsycINFO, CINAHL, and Ichu-shi were searched from inception to May 2022. Quantitative and qualitative studies were separately analyzed using narrative synthesis and meta-ethnography. Each finding was synthesized using a line of argument. RESULTS Twenty-four studies (13 quantitative and 11 qualitative studies) were included. Six quantitative studies reported unmet needs in survivors of adolescent and young adult (n=1) and adulthood (n=5) cancer. No longitudinal studies regarding changes in unmet needs were identified. One study reported that adults preferred care/support providers. The quantitative studies identified more help in physical (48.2-51.0%, n=2) and psychological issues (17.4-78.8%, n=5), information (27.9-58.0%, n=3), and healthcare services (25.3-67.1%, n=2) among adults. The qualitative studies emphasized more tailor-made information about life events for young cancer survivors. More empathic and trustworthy interactions with surrounding people, including healthcare professionals, were demanded, regardless of age. A line of argument illustrated that cancer survivors had insufficient resources for activities and empowerment to face life with cancer at all phases. CONCLUSIONS Japanese cancer survivors' unmet needs are diverse. More information and resources for psychological care/support and local healthcare services post-treatment are needed, which may hinder the optimal transition to survivorship. IMPLICATIONS FOR CANCER SURVIVORS The synthesized evidence should be utilized to implement a comprehensive care/support system in practice and educate people surrounding cancer survivors, regardless of age.
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Affiliation(s)
- Miyako Tsuchiya
- Research Institute of Nursing, Musashino University, 3-3-3, Ariake, Koto-ku, Tokyo, 135-8181, Japan.
- Former Division of Healthcare Delivery, Survivorship and Policy Research, Institute of Cancer Control, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Makiko Tazaki
- Former Division of Healthcare Delivery, Survivorship and Policy Research, Institute of Cancer Control, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Graduate School of Nursing, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8672, Japan
| | - Risako Fujita
- Former Division of Healthcare Delivery, Survivorship and Policy Research, Institute of Cancer Control, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Shirokanetakanawa Clinic, 1-13-11, Shirokane, Minato-ku, Tokyo, 108-0072, Japan
| | - Shoko Kodama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Yoshinori Takata
- Department of Nursing, Japanese Red Cross College of Nursing, 4-1-3 Hiroo, Shibuya City, Tokyo, 150-0012, Japan
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15
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Keane D, Phillips G, Mitchell N, Connolly RM, Hegarty J. Improving quality of life and symptom experience in patients with metastatic breast cancer: A systematic review of supportive care interventions. Psychooncology 2023; 32:1192-1207. [PMID: 37434307 DOI: 10.1002/pon.6183] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE The prognosis for individuals with metastatic breast cancer (MBC) has improved in recent decades. This expanding cohort has unique psychological and psychosocial needs, yet targeted supportive care interventions are underdeveloped. This systematic review seeks to summarise the available evidence on the effectiveness of supportive care interventions in improving quality of life and symptom experience of individuals living with MBC so that services can be developed to address the unmet needs of this cohort in future. METHODS Academic Search Complete, CINAHL, ERIC, Medline and SocINDEX were searched for publications investigating the effect of supportive care interventions specifically targeted at addressing the quality of life or symptom experience of individuals living with MBC. Three reviewers independently screened and selected studies. Quality appraisal and assessed risk of bias were carried out. RESULTS The search yielded 1972 citations. Thirteen studies met the inclusion criteria. Interventions included psychological (n = 3), end of life discussion and preparation (n = 2), physical activity (n = 4), lifestyle (n = 2), and medication self-management support (n = 2). Three studies reported significant improvement in quality of life, two of which reported improved symptom experience in at least one symptom. Three further physical activity interventions showed improvement in at least one of the symptoms investigated. CONCLUSION Studies reporting a statistically significant effect on quality of life and improved symptom experience were extremely heterogenous. We can tentatively suggest that multimodal and frequently administered interventions are effective, with physical activity interventions positively impacting on symptom experience, however further research is required.
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Affiliation(s)
- Danielle Keane
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Grace Phillips
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | | | - Roisin M Connolly
- Cancer Research @UCC, College of Medicine & Health, University College Cork, Cork, Ireland
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
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16
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Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship. Nat Rev Clin Oncol 2023; 20:527-542. [PMID: 37231127 PMCID: PMC10211308 DOI: 10.1038/s41571-023-00776-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.
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Affiliation(s)
- Maryam B Lustberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Aakash Desai
- Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cristiane Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Brazil
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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17
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Sequeira M, Pereira C, Alvarez MJ. Promoting physical activity within breast cancer survivors using behavior change techniques: N-of-1 randomized controlled trials. Health Promot Int 2023; 38:daad075. [PMID: 37466433 DOI: 10.1093/heapro/daad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Survivors of breast cancer are an important target for health promotion interventions, and physical activity (PA) is recommended with benefits being well established. More and more behavior theory guided interventions are planned and tailored to the individuals, targeting specifics needs and personal characteristics. We aimed to test the effectiveness of two behavior change techniques [coping planning (CP) and self-monitoring (SM)] for promoting PA in survivors of breast cancer, using a single-case design. In a powerful multiple sample N-of-1 RCT, 10 women post-breast cancer (M = 52.8 years) were randomly assigned to four experimental conditions (CP and/or SM, control) for 60 days and their daily step count was observed. The overall effects were analyzed using multilevel time-series with random intercepts. Time-series regression models and supplementary pairwise analyses were conducted for individuals. Multilevel analyses showed significant effects of CP and SM. Single-case analyses showed that six participants walked significantly more on the intervention days, that combined interventions were effective for five participants, but two participants had better results with the other two conditions. Combined self-regulatory techniques were more effective in promoting PA however, individual variability should be considered in future studies with survivors of breast cancer. Retrospectively registered: https://osf.io/eakjy/?view_only=81bf3dc084a0410a8ea28265e0f3c360, 31-01-2023.(raise query).
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Affiliation(s)
- Margarida Sequeira
- CICPSI, Department of Psychology, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- CIIAS, Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setubal, Portugal
| | - Cícero Pereira
- ICS, Department of Psychology, Instituto de Ciências Sociais da Universidade de Lisboa, Lisbon, Portugal
| | - Maria-João Alvarez
- CICPSI, Department of Psychology, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
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18
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Lofters A, Khalil I, Sopcak N, Shea-Budgell M, Meaney C, Fernandes C, Moineddin R, Campbell-Scherer D, Aubrey-Bassler K, Manca DP, Grunfeld E. Opportunities to improve quality of care for cancer survivors in primary care: findings from the BETTER WISE study. Support Care Cancer 2023; 31:430. [PMID: 37389679 DOI: 10.1007/s00520-023-07883-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE The BETTER WISE (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care for Wellness of Cancer Survivors and Patients) intervention is an evidence-based approach to prevention and screening for cancers and chronic diseases in primary care that also includes comprehensive follow-up for breast, prostate and colorectal cancer survivors. We describe the process of harmonizing cancer survivorship guidelines to create a BETTER WISE cancer surveillance algorithm and describe both the quantitative and qualitative findings for BETTER WISE participants who were breast, prostate or colorectal cancer survivors. We describe the results in the context of the COVID-19 pandemic. METHODS We reviewed high-quality survivorship guidelines to create a cancer surveillance algorithm. We conducted a cluster randomized trial in three Canadian provinces with two composite index outcome measured 12 months after baseline, and also collected qualitative feedback on the intervention. RESULTS There were 80 cancer survivors for whom we had baseline and follow-up data. Differences between the composite indices in the two study arms were not statistically significant, although a post hoc analysis suggested the COVID-19 pandemic was a key factor in these results. Qualitative finding suggested that participants and stakeholders generally viewed BETTER WISE positively and emphasized the effects of the pandemic. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS BETTER WISE shows promise for providing an evidence-based, patient-centred, comprehensive approach to prevention, screening and cancer surveillance for cancer survivors in the primary care setting. TRIAL REGISTRATION ISRCTN21333761. Registered on December 19, 2016, http://www.isrctn.com/ISRCTN21333761 .
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Affiliation(s)
- Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
| | - Ielaf Khalil
- Sinai Health, 600 University Ave, Toronto, Canada
| | - Nicolette Sopcak
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - Melissa Shea-Budgell
- Charbonneau Cancer Institute and Department of Oncology, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Carolina Fernandes
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, 2-590 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada
| | - Kris Aubrey-Bassler
- Discipline of Family Medicine, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John's, Newfoundland, A1B 3V6, Canada
| | - Donna Patricia Manca
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, 2-590 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada
- Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive Northwest, Edmonton, Alberta, T6L 5X8, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
- Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, ON, M5G 0A3, Canada
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19
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Russell L, McIntosh R, Martin C, Soo WK, Ugalde A. Implementation of a referral pathway for cancer survivors to access allied health services in the community. BMC Health Serv Res 2023; 23:440. [PMID: 37143117 PMCID: PMC10159668 DOI: 10.1186/s12913-023-09425-4] [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: 01/11/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The growing demands for multidisciplinary cancer survivorship care require new approaches to address the needs of people living after a cancer diagnosis. Good Life-Cancer Survivorship is a self-management support survivorship program delivered by community allied health (AH) services for people diagnosed with cancer. A pilot study established the benefits of Good Life-Cancer Survivorship to help survivors manage their health and wellbeing in the community health setting. This study expanded the program to four community health services and evaluated the implementation outcomes of the referral pathway to the survivorship program. METHODS Eligible cancer survivors attending hospital oncology services were referred to the survivorship program. Data was collected between 19/02/2021-22/02/2022 and included allied health service utilisation, consumer surveys, and interviews to understand consumer experience with the referral pathway. Interviews and focus groups with hospital and community health professionals explored factors influencing the referral uptake. Implementation outcomes included Adoption, Acceptability, Appropriateness, Feasibility, and Sustainability. RESULTS Of 35 eligible survivors (mean age 65.5 years, SD = 11.0; 56% women), 31 (89%) accepted the referral. Most survivors had two (n = 14/31; 45%) or more (n = 11/31; 35%) allied health needs. Of 162 AH appointments (median appointment per survivor = 4; range = 1-15; IQR:5), 142/162 (88%) were scheduled within the study period and 126/142 (89%) were attended. Consumers' interviews (n = 5) discussed the referral pathway; continuation of survivorship care in community health settings; opportunities for improvement of the survivorship program. Interviews with community health professionals (n = 5) highlighted the impact of the survivorship program; cancer survivorship care in community health; sustainability of the survivorship program. Interviews (n = 3) and focus groups (n = 7) with hospital health professionals emphasised the importance of a trusted referral process; a holistic and complementary model of care; a person-driven process; the need for promoting the survivorship program. All evaluations favourably upheld the five implementation outcomes. CONCLUSIONS The referral pathway provided access to a survivorship program that supported survivors in self-management strategies through tailored community allied health services. The referral pathway was well adopted and demonstrated acceptability, appropriateness, and feasibility. This innovative care model supports cancer survivorship care delivery in community health settings, with clinicians recommending sustaining the referral pathway.
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Affiliation(s)
- Lahiru Russell
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Australia.
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia.
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold St, Box Hill, Victoria, 3128, Australia.
| | | | | | - Wee Kheng Soo
- healthAbility, Box Hill, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Anna Ugalde
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
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20
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Nekhlyudov L, Snow C, Knelson LP, Dibble KE, Alfano CM, Partridge AH. Primary care providers' comfort in caring for cancer survivors: Implications for risk-stratified care. Pediatr Blood Cancer 2023; 70:e30174. [PMID: 36583466 DOI: 10.1002/pbc.30174] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022]
Abstract
Personalized, risk-stratified care aims to "right size" the involvement of primary care providers (PCPs), oncology and specialized practitioners in caring for cancer survivors. Our survey found limited comfort among PCPs in cancer surveillance and management of treatment-related effects. In hypothetical case scenarios, PCPs reported least comfort in caring for a survivor of childhood cancer, followed by young adult-onset cancer, and greater comfort in caring for a survivor of adult-onset breast cancer. While education and training of PCPs is essential, risk-stratification strategies need to identify patients who may transition to primary care and those who may require ongoing survivorship-focused follow-up.
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Affiliation(s)
- Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Craig Snow
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lauren P Knelson
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kate E Dibble
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Catherine M Alfano
- Cancer Care Management and Research, Northwell Health Cancer Institute, New York, New York, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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21
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Beltran-Bless AA, Alshamsan B, Alzahrani MJ, Hilton J, Baines KA, Samuel V, Pond GR, Vandermeer L, Clemons M, Larocque G. Regularly scheduled physical examinations and the detection of breast cancer recurrences. Breast 2023; 69:274-280. [PMID: 36922304 PMCID: PMC10034490 DOI: 10.1016/j.breast.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE Follow-up care of early breast cancer (EBC) patients usually includes routinely scheduled physical examinations. While ASCO guidelines recommend a physical exam every three to six months for the first three years, little evidence supports this schedule. We evaluated recurrence detection of patients transferred into a single centre survivorship program that follows ASCO recommendations. METHODS Patients with EBC referred to the Wellness Beyond Cancer Program (WBCP) who had breast cancer recurrence between February 1, 2013, and January 1, 2019 were reviewed. Descriptive analyses were used to present patient and disease characteristics stratified by type of recurrence and mode of cancer detection. RESULTS Of 206 recurrences, 135 were distant recurrences (65.5%), 41 were ipsilateral breast recurrences (19.9%), and 30 were contralateral breast primaries (14.6%). Distant recurrences were primarily detected via patient-reported symptoms (125/135, 92.6%). 53.7% (22/41) of ipsilateral breast recurrences were detected by patients and 41.5% (17/41) by routine imaging. Contralateral breast primaries were primarily detected by imaging 83.3% (25/30) and patient-reported symptoms 16.7% (5/30). Only 2/206 (1.14%) recurrences/new primaries were detected by healthcare providers at routinely scheduled follow-up visits. CONCLUSIONS Despite following ASCO guidelines, healthcare providers rarely detect recurrences at routinely scheduled follow-up appointments. Our data suggests that approximately 35, 000 follow-up visits were required for healthcare providers to detect these 2 recurrences. While reduced in-person visits may affect other aspects of follow-up care (e.g. toxicity management), it appears unlikely, provided patients attend regular screening tests, that less frequent in-person follow-up is associated with worse breast cancer-related outcomes.
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Affiliation(s)
- Ana-Alicia Beltran-Bless
- Division of Medical Oncology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada, K1H 8L6; Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1Y 4E9
| | - Bader Alshamsan
- Division of Medical Oncology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada, K1H 8L6; Department of Medicine, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Mashari Jemaan Alzahrani
- Division of Medical Oncology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada, K1H 8L6; Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1Y 4E9
| | - John Hilton
- Division of Medical Oncology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada, K1H 8L6; Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1Y 4E9
| | - Kelly-Anne Baines
- Ottawa Hospital Cancer Centre, The Ottawa Hospital, Ottawa, ON, Canada
| | - Vicky Samuel
- Ottawa Hospital Cancer Centre, The Ottawa Hospital, Ottawa, ON, Canada
| | - Gregory R Pond
- Ontario Clinical Oncology Group, Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Vandermeer
- Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1Y 4E9
| | - Mark Clemons
- Division of Medical Oncology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada, K1H 8L6; Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1Y 4E9.
| | - Gail Larocque
- Ottawa Hospital Cancer Centre, The Ottawa Hospital, Ottawa, ON, Canada
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22
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Chan RJ, Crawford-Williams F, Crichton M, Joseph R, Hart NH, Milley K, Druce P, Zhang J, Jefford M, Lisy K, Emery J, Nekhlyudov L. Effectiveness and implementation of models of cancer survivorship care: an overview of systematic reviews. J Cancer Surviv 2023; 17:197-221. [PMID: 34786652 PMCID: PMC8594645 DOI: 10.1007/s11764-021-01128-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To critically assess the effectiveness and implementation of different models of post-treatment cancer survivorship care compared to specialist-led models of survivorship care assessed in published systematic reviews. METHODS MEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were searched from January 2005 to May 2021. Systematic reviews that compared at least two models of cancer survivorship care were included. Article selection, data extraction, and critical appraisal were conducted independently by two authors. The models were evaluated according to cancer survivorship care domains, patient and caregiver experience, communication and decision-making, care coordination, quality of life, healthcare utilization, costs, and mortality. Barriers and facilitators to implementation were also synthesized. RESULTS Twelve systematic reviews were included, capturing 53 primary studies. Effectiveness for managing survivors' physical and psychosocial outcomes was found to be no different across models. Nurse-led and primary care provider-led models may produce cost savings to cancer survivors and healthcare systems. Barriers to the implementation of different models of care included limited resources, communication, and care coordination, while facilitators included survivor engagement, planning, and flexible services. CONCLUSIONS Despite evidence regarding the equivalent effectiveness of nurse-led, primary care-led, or shared care models, these models are not widely adopted, and evidence-based recommendations to guide implementation are required. Further research is needed to address effectiveness in understudied domains of care and outcomes and across different population groups. IMPLICATIONS FOR CANCER SURVIVORS Rather than aiming for an optimal "one-size fits all" model of survivorship care, applying the most appropriate model in distinct contexts can improve outcomes and healthcare efficiency.
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Affiliation(s)
- Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South, Australia.
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Megan Crichton
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science & Medicine, Bond University, Robina, QLD, Australia
| | - Ria Joseph
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Kristi Milley
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Paige Druce
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Jianrong Zhang
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Jefford
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karolina Lisy
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jon Emery
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Larissa Nekhlyudov
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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23
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Koczwara B, Chan A, Jefford M, Lam WWT, Taylor C, Wakefield CE, Bhoo-Pathy N, Gyawali B, Harvet G, Lou Y, Pramesh CS, Takahashi M, Ke Y, Chan RJ. Cancer Survivorship in the Indo-Pacific: Priorities for Progress. JCO Glob Oncol 2023; 9:e2200305. [PMID: 36749908 PMCID: PMC10166466 DOI: 10.1200/go.22.00305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA.,Department of Oncology Pharmacy, National Cancer Centre Singapore, Singapore
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Wendy W T Lam
- Jockey Club Institute of Cancer Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Centre for Psycho-oncology Research and Training, School of Public Health, The University of Hong Kong, Hong Kong, China
| | | | - Claire E Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics and Child Health, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bishal Gyawali
- Queen's Global Oncology Program, Department of Oncology, Queen's University, Kingston, Canada
| | - Gregory Harvet
- Department of Paediatrics, Centre Hospitalier Territorial, Nouméa, New Caledonia
| | - Yan Lou
- School of Nursing, Department of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Miyako Takahashi
- Japan Cancer Survivorship Network, Tokyo, Japan.,Iwate Medical University, Iwate, Japan
| | - Yu Ke
- Tokyo Jikei University School of Medicine, Tokyo, Japan
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
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24
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Wollersheim BM, van der Poel HG, van Asselt KM, Pos FJ, Tillier CN, Akdemir E, Vis AN, Lampe MI, van den Bergh R, Somford DM, Knipscheer B, Cauberg ECC, Noordzij A, Aaronson NK, Boekhout AH, van de Poll-Franse LV. Quality of early prostate cancer follow-up care from the patients’ perspective. Support Care Cancer 2022; 30:10077-10087. [DOI: 10.1007/s00520-022-07396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022]
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25
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Bellas O, Kemp E, Edney L, Oster C, Roseleur J. The impacts of unmet supportive care needs of cancer survivors in Australia: A qualitative systematic review. Eur J Cancer Care (Engl) 2022; 31:e13726. [PMID: 36226338 DOI: 10.1111/ecc.13726] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/26/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cancer incidence and survivorship are increasing worldwide. With more people living through and beyond cancer, there is a subsequent increase in their supportive care needs. This systematic review of qualitative studies aimed to describe the impacts of unmet supportive care needs on cancer survivors in Australia. METHODS Databases MEDLINE, EMBASE and Scopus were searched, and after screening and applying eligibility criteria, 27 qualitative studies were included. Findings were synthesised according to the Supportive Care Framework for Cancer Care, including informational, physical, practical, emotional, psychological, social and spiritual need domains. RESULTS The systematic review identified impacts of unmet informational, physical, practical, emotional and psychological needs. Frequently identified impacts of unmet informational needs were feelings of abandonment and isolation, distress, confusion and regret. Common impacts of unmet physical and practical needs were financial burden and return-to-work difficulties. Over half of all unmet supportive care needs caused emotional and psychological impacts. CONCLUSIONS Findings identify the detrimental emotional and psychological impacts resulting from a range of unmet supportive care needs. The review highlights the interconnections between supportive care need domains thereby enhancing the understanding of the impacts of unmet SCNs. Findings may inform policy and practice change to improve supportive cancer care.
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Affiliation(s)
- Olivia Bellas
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Emma Kemp
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Laura Edney
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Candice Oster
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Jackie Roseleur
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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26
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Factors influencing cancer survivors' experiences with follow-up cancer care: results from the pan-Canadian Experiences of Cancer Patients in Transition Study survey. Support Care Cancer 2022; 30:9559-9575. [PMID: 36123549 DOI: 10.1007/s00520-022-07357-z] [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: 04/02/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care. METHODS In 2016, the Canadian Partnership Against Cancer collected survey responses from cancer survivors about their experiences with follow-up cancer care. We included respondents from this survey if they were diagnosed with non-metastatic breast, hematologic, colon, melanoma, and prostate cancer. Our primary outcome was cancer survivors' self-reported overall experience with follow-up cancer care. We used multivariable logistic regression to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care. RESULTS Of the 8402 cancer survivors included in our study, 81.8% (n = 6,875) reported a positive experience with their follow-up cancer care. The individual factors associated with positive overall experiences were more commonly those associated with self-perceptions of respondents' personal health and well-being rather than baseline sociodemographic factors, such as sex, income, or education. For example, respondents were more likely to report a positive experience if they perceived their quality of life as good (OR 1.9, 95% CI 1.0-3.5, p < 0.01) or reported not having an unmet practical concern (OR 1.3, 95% CI 1.1-1.6, p < 0.01). The structural factors most strongly associated with positive overall experiences included respondents perceiving their oncology specialist was in charge of their follow-up cancer care (OR 5.2, 95% CI 3.6-7.5, p < 0.01) and reporting the coordination of their follow-up cancer care among healthcare providers was good or very good (OR 8.4, 95% CI 6.7-10.6, p < 0.01). CONCLUSION While real-world experiences with follow-up cancer care in Canada are reported to be positive by most cancer survivors included in this study, we found differences exist based on individual and structural factors. A better understanding of the reasons for these differences is required to guide the provision of high-quality follow-up care that is adapted to the needs and resources of individuals and contexts.
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27
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Fu JB, Stout NL, Egleston BL. The critical need to implement and utilize patient-reported measures of function in cancer care delivery. Cancer 2022; 128:3155-3157. [PMID: 35789997 PMCID: PMC10001431 DOI: 10.1002/cncr.34373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023]
Abstract
The study by Smith et al. on the Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile shows that it can be used to measure how an individual functions and how his or her function changes during cancer treatments. This is important because most patients will experience a decline in function during cancer treatment and will struggle to fully participate in their life roles. Strong evidence demonstrates that rehabilitation improves function for individuals with cancer; rehabilitation is relatively underutilized. We suggest that using the PROMIS tool as a repeated measure throughout cancer treatment will help to identify those with functional decline who will benefit most from rehabilitation.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicole L Stout
- Department of Hematology and Oncology, West Virginia University School of Medicine, Morgantown, West, Virginia, USA
- West Virginia University Cancer Institute, Morgantown, West, Virginia, USA
- Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, West, Virginia, USA
| | - Brian L Egleston
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
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28
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Ee C, MacMillan F, Boyages J, McBride K. Barriers and enablers of weight management after breast cancer: a thematic analysis of free text survey responses using the COM-B model. BMC Public Health 2022; 22:1587. [PMID: 35987564 PMCID: PMC9392910 DOI: 10.1186/s12889-022-13980-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Weight gain is common after breast cancer. The aim of this study was to identify and describe the barriers to and enablers of successful weight management for women with breast cancer. Methods This was a combined inductive and deductive framework analysis of free text responses to an anonymous cross-sectional survey on weight after breast cancer. Women were recruited mainly through the Breast Cancer Network Australia Review and Survey Group. We applied deductive thematic analysis to free text responses to questions on barriers, enablers, research priorities, and one open-ended question at the end of the survey using the Capability, Opportunity, Motivation and Behaviour (COM-B) model as a framework. Subthemes that arose from the inductive analysis were mapped onto the COM-B model framework. Findings were used to identify behaviour change intervention functions. Results One hundred thirty-three women provided free text responses. Most women were of Caucasian origin and had been diagnosed with non-metastatic breast cancer, with a mean age of 59.1 years. Women's physical capability to adopt and sustain healthy lifestyle habits was significantly affected by treatment effects and physical illness, and some lacked psychological capability to self-regulate the face of stress and other triggers. Limited time and finances, and the social impact of undergoing cancer treatment affected the ability to control their diet. Frustration and futility around weight management were prominent. However, some women were confident in their abilities to self-regulate and self-monitor lifestyle behaviours, described support from friends and health professionals as enablers, and welcomed the physical and psychological benefits of being active in the context of embracing transformation and self-care after cancer. Conclusion Women need specific advice and support from peers, friends and families and health professionals. There is a substantial gap in provision of supportive care to enable women to adopt and sustain healthy lifestyles. Environmental restructuring (including financial support), incentivization (creating an expectation of looking and feeling better), persuasion and coercion (aiming to prevent recurrence), and equipping women with specific knowledge and skills, would also facilitate optimal lifestyle behaviours and weight management. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13980-6.
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29
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Lefkowitz D. Black boxes and information pathways: An actor-network theory approach to breast cancer survivorship care. Soc Sci Med 2022; 307:115184. [PMID: 35853317 PMCID: PMC10403999 DOI: 10.1016/j.socscimed.2022.115184] [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: 03/24/2022] [Revised: 06/06/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022]
Abstract
Many women diagnosed with breast cancer today can expect to live long after completing their treatment. This growing population of survivors encounters distinct post-treatment health and information needs. Existing survivorship care models take information as a given, black boxing it. I use Actor-Network Theory to examine how information actually works for women after they complete breast cancer treatment, and how it shapes their understanding of survivorship. I draw on in-depth interviews with breast cancer survivors (n = 82) and a wide range of providers (n = 84) in a medically underserved region of Southern California. Black boxes and information pathways convey experiential dimensions of cancer care; they are also metaphoric constructs. The black box metaphor refers to the cancer experience as a container; the pathways metaphor refers to a journey. Each of these metaphors expresses salient dimensions of the cancer experience and has implications for post-treatment survivorship. When healthcare information flows smoothly and invisibly, its pathways become black boxed. Black boxes can be helpful when they function effectively. But since black boxes conceal their inner workings, it is challenging to intervene when difficulties arise. I provide three examples of difficulties that complicate women's transition to post-treatment survivorship: (1) when survivors fail to recognize treatment-related late effects, (2) do not understand they have a terminal diagnosis, or (3) worry that their treatment accomplished nothing. Contextualized within survivorship scholarship, this study recommends opening black boxes to examine how information pathways could connect women differently to improve survivorship care.
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Affiliation(s)
- Deborah Lefkowitz
- Center for Social Innovation, School of Public Policy, University of California, Riverside, CA, USA; School of Nursing, University of Victoria, Victoria, BC, Canada.
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30
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Chen M, Gong J, Li Q. The application of eHealth in cancer survivorship care: A review of web-based dyadic interventions for post-treatment cancer survivors and caregivers. Asia Pac J Oncol Nurs 2022; 9:100109. [PMID: 36118622 PMCID: PMC9475270 DOI: 10.1016/j.apjon.2022.100109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Both cancer survivors and caregivers often experience a range of problems and unmet needs during the post-treatment survivorship. Web-based dyadic interventions may be critical for cancer survivors and their caregivers. This article aims to systematically explore existing web-based dyadic interventions for post-treatment cancer survivors and caregivers in terms of intervention focus, content, delivery, and outcomes and to provide valuable recommendations for future research. Methods A comprehensive literature search was conducted to identify articles published in English or Chinese in the English databases PubMed, EMBASE, MEDLINE, PsycINFO, and Cochrane Library, and the Chinese databases CNKI and Wanfang Data, from database inception to March 2022. The literature references were also manually searched for additional eligible articles. Results Thirteen studies were included for analysis in this review. Cancer couple dyads were the main target of the interventions that were included. Information support, psychotherapy, self-management skills training, dyadic coping, and social support were the main intervention treatment elements. The combined results in this review support the feasibility, usability, and acceptability of eHealth interventions and showed trends in positive intervention effects for cancer survivors and caregivers in terms of self-efficacy, quality of life, physical health, mental health, and dyadic relationship. Conclusions This review identifies the positive outcomes of web-based dyadic interventions for post-treatment cancer survivors and caregivers. Further development and refinement of post-treatment cancer survivor-caregiver dyadic web-based interventions, with personalized online platforms and multiple components for supportive care needs, should be promoted.
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Affiliation(s)
- Meizhen Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Jiali Gong
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
- Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, China
- Corresponding author.
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Usability, acceptability, and implementation strategies for the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm: a Delphi study. Support Care Cancer 2022; 30:7407-7418. [PMID: 35614154 DOI: 10.1007/s00520-022-07164-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Oncology guidelines recommend participation in cancer rehabilitation or exercise services (CR/ES) to optimize survivorship. Yet, connecting the right survivor, with the right CR/ES, at the right time remains a challenge. The Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm was developed to enhance CR/ES clinical decision-making and facilitate access to CR/ES. We used Delphi methodology to evaluate usability, acceptability, and determine pragmatic implementation priorities. METHODS Participants completed three online questionnaires including (1) simulated case vignettes, (2) 4-item acceptability questionnaire (0-5 pts), and (3) series of items to rank algorithm implementation priorities (potential users, platforms, strategies). To evaluate usability, we used Chi-squared test to compare frequency of accurate pre-exercise medical clearance and CR/ES triage recommendations for case vignettes when using EXCEEDS vs. without. We calculated mean acceptability and inter-rater agreement overall and in 4 domains. We used the Eisenhower Prioritization Method to evaluate implementation priorities. RESULTS Participants (N = 133) mostly represented the fields of rehabilitation (69%), oncology (25%), or exercise science (17%). When using EXCEEDS (vs. without), their recommendations were more likely to be guideline concordant for medical clearance (83.4% vs. 66.5%, X2 = 26.61, p < .0001) and CR/ES triage (60.9% vs. 51.1%, X2 = 73.79, p < .0001). Mean acceptability was M = 3.90 ± 0.47; inter-rater agreement was high for 3 of 4 domains. Implementation priorities include 1 potential user group, 2 platform types, and 9 implementation strategies. CONCLUSION This study demonstrates the EXCEEDS algorithm can be a pragmatic and acceptable clinical decision support tool for CR/ES recommendations. Future research is needed to evaluate algorithm usability and acceptability in real-world clinical pathways.
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Risk Stratification and Cancer Follow-Up: Towards More Personalized Post-Treatment Care in Canada. Curr Oncol 2022; 29:3215-3223. [PMID: 35621651 PMCID: PMC9139666 DOI: 10.3390/curroncol29050261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/15/2022] Open
Abstract
After treatment, cancer survivors require ongoing, comprehensive care to improve quality of life, reduce disability, limit complications, and restore function. In Canada and internationally, follow-up care continues to be delivered most often by oncologists in institution-based settings. There is extensive evidence to demonstrate that this model of care does not work well for many survivors or our cancer systems. Randomized controlled trials have clearly demonstrated that alternate approaches to follow-up care are equivalent to oncologist-led follow-up in terms of patient outcomes, such as recurrence, survival, and quality of life in a number of common cancers. In this paper, we discuss the state of follow-up care for survivors of prevalent cancers and the need for more personalized models of follow-up. Indeed, there is no one-size-fits-all solution to post-treatment follow-up care, and more personalized approaches to follow-up that are based on individual risks and needs after cancer treatment are warranted. Canada lags behind when it comes to personalizing follow-up care for cancer survivors. There are many reasons for this, including difficulty in determining who is best served by different follow-up pathways, a paucity of evidence-informed self-management education and supports for most survivors, poorly developed IT solutions and systems, and uneven coordination of care. Using implementation science theories, approaches, and methods may help in addressing these challenges and delineating what might work best in particular settings and circumstances.
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Huyghe N, Benidovskaya E, Stevens P, Van den Eynde M. Biomarkers of Response and Resistance to Immunotherapy in Microsatellite Stable Colorectal Cancer: Toward a New Personalized Medicine. Cancers (Basel) 2022; 14:2241. [PMID: 35565369 PMCID: PMC9105843 DOI: 10.3390/cancers14092241] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Immune Checkpoint Inhibitors (ICIs) are well recognized as a major immune treatment modality for multiple types of solid cancers. However, for colorectal cancer (CRC), ICIs are only approved for the treatment of Mismatch-Repair-Deficient and Microsatellite Instability-High (dMMR/MSI-H) tumors. For the vast majority of CRC, that are not dMMR/MSI-H, ICIs alone provide limited to no clinical benefit. This discrepancy of response between CRC and other solid cancers suggests that CRC may be inherently resistant to ICIs alone. In translational research, efforts are underway to thoroughly characterize the immune microenvironment of CRC to better understand the mechanisms behind this resistance and to find new biomarkers of response. In the clinic, trials are being set up to study biomarkers along with treatments targeting newly discovered immune checkpoint molecules or treatments combining ICIs with other existing therapies to improve response in MSS CRC. In this review, we will focus on the characteristics of response and resistance to ICIs in CRC, and discuss promising biomarkers studied in recent clinical trials combining ICIs with other therapies.
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Affiliation(s)
- Nicolas Huyghe
- Institut de Recherche Clinique et Expérimentale (Pole MIRO), UCLouvain, 1200 Brussels, Belgium; (N.H.); (E.B.); (P.S.)
| | - Elena Benidovskaya
- Institut de Recherche Clinique et Expérimentale (Pole MIRO), UCLouvain, 1200 Brussels, Belgium; (N.H.); (E.B.); (P.S.)
| | - Philippe Stevens
- Institut de Recherche Clinique et Expérimentale (Pole MIRO), UCLouvain, 1200 Brussels, Belgium; (N.H.); (E.B.); (P.S.)
| | - Marc Van den Eynde
- Institut de Recherche Clinique et Expérimentale (Pole MIRO), UCLouvain, 1200 Brussels, Belgium; (N.H.); (E.B.); (P.S.)
- Institut Roi Albert II, Department of Medical Oncology and Gastroenterology, Cliniques Universitaires St-Luc, 1200 Brussels, Belgium
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Jefford M, Howell D, Li Q, Lisy K, Maher J, Alfano CM, Rynderman M, Emery J. Improved models of care for cancer survivors. Lancet 2022; 399:1551-1560. [PMID: 35430022 PMCID: PMC9009839 DOI: 10.1016/s0140-6736(22)00306-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 12/24/2022]
Abstract
The number of survivors of cancer is increasing substantially. Current models of care are unsustainable and fail to address the many unmet needs of survivors of cancer. Numerous trials have investigated alternate models of care, including models led by primary-care providers, care shared between oncology specialists and primary-care providers, and care led by oncology nurses. These alternate models appear to be at least as effective as specialist-led care and are applicable to many survivors of cancer. Choosing the most appropriate care model for each patient depends on patient-level factors (such as risk of longer-term effects, late effects, individual desire, and capacity to self-manage), local services, and health-care policy. Wider implementation of alternative models requires appropriate support for non-oncologist care providers and endorsement of these models by cancer teams with their patients. The COVID-19 pandemic has driven some changes in practice that are more patient-centred and should continue. Improved models should shift from a predominant focus on detection of cancer recurrence and seek to improve the quality of life, functional outcomes, experience, and survival of survivors of cancer, reduce the risk of recurrence and new cancers, improve the management of comorbidities, and reduce costs to patients and payers. This Series paper focuses primarily on high-income countries, where most data have been derived. However, future research should consider the applicability of these models in a wider range of health-care settings and for a wider range of cancers.
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Affiliation(s)
- Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Doris Howell
- Princess Margaret Cancer Research Institute, Toronto, ON, Canada
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Catherine M Alfano
- Northwell Health Cancer Institute, Lake Success, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Meg Rynderman
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jon Emery
- Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Sequeira M, Luz R, Alvarez MJ. The Practice of Physical Activity After Breast Cancer Treatments: A Qualitative Study Among Portuguese Women. Front Psychol 2022; 13:823139. [PMID: 35369245 PMCID: PMC8965006 DOI: 10.3389/fpsyg.2022.823139] [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: 11/26/2021] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Women survivors of breast cancer treatments face significant challenges around initiation or maintenance of physical activity (PA) as they transit to recovery. Embracing their needs and preferences is important to increase adherence. This study aimed to explore the perspectives of Portuguese women survivors of breast cancer regarding regular performance of PA and individual choices and strategies that should be considered in designing effective interventions. Methods The individual semi-structured interviews (N = 20) were analyzed through thematic analysis, following an inductive process, seeking to identify the barriers, facilitators, and particular influencing circumstances associated with regular PA. Results Four themes and several contextual, emotional, physical, and social factors were identified as determinants of regular PA. Guilt, women’s duties, and altruism to help close relatives were identified as emotional and cultural factors that are less-found in the existing literature. PA showed influence both from health professionals’ counseling and from knowledge and beliefs held by these women. Conclusion While confirming the already-known impact of breast cancer diagnosis and treatments on PA, which redefine participants’ availability to be active, the findings highlight beliefs and specific emotional factors that should be considered when planning culturally sensitive interventions.
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Affiliation(s)
- Margarida Sequeira
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal.,CIIAS, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Rita Luz
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Maria-João Alvarez
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
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Michaeli JC, Michaeli DT, Boch T, Albers S, Michaeli T. Socio-economic burden of disease: Survivorship costs for renal cell carcinoma. Eur J Cancer Care (Engl) 2022; 31:e13569. [PMID: 35293070 DOI: 10.1111/ecc.13569] [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: 11/05/2021] [Revised: 01/27/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study is to assess the risk-stratified 10-year socio-economic burden of renal cell carcinoma (RCC) follow-up costs after initial treatment in Germany from 2000 to 2020. METHODS A micro-costing method considering direct and indirect medical expenditure associated with follow-up procedures was employed to calculate survivorship costs per patient. The frequencies of physician-patient visits, examinations and diagnostic tests were extracted from guidelines, whilst expenses were sourced from literature and official scales of tariffs. Societal costs were calculated based on three perspectives: patients, providers and insurers. RESULTS Mean societal 10-year follow-up costs per patient amounted to EUR 3,377 (95%CI: 2,969-3,791) for low-risk, EUR 3,367 (95%CI: 3,003-3,692) for medium-risk and EUR 4,299 (95%CI: 3,807-4,755) for high-risk RCC in 2020. Spending increased by +32% from 2000 to 2020 for low-risk RCC, whilst medium-and high-risk RCC expenditure was cut by -39% and -22%, respectively. Patients shouldered 27%, providers 43% and insurers 35% of costs in 2020. Resources were consumed by medical imaging (52%), physician-patient consultations (31%), travel expenses (17%) and blood tests (1%). CONCLUSION Results highlight the economic burden cancer survivorship poses for society. Cancer survivors require individualised, evidence-based and insurance-covered follow-up schedules to permit the early detection of side-effects, metastasis and secondary malignancies.
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Affiliation(s)
- Julia Caroline Michaeli
- Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.,Department of Obstetrics and Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
| | - Daniel Tobias Michaeli
- Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.,Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.,Third Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Boch
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.,Third Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.,Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Albers
- Department of Orthopedic Surgery, ATOS Klinik Fleetinsel Hamburg, Hamburg, Germany
| | - Thomas Michaeli
- Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.,Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.,Third Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.,Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Modifiable pre-treatment factors are associated with quality of life in women with gynaecological cancers at diagnosis and one year later: Results from the HORIZONS UK national cohort study. Gynecol Oncol 2022; 165:610-618. [DOI: 10.1016/j.ygyno.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/09/2022]
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Michaeli JC, Michaeli T, Boch T, Albers S, Michaeli DT. Socio-economic burden of disease: survivorship costs for bladder cancer. J Cancer Policy 2022; 32:100326. [DOI: 10.1016/j.jcpo.2022.100326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/26/2022] [Accepted: 02/06/2022] [Indexed: 12/14/2022]
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Love M, Debay M, Hudley AC, Sorsby T, Lucero L, Miller S, Sampath S, Amini A, Raz D, Kim J, Pathak R, Chen YJ, Kaiser A, Melstrom K, Fakih M, Sun V. Cancer Survivors, Oncology, and Primary Care Perspectives on Survivorship Care: An Integrative Review. J Prim Care Community Health 2022; 13:21501319221105248. [PMID: 35678264 PMCID: PMC9189519 DOI: 10.1177/21501319221105248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Evidence-based models of cancer survivorship care are lacking. Such models should take into account the perspectives of all stakeholders. The purpose of this integrative review is to examine the current state of the literature on cancer survivorship care from the cancer survivor, the oncology care team, and the primary care team perspectives. Methods: Using defined inclusion and exclusion criteria, we conducted a literature search of PubMed, PsycINFO, CINAHL, and Scopus databases to identify relevant articles on the stakeholders’ perspectives on cancer survivorship care published between 2010 and 2021. We reviewed and abstracted eligible articles to synthesize findings. Results: A total of 21 studies were included in the review. Barriers to the receipt and provision of cancer survivorship care quality included challenges with communication, cancer care delivery, and knowledge. Conclusion: Persistent stakeholder-identified barriers continue to hinder the provision of quality cancer survivorship care. Improved communication, delivery of care, knowledge/information, and resources are needed to improve the quality of survivorship care. Novel models of cancer survivorship care that address the needs of survivors, oncology teams, and PCPs are needed.
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Affiliation(s)
| | - Marc Debay
- University of California, Riverside, Riverside, CA, USA
| | | | | | | | | | | | | | - Dan Raz
- City of Hope, Duarte, CA, USA
| | - Jae Kim
- City of Hope, Duarte, CA, USA
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Love M, Debay M, Hudley AC, Sorsby T, Lucero L, Miller S, Sampath S, Amini A, Raz D, Kim J, Pathak R, Chen YJ, Kaiser A, Melstrom K, Fakih M, Sun V. Cancer Survivors, Oncology, and Primary Care Perspectives on Survivorship Care: An Integrative Review. J Prim Care Community Health 2022; 13:21501319221105248. [PMID: 35678264 DOI: 10.1177/21501319221105248] [citation(s)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
PURPOSE Evidence-based models of cancer survivorship care are lacking. Such models should take into account the perspectives of all stakeholders. The purpose of this integrative review is to examine the current state of the literature on cancer survivorship care from the cancer survivor, the oncology care team, and the primary care team perspectives. METHODS Using defined inclusion and exclusion criteria, we conducted a literature search of PubMed, PsycINFO, CINAHL, and Scopus databases to identify relevant articles on the stakeholders' perspectives on cancer survivorship care published between 2010 and 2021. We reviewed and abstracted eligible articles to synthesize findings. RESULTS A total of 21 studies were included in the review. Barriers to the receipt and provision of cancer survivorship care quality included challenges with communication, cancer care delivery, and knowledge. CONCLUSION Persistent stakeholder-identified barriers continue to hinder the provision of quality cancer survivorship care. Improved communication, delivery of care, knowledge/information, and resources are needed to improve the quality of survivorship care. Novel models of cancer survivorship care that address the needs of survivors, oncology teams, and PCPs are needed.
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Affiliation(s)
| | - Marc Debay
- University of California, Riverside, Riverside, CA, USA
| | | | | | | | | | | | | | - Dan Raz
- City of Hope, Duarte, CA, USA
| | - Jae Kim
- City of Hope, Duarte, CA, USA
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O’Malley DM, Alfano CM, Doose M, Kinney AY, Lee SJC, Nekhlyudov L, Duberstein P, Hudson SV. Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research. Transl Behav Med 2021; 11:1989-1997. [PMID: 34850934 PMCID: PMC8634312 DOI: 10.1093/tbm/ibab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this commentary, we discuss opportunities to optimize cancer care delivery in the next decade building from evidence and advancements in the conceptualization and implementation of multi-level translational behavioral interventions. We summarize critical issues and discoveries describing new directions for translational behavioral research in the coming decade based on the promise of the accelerated application of this evidence within learning health systems. To illustrate these advances, we discuss cancer prevention, risk reduction (particularly precision prevention and early detection), and cancer treatment and survivorship (particularly risk- and need-stratified comprehensive care) and propose opportunities to equitably improve outcomes while addressing clinician shortages and cross-system coordination. We also discuss the impacts of COVID-19 and potential advances of scientific knowledge in the context of existing evidence, the need for adaptation, and potential areas of innovation to meet the needs of converging crises (e.g., fragmented care, workforce shortages, ongoing pandemic) in cancer health care delivery. Finally, we discuss new areas for exploration by applying key lessons gleaned from implementation efforts guided by advances in behavioral health.
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Affiliation(s)
- Denalee M O’Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
| | - Catherine M Alfano
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michelle Doose
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anita Y Kinney
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Simon J Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Department of Population and Data Sciences, UT-Southwestern, Dallas, TX, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Brigham & Womens’ Primary Care Medical Associates, Boston, MA, USA
| | - Paul Duberstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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Mikles SP, Griffin AC, Chung AE. Health information technology to support cancer survivorship care planning: A systematic review. J Am Med Inform Assoc 2021; 28:2277-2286. [PMID: 34333588 PMCID: PMC8449616 DOI: 10.1093/jamia/ocab134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/13/2021] [Accepted: 06/23/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The study sought to conduct a systematic review to explore the functions utilized by electronic cancer survivorship care planning interventions and assess their effects on patient and provider outcomes. MATERIALS AND METHODS Based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, studies published from January 2000 to January 2020 were identified in PubMed, CINAHL, EMBASE, PsychINFO, Scopus, Web of Science, and the ACM Digital Library . The search combined terms for cancer, survivorship, care planning, and health information technology (HIT). Eligible studies evaluated the effects of a HIT intervention on usability, knowledge, process, or health-related outcomes. A total of 578 abstracts were reviewed, resulting in 60 manuscripts describing 40 studies. Thematic analyses were used to define meta-themes of system functions, and Fisher's exact tests were used to examine associations between functions and outcomes. RESULTS Patients were the target end users for 18 interventions, while 12 targeted providers and 10 targeted both groups. Interventions used patient-reported outcomes collection (60%), automated content generation (58%), electronic sharing (40%), persistent engagement (28%), and communication features (20%). Overall, interventions decreased the time to create survivorship care plans (SCPs) and supported care planning knowledge and abilities, but results were mixed for effects on healthcare utilization, SCP sharing, and provoking anxiety. Persistent engagement features were associated with improvements in health or quality-of-life outcomes (17 studies, P = .003). CONCLUSIONS Features that engaged users persistently over time were associated with better health and quality-of-life outcomes. Most systems have not capitalized on the potential of HIT to share SCPs across a care team and support care coordination.
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Affiliation(s)
- Sean P Mikles
- Lineberger Comprehensive Cancer Outcomes Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley C Griffin
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Arlene E Chung
- Lineberger Comprehensive Cancer Outcomes Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Program on Health and Clinical Informatics, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Alfano CM, Suarez-Almazor M, Rodriguez MA, Palos GR, Gilmore KR. Innovating the Personalization of Stratified Survivorship Care Pathways: Using a Cancer Data Ecosystem to Improve Care Access, Outcomes, Efficiency, and Costs. J Natl Cancer Inst Monogr 2021; 2021:3-9. [PMID: 34478510 DOI: 10.1093/jncimonographs/lgaa011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/21/2020] [Indexed: 01/22/2023] Open
Abstract
New models of survivorship care are needed that improve outcomes for the growing number of cancer survivors, address the increasing complexity of their health needs, and deal with the shortage of clinicians and rising costs of this care. Technology can aid the delivery of personalized, stratified survivorship care pathways where the intensity of care, the care setting, and the providers required for that care vary with survivors' needs. Building a cancer data ecosystem of connected data streams that supports and learns from each patient can be used to streamline care, enhance efficiency, reduce costs, and facilitate research. This manuscript describes the input, analytics, and output components of the cancer data ecosystem that must be built and connected and also provides a real-world use case of how such a system could transform care in a large US comprehensive cancer center.
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Affiliation(s)
- Catherine M Alfano
- Northwell Health Cancer Institute, New York, NY, USA.,Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.,Center for Personalized Health, Feinstein Institutes for Medical Research, New York, NY, USA
| | - Maria Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guadalupe R Palos
- Clinical Protocol Administration, Survivorship Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine R Gilmore
- Survivorship Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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van der Kruk SR, Butow P, Mesters I, Boyle T, Olver I, White K, Sabesan S, Zielinski R, Chan BA, Spronk K, Grimison P, Underhill C, Kirsten L, Gunn KM. Psychosocial well-being and supportive care needs of cancer patients and survivors living in rural or regional areas: a systematic review from 2010 to 2021. Support Care Cancer 2021; 30:1021-1064. [PMID: 34392413 PMCID: PMC8364415 DOI: 10.1007/s00520-021-06440-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023]
Abstract
Purpose To summarise what is currently known about the psychosocial morbidity, experiences, and needs of people with cancer and their informal caregivers, who live in rural or regional areas of developed countries. Methods Eligible studies dating from August 2010 until May 2021 were identified through several online databases, including MEDLINE, EMBASE, PsychINFO, and RURAL (Rural and Remote Health Database). Results were reported according to the PRISMA guidelines and the protocol was registered on PROSPERO (CRD42020171764). Results Sixty-five studies were included in this review, including 20 qualitative studies, 41 quantitative studies, and 4 mixed methods studies. Qualitative research demonstrated that many unique psychosocial needs of rural people remain unmet, particularly relating to finances, travel, and accessing care. However, most (9/19) quantitative studies that compared rural and urban groups reported no significant differences in psychosocial needs, morbidity, or quality of life (QOL). Five quantitative studies reported poorer psychosocial outcomes (social and emotional functioning) in urban cancer survivors, while three highlighted poorer outcomes (physical functioning, role functioning, and self-reported mental health outcomes) in the rural group. Conclusion Recent research shows that rural people affected by cancer have unique unmet psychosocial needs relating to rurality. However, there was little evidence that rural cancer survivors report greater unmet needs than their urban counterparts. This contrasts to the findings from a 2011 systematic review that found rural survivors consistently reported worse psychosocial outcomes. More population-based research is needed to establish whether uniquely rural unmet needs are due to general or cancer-specific factors.
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Affiliation(s)
- Shannen R. van der Kruk
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW Australia
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Terry Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA Australia
| | - Kate White
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Sabe Sabesan
- College of Medicine and Dentistry (CMD), James Cook University, QLD, Townsville, Australia
| | - Rob Zielinski
- Central West Cancer Care Centre, Orange Base Hospital, Orange, NSW Australia
- Western Sydney University, Sydney, NSW Australia
| | - Bryan A. Chan
- School of Medicine, Griffith University, Brisbane, QLD Australia
| | - Kristiaan Spronk
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA Australia
| | - Peter Grimison
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, NSW Australia
| | | | | | - Kate M. Gunn
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA Australia
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45
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Stiller A, Goodwin BC, Crawford-Williams F, March S, Ireland M, Aitken JF, Dunn J, Chambers SK. The Supportive Care Needs of Regional and Remote Cancer Caregivers. ACTA ACUST UNITED AC 2021; 28:3041-3057. [PMID: 34436032 PMCID: PMC8395470 DOI: 10.3390/curroncol28040266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022]
Abstract
Objective: As cancer survival rates continue to increase, so will the demand for care from family and friends, particularly in more isolated settings. This study aims to examine the needs of cancer caregivers in regional and remote Australia. Methods: A total of 239 informal (i.e., non-professional) cancer caregivers (e.g., family/friends) from regional and remote Queensland, Australia, completed the Comprehensive Needs Assessment Tool for Cancer Caregivers (CNAT-C). The frequencies of individuals reporting specific needs were calculated. Logistic regression analyses assessed the association between unmet needs and demographic characteristics and cancer type. Results: The most frequently endorsed needs were lodging near hospital (77%), information about the disease (74%), and tests and treatment (74%). The most frequent unmet needs were treatment near home (37%), help with economic burden (32%), and concerns about the person being cared for (32%). Younger and female caregivers were significantly more likely to report unmet needs overall (OR = 2.12; OR = 0.58), and unmet healthcare staff needs (OR = 0.35; OR = 1.99, respectively). Unmet family and social support needs were also significantly more likely among younger caregivers (OR = 0.35). Caregivers of breast cancer patients (OR = 0.43) and older caregivers (OR = 0.53) were significantly less likely to report unmet health and psychology needs. Proportions of participants reporting needs were largely similar across demographic groups and cancer type with some exceptions. Conclusions: Caregiver health, practical issues associated with travel, and emotional strain are all areas where regional and remote caregivers require more support. Caregivers’ age and gender, time since diagnosis and patient cancer type should be considered when determining the most appropriate supportive care.
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Affiliation(s)
- Anna Stiller
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Brisbane, QLD 4006, Australia; (B.C.G.); (F.C.-W.); (J.F.A.); (J.D.)
- Centre for Health Research, University of Southern Queensland, Springfield, QLD 4300, Australia; (S.M.); (M.I.)
- Correspondence:
| | - Belinda C. Goodwin
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Brisbane, QLD 4006, Australia; (B.C.G.); (F.C.-W.); (J.F.A.); (J.D.)
- Centre for Health Research, University of Southern Queensland, Springfield, QLD 4300, Australia; (S.M.); (M.I.)
| | - Fiona Crawford-Williams
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Brisbane, QLD 4006, Australia; (B.C.G.); (F.C.-W.); (J.F.A.); (J.D.)
- Centre for Health Research, University of Southern Queensland, Springfield, QLD 4300, Australia; (S.M.); (M.I.)
- Cancer Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Sonja March
- Centre for Health Research, University of Southern Queensland, Springfield, QLD 4300, Australia; (S.M.); (M.I.)
- School of Psychology and Counselling, University of Southern Queensland, Ipswich, QLD 4305, Australia
| | - Michael Ireland
- Centre for Health Research, University of Southern Queensland, Springfield, QLD 4300, Australia; (S.M.); (M.I.)
- School of Psychology and Counselling, University of Southern Queensland, Ipswich, QLD 4305, Australia
| | - Joanne F. Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Brisbane, QLD 4006, Australia; (B.C.G.); (F.C.-W.); (J.F.A.); (J.D.)
- Centre for Health Research, University of Southern Queensland, Springfield, QLD 4300, Australia; (S.M.); (M.I.)
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
- School of Public Health, The University of Queensland, Springfield, QLD 4300, Australia
| | - Jeff Dunn
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Brisbane, QLD 4006, Australia; (B.C.G.); (F.C.-W.); (J.F.A.); (J.D.)
- Centre for Health Research, University of Southern Queensland, Springfield, QLD 4300, Australia; (S.M.); (M.I.)
- Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD 4222, Australia
- Prostate Cancer Foundation of Australia, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007, Australia;
| | - Suzanne K. Chambers
- Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007, Australia;
- Faculty of Health Sciences, Australian Catholic University, Banyo, Brisbane, QLD 4014, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Perth, WA 6027, Australia
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Mollica MA, Mayer DK, Oeffinger KC, Kim Y, Buckenmaier SS, Sivaram S, Muha C, Taib NA, Andritsch E, Asuzu CC, Bochis OV, Diaz S, Trill MD, Garcia PJ, Grassi L, Uchitomi Y, Shaikh AJ, Jefford M, Lee HJ, Johansen C, Luyirika E, Maher EJ, Mallillin MMB, Maniragaba T, Mehnert-Theuerkauf A, Pramesh CS, Siesling S, Spira O, Sussman J, Tang L, Hai NV, Yalcin S, Jacobsen PB. Follow-Up Care for Breast and Colorectal Cancer Across the Globe: Survey Findings From 27 Countries. JCO Glob Oncol 2021; 6:1394-1411. [PMID: 32955943 PMCID: PMC7529533 DOI: 10.1200/go.20.00180] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The purpose of this study was to describe follow-up care for breast and colorectal cancer survivors in countries with varying levels of resources and highlight challenges regarding posttreatment survivorship care. METHODS We surveyed one key stakeholder from each of 27 countries with expertise in survivorship care on questions including the components/structure of follow-up care, delivery of treatment summaries and survivorship care plans, and involvement of primary care in survivorship. Descriptive analyses were performed to characterize results across countries and variations between the WHO income categories (low, middle, high). We also performed a qualitative content analysis of narratives related to survivorship care challenges to identify major themes. RESULTS Seven low- or /lower-middle-income countries (LIC/LMIC), seven upper-middle-income countries (UMIC), and 13 high-income countries (HICs) were included in this study. Results indicate that 44.4% of countries with a National Cancer Control Plan currently address survivorship care. Additional findings indicate that HICs use guidelines more often than those in LICs/LMICs and UMICs. There was great variation among countries regardless of income level. Common challenges include issues with workforce, communication and care coordination, distance/transportation issues, psychosocial support, and lack of focus on follow-up care. CONCLUSION This information can guide researchers, providers, and policy makers in efforts to improve the quality of survivorship care on a national and global basis. As the number of cancer survivors increases globally, countries will need to prioritize their long-term needs. Future efforts should focus on efforts to bridge oncology and primary care, building international partnerships, and implementation of guidelines.
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Affiliation(s)
| | - Deborah K Mayer
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | - Nur Aishah Taib
- Graddip Genet Counsell, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Ovidiu V Bochis
- Universitatea de Medicina si Farmacie Iuliu Hatieganu Facultatea de Medicina, Cluj-Napoca, Romania
| | - Sheila Diaz
- Universidad Autonoma de Santo Domingo Facultad Ciencias de la Salud, Santo Domingo, Dominican Republic
| | - Maria Die Trill
- Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | | | | | | | - Michael Jefford
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | | | | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation and University of Twente, Enschede, the Netherlands
| | - Orit Spira
- Israel Cancer Association, Givatayim, Israel
| | | | - Lili Tang
- Peking University Cancer Hospital, Beijing, People's Republic of China
| | - Nguyen V Hai
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Suayib Yalcin
- Hacettepe University Institute of Cancer, Ankara, Turkey
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Silvaggi F, Silvani A, Lamperti EA, Leonardi M. Pathways of follow-up care in an Italian center: retrospective study on patients with gliomas II and III. Neurol Sci 2021; 43:1303-1310. [PMID: 34235605 DOI: 10.1007/s10072-021-05415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Glioma is the most common primary brain cancer in adults. Long-term and progression-free survivals are dependent on the type and grade of glioma, as well as on the extent of resection and postoperative treatments. In Italy, it is unclear how long follow-up care should last and whether the primary care sector is either willing or able to take this on. The aim is to determine pathways of follow-up care and evaluate the professional attitude of doctors to prescribe to patient visits and exams after surgery. METHODS A retrospective study was performed on patients with glioma II and III who underwent surgery at tertiary care Neurological Institute Besta of Milan (FINCB) from 2012 to 2020. Data were collected through electronic medical records and inserted in an ad hoc developed database. RESULTS Three pathways have been identified: a common preliminary pathway (from the pre-operative visit to surgery) for all patients undergoing surgery for gliomas II and III and two follow-up pathways (with or without second surgery). CONCLUSIONS FINCB has developed care pathways that are sometimes personalized according to the doctor's expertise and attitude to prescribe new examinations. Given the lack of guidelines on this issue, we can cautiously conclude that it is necessary to identify whether, in addition to standard care, personalized supportive care intervention and pathway plan can significantly improve patients' outcome.
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Affiliation(s)
- Fabiola Silvaggi
- UOC Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
| | - Antonio Silvani
- Department of Clinical Neurosciences, UOC Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Elena Antonia Lamperti
- Department of Clinical Neurosciences, UOC Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Matilde Leonardi
- UOC Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
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Mizrahi D, Murnane A, Quinn S, Crowe J, Rosenbaum S, Adams D, Atkinson M. Exercise recommendations and referral patterns of oncology professionals. Asia Pac J Clin Oncol 2021; 18:295-302. [PMID: 34187099 DOI: 10.1111/ajco.13594] [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: 02/18/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exercise physiologists and physiotherapists can provide exercise interventions for cancer survivors; however, many do not access this support. Our primary aim explored referral habits to exercise professionals and attitudes of oncology professionals. Secondary aims explored fitness levels of oncology professionals and the relationship between fitness and exercise referral habits. METHODS Oncology professionals (n = 67) attending a national cancer conference in Australia participated in this cross-sectional study (23% doctors, 11% nurses, 25% allied health, and 41% other). A subgroup (n = 49) completed a fitness assessment measuring aerobic fitness (3-minute step test), muscle strength (handgrip dynamometry), and body composition (waist-to-hip ratio). Oncology professionals in a position to refer patients to exercise professionals were assessed on their history of patient referrals. RESULTS Sixty-seven of 750 eligible conference delegates participated (9% recruitment rate), of which 73% completed fitness assessments. Participants displayed above average physical activity and fitness levels with 60% meeting exercise guidelines. The majority (92%) agreed that exercise is important among cancer survivors to attenuate treatment-associated symptoms. Most understand the role of exercise physiologists (61%) and physiotherapists (64%) in cancer care. Seventy-three percent reported that referral to exercise professionals is optimal to increase exercise participation. Most (82%) oncology professionals who are able to refer patients to exercise professionals have self-reported doing so, while 91% recommended exercise themselves. Sixty-two percent were aware of evidence-based exercise guidelines. Fitness levels (p = 0.25), strength (p = 0.88), and physical activity (p = 0.33) did not impact referrals made to exercise professionals. CONCLUSION There was high awareness exercise-oncology benefits and evidence-based guidelines existed among sampled participants. Oncology professionals understand the role of exercise professionals, reflected by high self-reported referral rates. Implementing referral pathways to exercise professionals in cancer care may facilitate improved patient outcomes.
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Affiliation(s)
- David Mizrahi
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Murnane
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Sharni Quinn
- Physiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jessica Crowe
- Physiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,Black Dog Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Diana Adams
- Macarthur Cancer Therapy Centre, Sydney South West Area Health Service, Sydney, New South Wales, Australia
| | - Morgan Atkinson
- Youth Cancer Services South Australia and Northern Territory, Adelaide, South Australia, Australia.,Department of Clinical Haematology and Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Lisy K, Ly L, Kelly H, Clode M, Jefford M. How Do We Define and Measure Optimal Care for Cancer Survivors? An Online Modified Reactive Delphi Study. Cancers (Basel) 2021; 13:cancers13102299. [PMID: 34064957 PMCID: PMC8150859 DOI: 10.3390/cancers13102299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 02/06/2023] Open
Abstract
This research sought to answer the question 'what quality criteria do survivorship experts consider to be important in achieving optimal cancer survivorship care?'. An online modified reactive Delphi survey consisting of two rounds was completed with experts including consumers, clinicians, researchers, policymakers and quality and accreditation professionals. Survey items were based on international literature and considered three domains: Policy, process and outcome. In round 1 (R1), experts ranked the importance of 68 criteria on a five-point Likert scale. Criteria were retained if scored 4 (important) or 5 (very important) by >75% participants. In round 2 (R2), experts ranked top 10 criteria per domain. Response rates were 79% (70/89) and 84% (76/91), respectively. After R1, six criteria were removed and six were added. From R2, ten items for each domain were retained. These 30 items formed the Quality Framework. A consensus meeting considered priority items from the Quality Framework and feasibility of data collection. Prioritized items included having a policy on survivorship care; the existence of a multidisciplinary survivorship program (policy); appropriate processes to assess survivors' emotional, psychological and physical needs following treatment and stratification to appropriate models of care (process); and collecting patient-reported outcomes, quality of life and survival rates (outcome).
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Affiliation(s)
- Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (H.K.); (M.C.)
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Lena Ly
- Faculty of Medicine, Melbourne School of Population and Global Health, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Helana Kelly
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (H.K.); (M.C.)
| | - Melanie Clode
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (H.K.); (M.C.)
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (H.K.); (M.C.)
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
- Correspondence: ; Tel.: +61-3-8559-7902; Fax: +61-3-8559-7739
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Howell D, Mayer DK, Fielding R, Eicher M, Verdonck-de Leeuw IM, Johansen C, Soto-Perez-de-Celis E, Foster C, Chan R, Alfano CM, Hudson SV, Jefford M, Lam WWT, Loerzel V, Pravettoni G, Rammant E, Schapira L, Stein KD, Koczwara B. Management of Cancer and Health After the Clinic Visit: A Call to Action for Self-Management in Cancer Care. J Natl Cancer Inst 2021; 113:523-531. [PMID: 32525530 PMCID: PMC8096367 DOI: 10.1093/jnci/djaa083] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/29/2020] [Accepted: 06/04/2020] [Indexed: 12/25/2022] Open
Abstract
Individuals with cancer and their families assume responsibility for management of cancer as an acute and chronic disease. Yet, cancer lags other chronic diseases in its provision of proactive self-management support in routine, everyday care leaving this population vulnerable to worse health status, long-term disability, and poorer survival. Enabling cancer patients to manage the medical and emotional consequences and lifestyle and work changes due to cancer and treatment is essential to optimizing health and recovery across the continuum of cancer. In this paper, the Global Partners on Self-Management in Cancer puts forth six priority areas for action: Action 1: Prepare patients and survivors for active involvement in care; Action 2: Shift the care culture to support patients as partners in cocreating health and embed self-management support in everyday health-care provider practices and in care pathways; Action 3: Prepare the workforce in the knowledge and skills necessary to enable patients in effective self-management and reach consensus on core curricula; Action 4: Establish and reach consensus on a patient-reported outcome system for measuring the effects of self-management support and performance accountability; Action 5: Advance the evidence and stimulate research on self-management and self-management support in cancer populations; Action 6: Expand reach and access to self-management support programs across care sectors and tailored to diversity of need and stimulation of research to advance knowledge. It is time for a revolution to better integrate self-management support as part of high-quality, person-centered support and precision medicine in cancer care to optimize health outcomes, accelerate recovery, and possibly improve survival.
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Affiliation(s)
- Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Research Center and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Deborah K Mayer
- School of Nursing, University of North Carolina & Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Richard Fielding
- University of Hong Kong Jockey Club Institute of Cancer Care, Hong Kong, China
| | - Manuela Eicher
- Department of Oncology, Lausanne University Hospital, Institute of Higher Education and Research in Health Care, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Irma M Verdonck-de Leeuw
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Department of Otolaryongoly/Head & Neck Surgery, Cancer Centre, Amsterdam, The Netherlands
| | | | | | - Claire Foster
- School of Health Sciences, University of Southampton, Surrey, UK
| | - Raymond Chan
- Princess Alexander Hospital and Queensland University of Technology, Brisbane, Australia
| | | | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Cancer Institute of New Jersey and Rutgers Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Wendy W T Lam
- Division of Behavioural Sciences, School of Public Health, and Jockey Club Institute of Cancer Care, University of Hong Kong, Hong Kong, China
| | - Victoria Loerzel
- University of Central Florida College of Nursing, Orlando, FL, USA
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Instituto Europeo di Oncologia (IEO), European Institute of Oncology, Milan, Italy
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Kevin D Stein
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bogda Koczwara
- Department of Medical Oncology, & Flinders University, Bedford Park, South Australia and members of the Global Partners for Self-Management in Cancer (GPS)
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