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Stal J, Piombo SE, Kysh L, Kagramanov D, Freyer DR, Turner BJ, Hempel S, Miller KA. The integration of primary care and childhood cancer survivorship care: a scoping review. J Cancer Surviv 2024; 18:635-650. [PMID: 36534343 DOI: 10.1007/s11764-022-01296-8] [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: 08/30/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This scoping review describes existing care models that integrate primary care and childhood cancer survivorship care, examines the effectiveness of these models, and characterizes barriers and facilitators to their integration. METHODS A systematic search (PubMed®, CINAHL®, Embase®) was conducted to identify citations which were evaluated against inclusion criteria using the PICOTTS framework. The PRISMA-ScR extension for scoping reviews was used to report review findings (protocol https://osf.io/92xbg ). RESULTS Twenty-three studies were included. Three care models integrating primary care and childhood cancer survivorship care were identified: consultative shared care in a primary care setting (N = 3); longitudinal shared care (N = 2); and PCP-led care employing a survivorship care plan (N = 5). While many described risk-adapted care, few used risk stratification approaches to inform care. Measures of model effectiveness varied, with discrepant findings regarding late effects detection in PCP-led approaches. The most frequently cited barriers and facilitators reflected provider- and system-level factors (PCP knowledge/experience identified as greatest barrier (N = 11); clinical information from oncologist identified as greatest facilitator (N = 9)). CONCLUSIONS Identified models depended on PCP knowledge and healthcare system coordination, and studies suggested the need for strong oncologic involvement in follow-up care. Improved training for PCPs and the coordinated transfer of clinical information could facilitate their involvement in such care. Overall, standardized measures of effectiveness are needed to deliver optimal childhood cancer survivorship care. IMPLICATIONS FOR CANCER SURVIVORS The literature revealed three care models defined by SCP use, provider involvement, and continuity of care, with several studies recommending oncologic involvement in follow-up care for high-risk survivors.
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Affiliation(s)
- Julia Stal
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Sarah E Piombo
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Dalia Kagramanov
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - David R Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Barbara J Turner
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Gehr Family Center for Health Systems Research and Innovation, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Susanne Hempel
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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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 2024:10.1007/s40271-024-00697-4. [PMID: 38702574 DOI: 10.1007/s40271-024-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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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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Garcia SF, O'Connor M, Kinahan K, Duffy M, Klein M, McCrum A, Didwania A, Kircher SM. Advancing survivorship at a comprehensive cancer center: integrating clinical care, education and research initiatives at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center. J Cancer Surviv 2024; 18:17-22. [PMID: 38294597 DOI: 10.1007/s11764-023-01518-7] [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: 11/14/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
The unprecedented and growing number of cancer survivors requires comprehensive quality care that includes cancer surveillance, symptom management, and health promotion to reduce morbidity and mortality and improve quality of life. However, coordinated and sustainable survivorship care has been challenged by barriers at multiple levels. We outline the survivorship programs at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center that have evolved over two decades. Our current survivorship clinics comprise STAR (Survivors Taking Action and Responsibility) for adult survivors of childhood cancers; Adult Specialty Survivorship for survivors of breast, colorectal and testicular cancers, lymphomas, and leukemias; and Gynecologic Oncology Survivorship. Care provision models align with general, disease/treatment-specific, and integrated survivorship models, respectively. Reimbursement for survivorship services has been bolstered by institutional budget allocations. We have standardized survivor education, counseling, and referrals through electronic health record (EHR)-integrated survivorship care plan (SCP) templates that incorporate partial auto-population. We developed EHR-integrated data collection tools (e.g., dashboards; SmartForm, and registry) to facilitate data analytics, personalized patient referrals, and reports to the Commission on Cancer (CoC). We report to the CoC on SCP delivery, dietitian encounters, and DEXA scans. For the last decade, our Cancer Survivorship Institute has aligned the efforts of clinicians, researchers, and educators. The institute promotes evidence-based care, high-impact research, and state-of-the-science educational programs for professionals, survivors, and the community. Future plans include expansion of clinical services and funding for applied research centered on the unique needs of post-treatment cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: The survivorship programs at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center underscore the imperative for comprehensive, coordinated, and sustainable survivorship care to address the needs of increasing numbers of cancer survivors, with a focus on evidence-based clinical practices, associated research, and educational initiatives.
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Affiliation(s)
- Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA.
- Northwestern Medicine, Chicago, IL, USA.
| | - Mary O'Connor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Aarati Didwania
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
- Northwestern Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sheetal M Kircher
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
- Northwestern Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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5
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Demoor-Goldschmidt C, Veillon P, Esvan M, Leonard M, Chauvet S, Bertrand A, Carausu L, Delehaye F, Lejeune J, Rouger J, Schneider P, Thomas C, Millot F, Claude L, Leseur J, Missohou F, Supiot S, Bihannic N, Debroise I, Jeanneaud C, Lebreton E, Roumy M, Aguerris L, Chrétien JM, Gandemer V, Pellier I. A software tool to support follow-up care in a French childhood cancer cohort: construction and feasibility. BMC Cancer 2024; 24:130. [PMID: 38267891 PMCID: PMC10809785 DOI: 10.1186/s12885-024-11857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Treatment summaries and a personalized survivorship care plans based on internationally approved, organ-specific follow-up care recommendations are essential in preserving the health and quality of life for cancer survivors. Cohorts made up of survivors of childhood cancer have made significant contributions to the understanding of early mortality, somatic late complications, and psychosocial outcomes among former patients. New treatment protocols are needed to enhance survival and reduce the potential risk and severity of late effects, and working with treatment databases is crucial in doing so. CONSTRUCTION AND CONTENT In the GOCE (Grand Ouest Cancer de l'Enfant [Western Region Childhood Cancer]) network, in a participative approach, we developed the LOG-after medical tool, on which health data are registered and can be extracted for analysis. Its name emphasizes the tool's goal, referring to 'logiciel' (the French word for software) that focuses on the period "after" the acute phase. This tool is hosted on a certified health data server. Several interfaces have been developed that can be used depending on the user's profile. Here we present this innovative co-constructed tool that takes national aspects into account, including the results of the feasibility/satisfaction study and its perspective. UTILITY AND DISCUSSION The database contains data relating to 2558 patients, with samples from 1702 of these (66.54%) being held in a tumor bank. The average year in which treatment started was 2015 (ranging from December 1967 to November 2022: 118 patients were treated before 2012 and registered retrospectively when seen in long-term follow-up consultations or for another cancer since November 2021). A short questionnaire was distributed to healthcare professionals using the tool (physicians and research associates or technicians, n = 14), of whom 11 answered and were all satisfied. Access to the patient interface is currently open to 124 former patients. This was initially offered to 30 former patients who were over 15 years old, affected by the disease within the last 5 years, and had agreed to test it. Their opinions were collected by their doctor by e-mail, telephone, or during a consultation in an open-ended question and a non-directive interview. All patients were satisfied with the tool, with interest in testing it in the long term. Some former patients found that the tool provided them with some ease of mind; one, for instance, commented: "I feel lighter. I allow myself to forget. I know I will get a notification when the time comes." CONCLUSIONS Freely available to all users, LOG-after: (1) provides help with determining personalized survivorship care plans for follow-up; (2) builds links with general practitioners; (3) empowers the patient; and (4) enables health data to be exported for analysis. Database URL for presentation: https://youtu.be/2Ga64iausJE.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France.
- Department of Radiotherapy, Centre François Baclesse, University of Caen, Caen, France.
- Department of Supportive Care, Centre François Baclesse, University of Caen, Caen, France.
- Inserm U 1018, Epidemiology of Radiation, Gustave Roussy, Villejuif, France.
| | - Pascal Veillon
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France
| | - Maxime Esvan
- Department of Biostatitics, University Hospital of Rennes, Rennes, France
| | - Mathilde Leonard
- Department of Biostatitics, University Hospital of Rennes, Rennes, France
| | - Sophie Chauvet
- Department of Oncohematopediatrics, University Hospital of Nantes, Nantes, France
| | | | - Liana Carausu
- Department of Oncohematopediatrics, University Hospital of Brest, Brest, France
| | - Fanny Delehaye
- Department of Oncohematopediatrics, University Hospital of Caen, Caen, France
| | - Julien Lejeune
- Department of Oncohematopediatrics, University Hospital of Tours, Tours, France
| | - Jérémie Rouger
- Department of Oncohematopediatrics, University Hospital of Caen, Caen, France
| | - Pascale Schneider
- Department of Oncohematopediatrics, University Hospital of Rouen, Rouen, France
| | - Caroline Thomas
- Department of Oncohematopediatrics, University Hospital of Nantes, Nantes, France
| | - Frédéric Millot
- Department of Oncohematopediatrics, University Hospital of Poitiers, Poitiers, France
| | - Line Claude
- Department of Radiotherapy, Centre Leon Berard, Lyon, France
| | - Julie Leseur
- Department of Radiotherapy, Centre Eugène Marquis, Rennes, France
| | - Fernand Missohou
- Department of Radiotherapy, Centre François Baclesse, University of Caen, Caen, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de L'Ouest, Nantes, France
| | - Nathalie Bihannic
- Department of Oncohematopediatrics, University Hospital of Brest, Brest, France
| | | | - Carole Jeanneaud
- Department of Oncohematopediatrics, University Hospital of Tours, Tours, France
| | - Esther Lebreton
- Department of Oncohematopediatrics, University Hospital of Caen, Caen, France
| | - Marianne Roumy
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France
| | | | - Jean-Marie Chrétien
- Data Science Department, Clinical and Innovation Direction, CHU Angers, Angers, France
| | - Virginie Gandemer
- Department of Oncohematopediatrics, University Hospital of Rennes, Rennes, France
| | - Isabelle Pellier
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France
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Jalloh M, Cassell A, Niang L, Rebbeck T. Global viewpoints: updates on prostate cancer in Sub-Saharan Africa. BJU Int 2024; 133:6-13. [PMID: 37702258 DOI: 10.1111/bju.16178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Prostate cancer (PCa) is a major health concern in Sub-Saharan Africa (SSA), with high incidence and mortality rates. However, the widely used prostate-specific antigen (PSA) screening is not readily available or affordable in SSA. Alternative screening strategies, such as risk stratification approaches and cost-effective PSA tests, are being explored to target high-risk individuals and improve access to screening. Diagnosis of PCa in SSA is challenging due to the lack of access to diagnostic tools and limited healthcare resources. Clinical evaluation and digital rectal examination are commonly used, but PSA testing, magnetic resonance imaging, and biopsy are often limited. As a result, many men in SSA are diagnosed at advanced stages of the disease. Treatment options for PCa in SSA are often limited by a lack of resources and trained healthcare providers. Surgery, radiation therapy, and androgen-deprivation therapy are available but may be inaccessible to many patients. Cultural beliefs and stigma surrounding PCa further impact treatment decisions. Improved patient and community awareness, electronic medical records, and communication between patients and healthcare professionals can enhance evidence-based decision-making and advocate for policy changes. Understanding the genetic determinants and implementing comprehensive strategies can lead to improved outcomes and better control of PCa in SSA.
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Affiliation(s)
- Mohamed Jalloh
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
- Ecole Doctorale ED-2DS, Universite Iba Der Thiam de Thies, Thies, Senegal
| | - Ayun Cassell
- Department of Surgery, Liberia College of Physicians and Surgeons, Monrovia, Liberia
| | - Lamine Niang
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Timothy Rebbeck
- Dana-Farber Cancer Institute, University of Harvard, Boston, MA, USA
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Min Y, Zhu Y, Ye M, Zhu Q, Xu Y, Li X. Life quality improvement of patients with non-small cell lung cancer undergoing targeted therapy: A case study of continuous care. Medicine (Baltimore) 2023; 102:e35678. [PMID: 37932985 PMCID: PMC10627644 DOI: 10.1097/md.0000000000035678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023] Open
Abstract
To investigate the improvement effect of targeted therapy on non-small cell carcinoma patients life quality after the continuous nursing intervention. 104 non-small cell lung cancer patients in our hospital from July 2017 to November 2019 were allocated evenly and randomly into the control group (C) and the study group (S). By using clinical baseline data, quality of life questionnaire core 30 for cancer patients, evaluation of patient compliance behavior, the MOS item short-form health survey (SF-36), self rating depression scale (SDS), self rating anxiety scale (SAS), Overall Survival (OS) progression-free survival and adverse reaction symptoms were evaluated for the life quality of patients. There was comparability between the 2 sets of basic data. There was no significant difference in quality of life questionnaire core 30, SF-36, SAS, or SDS scores before treatment. After 3 months, there was a significant difference in the scores of various scales before treatment. At the same time, there was significant statistical significance before and after treatment in Group S. Their compliance rates were 84.62% and 98.08%. Adverse reactions incidence in Group S was lower. Taking a 2-year follow-up period as an example, significant statistical differences existed in OS and progression-free survival rates between adenocarcinoma and squamous carcinoma. SDS and SAS had high consistency in scoring with QLQ-30 and SF-36 scales. Targeted treatment for non-small cell carcinoma patients significantly improves their life quality and reduces the incidence of adverse reactions after continuous nursing intervention.
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Affiliation(s)
- Yonghua Min
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Nanhu District, Jiaxing City, Zhejiang Province, China
| | - Youcai Zhu
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Nanhu District, Jiaxing City, Zhejiang Province, China
| | - Min Ye
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Nanhu District, Jiaxing City, Zhejiang Province, China
| | - Qinya Zhu
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Nanhu District, Jiaxing City, Zhejiang Province, China
| | - Yumei Xu
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Nanhu District, Jiaxing City, Zhejiang Province, China
| | - Xiaofeng Li
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Nanhu District, Jiaxing City, Zhejiang Province, China
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8
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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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9
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Forrester M, Breitenfeld L, Castelo-Branco M, Aperta J. Identification of an oncological clinical pathway through questionnaires to health professionals. BMC Health Serv Res 2023; 23:1011. [PMID: 37726812 PMCID: PMC10510255 DOI: 10.1186/s12913-023-09964-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: 06/26/2022] [Accepted: 08/25/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Clinical Pathways in Oncology can benefit patients using organized interventions to standardize and increase care efficiency. Healthcare systems should have tools to identify their oncological clinical pathways for a better institutional organization to reduce mortality rates and contain costs without compromising quality. Our objective is to determine the regional Oncology Clinical Pathway from a first basic hypothesis using questionnaires directed to healthcare professionals considered key deciders within the Pathway. METHODS Study design consisted of data analysis of two structured region-wide questionnaires; built using available literature on Oncology Clinical Pathways, in a Portuguese Healthcare context and pre-tested in a focus group of key deciders (Physicians and nurses with management functions) from which a design was created. Queries analyzed the patients: tumor staging at service arrival; time intervals on tumor suspicion/diagnosis confirmation and diagnosis/first treatment; referral pathway; diagnostic networks and patient Follow-up. One questionnaire was sent to key deciders directly involved with Oncology patients at a Regional Hospital. 15 physicians and 18 nurses of this sample answered the questionnaire (approx. response rate = 67%). Another questionnaire sent to healthcare professionals in Primary Healthcare Centers yielded response rate 19.2%, N = 29 physicians and 46 nurses. Finally, we performed a descriptive analysis and a Cronbach Alpha reliability analysis. RESULTS Our findings reveal: different appreciations of tumor staging at arrival in Primary Healthcare Centers and Regional Hospitals (the latter receiving more metastatic cases); approximately 4 weeks between tumor suspicion-diagnostic and divided opinions regarding diagnostic-treatment time intervals. Primary Healthcare Centers depend on private laboratories for diagnostics confirmation, while the Hospitals resolve this locally. Referral pathways indicate almost half of the patients being sent from primary healthcare centers to National Reference Hospitals instead of a Regional Hospital. Patient follow-up is developed throughout the institutions, however, is more established at Regional Hospitals. As patients advance through the Oncology Clinical Pathway and toward treatment stages the number of healthcare professionals involved reduce. CONCLUSION Our questionnaires enable us to understand the real pathway between the different institutions involved and the main entry points of the patients into the Oncology Clinical Pathway.
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Affiliation(s)
- Mario Forrester
- Faculty of Health Sciences Universidade Da Beira Interior, Av. Infante D. Henrique, Covilhã, 6200-506, Portugal.
| | - Luiza Breitenfeld
- Faculty of Health Sciences Universidade Da Beira Interior, Av. Infante D. Henrique, Covilhã, 6200-506, Portugal
| | - Miguel Castelo-Branco
- Faculty of Health Sciences Universidade Da Beira Interior, Av. Infante D. Henrique, Covilhã, 6200-506, Portugal
| | - Jorge Aperta
- Sousa Martins Hospital, Avenida Rainha Dona Amélia, Guarda, 6300-858, Portugal
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10
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KC M, Fan J, Hyslop T, Hassan S, Cecchini M, Wang SY, Silber A, Leapman MS, Leeds I, Wheeler SB, Spees LP, Gross CP, Lustberg M, Greenup RA, Justice AC, Oeffinger KC, Dinan MA. Relative Burden of Cancer and Noncancer Mortality Among Long-Term Survivors of Breast, Prostate, and Colorectal Cancer in the US. JAMA Netw Open 2023; 6:e2323115. [PMID: 37436746 PMCID: PMC10339147 DOI: 10.1001/jamanetworkopen.2023.23115] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/28/2023] [Indexed: 07/13/2023] Open
Abstract
Importance Improvements in cancer outcomes have led to a need to better understand long-term oncologic and nononcologic outcomes and quantify cancer-specific vs noncancer-specific mortality risks among long-term survivors. Objective To assess absolute and relative cancer-specific vs noncancer-specific mortality rates among long-term survivors of cancer, as well as associated risk factors. Design, Setting, and Participants This cohort study included 627 702 patients in the Surveillance, Epidemiology, and End Results cancer registry with breast, prostate, or colorectal cancer who received a diagnosis between January 1, 2003, and December 31, 2014, who received definitive treatment for localized disease and who were alive 5 years after their initial diagnosis (ie, long-term survivors of cancer). Statistical analysis was conducted from November 2022 to January 2023. Main Outcomes and Measures Survival time ratios (TRs) were calculated using accelerated failure time models, and the primary outcome of interest examined was death from index cancer vs alternative (nonindex cancer) mortality across breast, prostate, colon, and rectal cancer cohorts. Secondary outcomes included subgroup mortality in cancer-specific risk groups, categorized based on prognostic factors, and proportion of deaths due to cancer-specific vs noncancer-specific causes. Independent variables included age, sex, race and ethnicity, income, residence, stage, grade, estrogen receptor status, progesterone receptor status, prostate-specific antigen level, and Gleason score. Follow-up ended in 2019. Results The study included 627 702 patients (mean [SD] age, 61.1 [12.3] years; 434 848 women [69.3%]): 364 230 with breast cancer, 118 839 with prostate cancer, and 144 633 with colorectal cancer who survived 5 years or more from an initial diagnosis of early-stage cancer. Factors associated with shorter median cancer-specific survival included stage III disease for breast cancer (TR, 0.54; 95% CI, 0.53-0.55) and colorectal cancer (colon: TR, 0.60; 95% CI, 0.58-0.62; rectal: TR, 0.71; 95% CI, 0.69-0.74), as well as a Gleason score of 8 or higher for prostate cancer (TR, 0.61; 95% CI, 0.58-0.63). For all cancer cohorts, patients at low risk had at least a 3-fold higher noncancer-specific mortality compared with cancer-specific mortality at 10 years of diagnosis. Patients at high risk had a higher cumulative incidence of cancer-specific mortality than noncancer-specific mortality in all cancer cohorts except prostate. Conclusions and Relevance This study is the first to date to examine competing oncologic and nononcologic risks focusing on long-term adult survivors of cancer. Knowledge of the relative risks facing long-term survivors may help provide pragmatic guidance to patients and clinicians regarding the importance of ongoing primary and oncologic-focused care.
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Affiliation(s)
- Madhav KC
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Jane Fan
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Terry Hyslop
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sirad Hassan
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Michael Cecchini
- Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Shi-Yi Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Andrea Silber
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michael S. Leapman
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut
| | - Ira Leeds
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Lisa P. Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Maryam Lustberg
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Rachel A. Greenup
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Amy C. Justice
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kevin C. Oeffinger
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Michaela A. Dinan
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
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11
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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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12
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Alaimo L, Moazzam Z, Brown ZJ, Endo Y, Ruzzenente A, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Soubrane O, Koerkamp BG, Endo I, Pawlik TM. Application of Hazard Function to Investigate Recurrence of Intrahepatic Cholangiocarcinoma After Curative-Intent Liver Resection: A Novel Approach to Characterize Recurrence. Ann Surg Oncol 2023; 30:1340-1349. [PMID: 36029379 DOI: 10.1245/s10434-022-12463-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/02/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate recurrence patterns after surgery for intrahepatic cholangiocarcinoma (ICC) relative to lymph node status, tumor extension, tumor burden score (TBS), and adjuvant chemotherapy. METHODS Patients who underwent curative-intent resection for ICC from 1990 to 2020 were enrolled from a multi-institutional database. The hazard function was applied to plot the hazard rates over time, with further stratification by T and N AJCC 8th edition categories, TBS, and adjuvant chemotherapy. RESULTS A total of 1192 patients underwent curative-intent resection for ICC and 59.9% experienced recurrence. Overall, the peak of recurrence occurred at 6.6 months. Among patients with negative lymph nodes, the T4-category had a higher peak rate of recurrence (0.1199 at 10.2 months) compared with other T-categories, while high TBS had an earlier peak of recurrence (4.2 months) compared with lower TBS. Among patients with N1 disease, T2-T4 categories had multipeak patterns of recurrence with higher hazard rates during the first 3 years after surgery in comparison with T1-category, while patients with high TBS had an earlier (4.0 months) and higher hazard peak rate compared with lower TBS groups. The administration of adjuvant chemotherapy was associated with delayed hazard rates of recurrence for N1 (4 months) and NX (6 months) categories. DISCUSSION The novel application of the hazard function to assess hazard rates and timing patterns of recurrence following resection for ICC demonstrated that recurrence varied based on T- and N-categories, as well as TBS. Hazard function-based recurrence data may be helpful to tailor counseling, surveillance, and adjuvant therapy recommendations.
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Affiliation(s)
- Laura Alaimo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.,Department of Surgery, University of Verona, Verona, Italy
| | - Zorays Moazzam
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zachary J Brown
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | | | - Matthew Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Todd W Bauer
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | | | - Carlo Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Feng Shen
- Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. .,Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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13
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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: 24] [Impact Index Per Article: 24.0] [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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14
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Skorstad M, Vistad I, Fegran L, Berntsen S, Johannessen B. Nurse-led consultations reinforced with eHealth technology: a qualitative study of the experiences of patients with gynecological cancer. BMC Nurs 2022; 21:326. [PMID: 36434602 PMCID: PMC9701034 DOI: 10.1186/s12912-022-01104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND During the last decade, the health care profession has moved toward personalized care and has focused on the diversity of survivorship needs after initial cancer treatment. Health care providers encourage empowering patients to participate actively in their own health management and survivorship. Consequently, we developed and piloted a new follow-up model for patients at a Norwegian hospital, referred to as the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology (LETSGO) model. Using LETSGO, a dedicated nurse replaces the physician in every second follow-up consultation, providing patients who have undergone cancer treatment with self-management techniques that are reinforced with eHealth technology via a specially designed app. Encouraging behavioral change and evaluating the late effects of treatment and recurrence symptoms are central components of self-management techniques. In addition, the app encourages physical activity and positive lifestyle changes, helps identify recurrence-related symptoms, and provides reminders of activity goals. This study aims to investigate experiences with nurse-led consultations supported by eHealth technology among the patients who piloted the LETSGO intervention. METHODS Semi-structured qualitative interviews were conducted to analyze the participants' experiences with the LETSGO intervention after six to seven months. RESULTS The participants in the LETSGO pilot felt safe and well cared for. They thought the nurse was less busy than the doctors appear to be, which made it easy for them to share any cancer-related challenges. Many participants reported increased empowerment and confidence in recognizing symptoms of cancer recurrence, and participants who used the app regularly were motivated to increase their physical activity levels. However, the participants also experienced some limitations and technical errors with the app. CONCLUSIONS Generally, the participants positively received the nurse-led consultations and eHealth technology, but an intervention study is required for further evaluation. In addition, the reported technical app errors should be resolved and tested prior to eHealth application implementation. Regardless, this study may be useful in planning personalized survivorship care studies. TRIAL REGISTRATION ClinicalTrials.gov, NCT03453788 . Registration March 5, 2018.
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Affiliation(s)
- Mette Skorstad
- grid.417290.90000 0004 0627 3712Department of Gynecology and Obstetrics, Sorlandet Hospital HF, Egsveien 100, 4615 Kristiansand, Norway ,grid.7914.b0000 0004 1936 7443Clinical Institute II, Medical Department, University of Bergen, Haukelandsveien 28, 5009 Bergen, Norway
| | - Ingvild Vistad
- grid.417290.90000 0004 0627 3712Department of Gynecology and Obstetrics, Sorlandet Hospital HF, Egsveien 100, 4615 Kristiansand, Norway ,grid.7914.b0000 0004 1936 7443Clinical Institute II, Medical Department, University of Bergen, Haukelandsveien 28, 5009 Bergen, Norway
| | - Liv Fegran
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing Science, University of Agder, Universitetsveien 25, 4630 Kristiansand, Norway
| | - Sveinung Berntsen
- grid.23048.3d0000 0004 0417 6230Department of Sport Science and Physical Education, University of Agder, Universitetsveien 25, 4630 Kristiansand, Norway
| | - Berit Johannessen
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing Science, University of Agder, Universitetsveien 25, 4630 Kristiansand, Norway
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15
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Harada T, Schmitz K, Helsper CW, Campbell G, Nekhlyudov L. Long-COVID and long-term cancer survivorship-Shared lessons and opportunities. Eur J Cancer Care (Engl) 2022; 31:e13712. [PMID: 36151916 PMCID: PMC9539058 DOI: 10.1111/ecc.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022]
Abstract
As of 2022, close to 90 million persons in the United States, 243 million persons in Europe and 585 million worldwide have been infected with the novel SARS‐CoV‐2 (COVID‐19) virus and survived. Estimates vary but suggest that up to 50% may experience long‐term sequelae, termed ‘Long‐COVID’. While Long‐COVID is a new condition, the phenomenon of disabling long‐term effects following an illness requiring ongoing surveillance and management is not. In this commentary, we discuss how Long‐COVID parallels the experiences of long‐term cancer survivors, highlight shared challenges and offer opportunities to improve research and clinical care for both growing populations of patients as well as other long‐term chronic, disabling conditions.
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Affiliation(s)
- Taku Harada
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn Schmitz
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Charles W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Grace Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Duquesne University School of Nursing and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Singarachari RA. Status of Cancer Survivorship Care: Should We Not Improve? IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2022. [DOI: 10.1055/s-0042-1755131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Bradley CJ, Kitchen S, Bhatia S, Bynum J, Darien G, Lichtenfeld JL, Oyer R, Shulman LN, Sheldon LK. Policies and Practices to Address Cancer's Long-term Adverse Consequences. J Natl Cancer Inst 2022; 114:1065-1071. [PMID: 35438165 PMCID: PMC9360463 DOI: 10.1093/jnci/djac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
As cancer detection and treatment improve, the number of long-term survivors will continue to grow, as will the need to improve their survivorship experience and health outcomes. We need to better understand cancer and its treatment's short- and long-term adverse consequences, and to prevent, detect, and treat these consequences effectively. Delivering care through a collaborative care model, standardizing information offered to and collected from patients, standardizing approaches to documenting, treating, and reducing adverse effects, and creating a data infrastructure to make population-based information widely available are all actions that can improve survivors' outcomes. National policies that address gaps in insurance coverage, the cost and value of treatment and survivorship care, and worker benefits such as paid sick leave can also concurrently reduce cancer burden. The National Cancer Policy Forum and the Forum on Aging, Disability, and Independence at the National Academies of Sciences, Engineering, and Medicine sponsored a virtual workshop on Addressing the Adverse Consequences of Cancer Treatment, November 9-10, 2020, to examine long-term adverse consequences of cancer treatment and to identify practices and policies to reduce treatment's negative impact on survivors. This commentary discusses high-priority issues raised during the workshop and offers a path forward.
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18
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Brauer ER, Ganz PA. Moving the Translational Needle in Breast Cancer Survivorship: Connecting Intervention Research to Clinical Practice. J Clin Oncol 2022; 40:2069-2073. [PMID: 35439031 DOI: 10.1200/jco.22.00174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Eden R Brauer
- School of Nursing, University of California, Los Angeles, Los Angeles, CA
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA.,Fielding School of Public Health and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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19
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Kenzik KM, Williams GR, Hollis R, Bhatia S. Healthcare utilization trajectory among survivors of colorectal cancer. J Cancer Surviv 2022; 17:729-737. [DOI: 10.1007/s11764-022-01206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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20
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Vaz-Luis I, Di Meglio A, Havas J, El-Mouhebb M, Lapidari P, Presti D, Soldato D, Pistilli B, Dumas A, Menvielle G, Charles C, Everhard S, Martin AL, Cottu PH, Lerebours F, Coutant C, Dauchy S, Delaloge S, Lin NU, Ganz PA, Partridge AH, André F, Michiels S. Long-Term Longitudinal Patterns of Patient-Reported Fatigue After Breast Cancer: A Group-Based Trajectory Analysis. J Clin Oncol 2022; 40:2148-2162. [PMID: 35290073 PMCID: PMC9242405 DOI: 10.1200/jco.21.01958] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Fatigue is recognized as one of the most burdensome and long-lasting adverse effects of cancer and cancer treatment. We aimed to characterize long-term fatigue trajectories among breast cancer survivors. METHODS We performed a detailed longitudinal analysis of fatigue using a large ongoing national prospective clinical study (CANcer TOxicity, ClinicalTrials.gov identifier: NCT01993498) of patients with stage I-III breast cancer treated from 2012 to 2015. Fatigue was assessed at diagnosis and year 1, 2, and 4 postdiagnosis. Baseline clinical, sociodemographic, behavioral, tumor-related, and treatment-related characteristics were available. Trajectories of fatigue and risk factors of trajectory-group membership were identified by iterative estimates of group-based trajectory models. RESULTS Three trajectory groups were identified for severe global fatigue (n = 4,173). Twenty-one percent of patients were in the high-risk group, having risk estimates of severe global fatigue of 94.8% (95% CI, 86.6 to 100.0) at diagnosis and 64.6% (95% CI, 59.2 to 70.1) at year 4; 19% of patients clustered in the deteriorating group with risk estimates of severe global fatigue of 13.8% (95% CI, 6.7 to 20.9) at diagnosis and 64.5% (95% CI, 57.3 to 71.8) at year 4; 60% were in the low-risk group with risk estimates of 3.6% (95% CI, 2.5 to 4.7) at diagnosis and 9.6% (95% CI, 7.5 to 11.7) at year 4. The distinct dimensions of fatigue clustered in different trajectory groups than those identified by severe global fatigue, being differentially affected by sociodemographic, clinical, and treatment-related factors. CONCLUSION Our findings highlight the multidimensional nature of cancer-related fatigue and the complexity of its risk factors. This study helps to identify patients with increased risk of severe fatigue and to inform personalized interventions to ameliorate this problem.
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Affiliation(s)
- Ines Vaz-Luis
- Gustave Roussy, Medical Oncology, Villejuif, France.,INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Antonio Di Meglio
- Gustave Roussy, Medical Oncology, Villejuif, France.,INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Julie Havas
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Mayssam El-Mouhebb
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Pietro Lapidari
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Daniele Presti
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Davide Soldato
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Barbara Pistilli
- Gustave Roussy, Medical Oncology, Villejuif, France.,INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Agnes Dumas
- Universite de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | | | | | | | | | - Sarah Dauchy
- Gustave Roussy, Supportive Care, IPLESP, Paris, France
| | | | | | | | | | - Fabrice André
- Gustave Roussy, Medical Oncology, Villejuif, France.,INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, INSERM, University Paris-Saclay, Villejuif, France.,Equipe labellisée Ligue Contre le Cancer, Villejuif, France
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21
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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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22
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Blaes AH. Research contributions from the First Cancer Center Survivorship Research Forum. J Cancer Surviv 2022; 16:1-3. [PMID: 35107799 PMCID: PMC8809209 DOI: 10.1007/s11764-021-01137-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/06/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Anne H Blaes
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
- Hematology/Oncology, Cancer Survivorship Services and Translational Research, University of Minnesota, Minneapolis, MN, USA.
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23
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Leach CR, Hudson SV, Diefenbach MA, Wiseman KP, Sanders A, Coa K, Chantaprasopsuk S, Stephens RL, Alfano CM. Cancer health self-efficacy improvement in a randomized controlled trial. Cancer 2022; 128:597-605. [PMID: 34668569 PMCID: PMC9930867 DOI: 10.1002/cncr.33947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/21/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND eHealth interventions can help cancer survivors self-manage their health outside the clinic. Little is known about how best to engage and assist survivors across the age and cancer treatment spectra. METHODS The American Cancer Society conducted a randomized controlled trial that assessed efficacy of, and engagement with, Springboard Beyond Cancer, an eHealth self-management program for cancer survivors. Intent-to treat analyses assessed effects of intervention engagement for treatment (on-treatment vs completed) overall (n = 176; 88 control, 88 intervention arm) and separately by age (<60 years vs older). Multiple imputation was used to account for participants who were lost to follow-up (n = 41) or missing self-efficacy data (n = 1) at 3 months follow-up. RESULTS Self-efficacy for managing cancer, the primary outcome of this trial, increased significantly within the intervention arm and for those who had completed treatment (Cohen's d = 0.26, 0.31, respectively). Additionally, participants with moderate-to-high engagement in the text and/or web intervention (n = 30) had a significantly greater self-efficacy for managing cancer-related issues compared to the control group (n = 68), with a medium effect size (Cohen's d = 0.44). Self-efficacy did not differ between the intervention and control arm at 3 months post-baseline. CONCLUSIONS Study results suggest that cancer survivors benefit variably from eHealth tools. To maximize effects of such tools, it is imperative to tailor information to a priori identified survivor subgroups and increase engagement efforts.
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24
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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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25
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Zengul AG, Zengul FD, Ozaydin B, Oner N, Fiveash JB. Identifying research themes and trends in the top 20 cancer journals through textual analysis. J Cancer Policy 2021; 30:100313. [DOI: 10.1016/j.jcpo.2021.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
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26
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Calman L, Turner J, Fenlon D, Permyakova NV, Wheelwright S, Patel M, Din A, Winter J, Richardson A, Smith PWF, Foster C. Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study. Colorectal Dis 2021; 23:3234-3250. [PMID: 34679253 PMCID: PMC9298990 DOI: 10.1111/codi.15949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/17/2021] [Indexed: 01/15/2023]
Abstract
AIM Depression experienced by people with colorectal cancer (CRC) is an important clinical problem affecting quality of life. Recognition of depression at key points in the pathway enables timely referral to support. This study aimed to examine depression before and 5 years after surgery to examine its prevalence and identify determinants. METHOD The ColoREctal Wellbeing (CREW) study is a prospective UK cohort study involving 872 adults with nonmetastatic CRC recruited before surgery with curative intent. Questionnaires completed before surgery and 3, 9, 15, 24, 36, 48 and 60 months after surgery captured socio-demographics and assessed depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and other psychosocial factors. Clinical details were also gathered. We present the prevalence of clinically significant depression (CES-D ≥ 20) over time and its predictors assessed before and 2 years after surgery. RESULTS Before surgery, 21.0% of the cohort reported CES-D ≥ 20 reducing to 14.7% 5 years after surgery. Presurgery risk factors predicting subsequent depression were clinically significant depression and anxiety, previous mental health service use, low self-efficacy, poor health, having neoadjuvant treatment and low social support. Postsurgery risk factors at 2 years predicting subsequent depression were clinically significant depression, negative affect, cognitive dysfunction, accommodation type and poor health. CONCLUSION Depression is highly pervasive in people with CRC, exceeding prevalence in the general population across follow-up. Our findings emphasize the need to screen and treat depression across the pathway. Our novel data highlight key risk factors of later depression at important and opportune time points: before surgery and at the end of routine surveillance. Early recognition and timely referral to appropriate support is vital to improve long-term psychological outcomes.
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Affiliation(s)
- Lynn Calman
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Joshua Turner
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Deborah Fenlon
- College of Human and Health SciencesSwansea UniversitySwanseaUK
| | | | | | - Mubarak Patel
- Division of Health SciencesUniversity of WarwickWarwickUK
| | - Amy Din
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Jane Winter
- School of Health SciencesUniversity of SouthamptonSouthamptonUK,University Hospitals Southampton NHS TrustSouthamptonUK
| | - Alison Richardson
- School of Health SciencesUniversity of SouthamptonSouthamptonUK,University Hospitals Southampton NHS TrustSouthamptonUK
| | - Peter W. F. Smith
- Social Statistics and DemographySocial SciencesUniversity of SouthamptonSouthamptonUK
| | - Claire Foster
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
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27
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Austin JD, Allicock M, Fernandez ME, Balasubramanian BA, Lee SC. Understanding the Delivery of Patient-Centered Survivorship Care Planning: An Exploratory Interview Study With Complex Cancer Survivors. Cancer Control 2021; 28:10732748211011957. [PMID: 34689577 PMCID: PMC8718161 DOI: 10.1177/10732748211011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Understanding key elements of the survivorship care planning process, such as patient-centered communication (PCC) and health self-efficacy, are critical for delivering patient-centered survivorship care to cancer survivors with multiple chronic conditions (“complex cancer survivors”). Building upon our team’s recent research efforts to examine the survivorship care planning process from a patient-centered lens, this exploratory study leveraged an ongoing quasi-experimental trial to elucidate the experience of complex cancer survivors with survivorship care planning and post-treatment management. Methods: We conducted a hypothesis-generating thematic content analysis on 8 interview transcripts. Results: Survivors reported positive experiences communicating with their oncology care team but the presence of multiple chronic conditions in addition to cancer creates additional barriers to patient-centered survivorship care. Conclusion: These findings support the need for further in-depth research aimed at improving PCC across all care teams and enabling self-management by delivering more personalized survivorship care planning that aligns with survivor’s needs, values, and preferences.
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Affiliation(s)
- Jessica D Austin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
| | - Simon Craddock Lee
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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28
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Andreu Y, Martinez P, Soto-Rubio A, Fernández S, Bosch C, Cervantes A. Colorectal cancer survival: prevalence of psychosocial distress and unmet supportive care needs. Support Care Cancer 2021; 30:1483-1491. [PMID: 34529142 PMCID: PMC8443896 DOI: 10.1007/s00520-021-06513-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/20/2021] [Indexed: 01/22/2023]
Abstract
Purpose The aim of this study was to determine the prevalence of distress and unmet supportive care needs in post-treatment colorectal cancer (CRC) survivors. Also, to explore the association between both variables and to identify potential associated sociodemographic and cancer-related risk factors. Methods A cross-sectional study of 200 CRC survivors who at least 1 month before had completed the primary treatment for CRC was conducted. The Brief Symptom Inventory-18 (BSI-18) and the Spanish version of Cancer Survivors’ Unmet Needs (S-CaSUN) were used. Results One in five CRC survivors showed clinical distress and 86% expressed at least one unmet need. Distress was positively associated with the prevalence of needs in all domains. All comprehensive care and information needs were expressed by at least 20% of survivors and some by more than 50%. Other needs also mentioned by 20% of survivors were financial support, ongoing case manager, and concerns about cancer recurrence. The risk factors associated were lower socioeconomic status, younger age, and a primary treatment that includes more than surgery. Conclusions The findings highlight the relevance of extending psychosocial care beyond the CRC primary medical treatment. A person-centered approach that addresses informational, emotional, social, and physical needs can increase satisfaction with care and also prevent psychological morbidity in CRC survivors.
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Affiliation(s)
- Yolanda Andreu
- Department of Personality, Assessment and Psychological Treatments, Universitat de València, Valencia, Spain
| | - Paula Martinez
- Area of Health Sciences, Valencian International University, 46002, Valencia, Spain.
| | - Ana Soto-Rubio
- Department of Personality, Assessment and Psychological Treatments, Universitat de València, Valencia, Spain
| | - Silvia Fernández
- Asociación Carena, Valencia, Spain.,Medical Oncology Unit, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Carles Bosch
- Medical Oncology Unit, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Andrés Cervantes
- Medical Oncology Department, Instituto de Investigación Sanitaria INCLIVA, University of Valencia, Valencia, Spain
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29
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Tremblay D, Touati N, Bilodeau K, Prady C, Usher S, Leblanc Y. Risk-Stratified Pathways for Cancer Survivorship Care: Insights from a Deliberative Multi-Stakeholder Consultation. Curr Oncol 2021; 28:3408-3419. [PMID: 34590587 PMCID: PMC8482148 DOI: 10.3390/curroncol28050295] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While the principle is supported by leading cancer institutions, translating knowledge to practice confronts a lack of clarity about the meaning of risk stratification, uncertainties around the expectations the model holds for different actors, and health system structures that impede communication and coordination across the care continuum. These barriers must be better understood and addressed to pave the way for future implementation. Recognizing that an innovation is more likely to be adopted when user experience is incorporated into the planning process, a deliberative consultation was held as a preliminary step to developing a pilot project of risk-stratified pathways for patients transitioning from specialized oncology teams to primary care providers. This article presents findings from the deliberative consultation that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: what does a risk stratified model of cancer survivorship care mean to care providers and users? What are the prerequisites for translating risk stratification into practice? What challenges are involved in establishing these prerequisites? The multi-stakeholder consultation provides empirical data to guide actions that support the development of risk-stratified pathways to coordinate survivorship care.
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Affiliation(s)
- Dominique Tremblay
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
- Correspondence: ; Tel.: +1-450-466-5000 (ext. 2885)
| | - Nassera Touati
- École Nationale d’Administration Publique, 4750 Henri-Julien Avenue, Montréal, QC H2T 3E5, Canada;
| | - Karine Bilodeau
- Faculté des Sciences Infirmières et Centre D’Innovation en Formation Infirmière, Université de Montréal, Montréal, QC H3T 1A8, Canada;
| | - Catherine Prady
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
- Centre Intégré de Cancérologie de la Montérégie, 3120 Boulevard Taschereau, Greenfield Park, QC J4V 2H1, Canada
| | - Susan Usher
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- École Nationale d’Administration Publique, 4750 Henri-Julien Avenue, Montréal, QC H2T 3E5, Canada;
| | - Yves Leblanc
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
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30
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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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31
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Alfano CM, Mayer DK, Beckjord E, Ahern DK, Galioto M, Sheldon LK, Klesges LM, Aronoff-Spencer E, Hesse BW. Mending Disconnects in Cancer Care: Setting an Agenda for Research, Practice, and Policy. JCO Clin Cancer Inform 2021; 4:539-546. [PMID: 32543897 DOI: 10.1200/cci.20.00046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cancer in the United States accounts for $600 billion in health care costs, lost work time and productivity, reduced quality of life, and premature mortality. The future of oncology delivery must mend disconnects to equitably improve patient outcomes while constraining costs and burden on patients, caregivers, and care teams. Embedding learning health systems into oncology can connect care, engaging patients and providers in fully interoperable data systems that remotely monitor patients; generate predictive and prescriptive analytics to facilitate appropriate, timely referrals; and extend the reach of clinicians beyond clinic walls. Incorporating functional learning systems into the future of oncology and follow-up care requires coordinated national attention to 4 synergistic strategies: (1) galvanize and shape public discourse to develop and adopt these systems, (2) demonstrate their value, (3) test and evaluate their use, and (4) reform policy to incentivize and regulate their use.
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Affiliation(s)
| | | | - Ellen Beckjord
- Population Health and Clinical Affairs, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David K Ahern
- Brigham and Women's Hospital, Boston, MA.,Connect2Health Task Force, Federal Communications Commission, Washington DC
| | - Michele Galioto
- ONS Center for Innovation at Oncology Nursing Society, Pittsburgh, PA
| | - Lisa K Sheldon
- ONS Center for Innovation at Oncology Nursing Society, Pittsburgh, PA
| | | | - Eliah Aronoff-Spencer
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO
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Khan S, Vahdani Y, Hussain A, Haghighat S, Heidari F, Nouri M, Haj Bloukh S, Edis Z, Mahdi Nejadi Babadaei M, Ale-Ebrahim M, Hasan A, Sharifi M, Bai Q, Hassan M, Falahati M. Polymeric micelles functionalized with cell penetrating peptides as potential pH-sensitive platforms in drug delivery for cancer therapy: A review. ARAB J CHEM 2021. [DOI: 10.1016/j.arabjc.2021.103264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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33
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Vistad I, Skorstad M, Demmelmaier I, Småstuen MC, Lindemann K, Wisløff T, van de Poll-Franse LV, Berntsen S. Lifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology (LETSGO study): a study protocol for a multicentre longitudinal interventional study using mobile health technology and biobanking. BMJ Open 2021; 11:e050930. [PMID: 34253678 PMCID: PMC8276283 DOI: 10.1136/bmjopen-2021-050930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The number of gynaecological cancer survivors is increasing and there is a need for a more sustainable model of follow-up care. Today's follow-up model is time-consuming and patients have reported unmet needs regarding information about their cancer and strategies for managing the consequences of treatment. The main aim of this study is to assess health-related empowerment-in terms of patient education, psychosocial support, and promotion of physical activity-in a new follow-up model by comparing it to standard follow-up in a quasi-randomised study involving intervention hospitals and control hospitals. METHODS AND ANALYSIS At the intervention hospitals, patients will be stratified by risk of recurrence and late effects to either 1 or 3 years' follow-up. Nurses will replace doctors in half of the follow-up visits and focus in particular on patient education, self-management and physical activity. They will provide patients with information and guide them in goal setting and action planning. These measures will be reinforced by a smartphone application for monitoring symptoms and promoting physical activity. At the control hospitals, patients will be included in the standard follow-up programme. All patients will be asked to complete questionnaires at baseline and after 3, 6, 12, 24 and 36 months. Blood samples will be collected for biobanking at 3, 12 and 36 months. The primary outcome is health-related empowerment. Secondary outcomes include health-related quality of life, adherence to physical activity recommendations, time to recurrence, healthcare costs and changes in biomarkers. Changes in these outcomes will be analysed using generalised linear mixed models for repeated measures. Type of hospital (intervention or control), time (measurement point), and possible confounders will be included as fixed factors. ETHICS AND DISSEMINATION The study is approved by the Regional Committee for Medical Research Ethics (2019/11093). Dissemination of findings will occur at the local, national and international levels. TRIAL REGISTRATION NUMBER NCT04122235.
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Affiliation(s)
- Ingvild Vistad
- Department of Gynaecology and Obstetrics, Sorlandet Hospital Kristiansand, Kristiansand, Norway
- Clinical Department 2, University of Bergen, Bergen, Hordaland, Norway
| | - Mette Skorstad
- Department of Gynaecology and Obstetrics, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Ingrid Demmelmaier
- Department of Public Health and Caring Sciences, Lifestyle and Rehabilitation in Long-term Illness, Uppsala Universitet, Uppsala, Sweden
| | | | - Kristina Lindemann
- Department of Gynaecologic Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Wisløff
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Lonneke V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Sveinung Berntsen
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Vest-Agder, Norway
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Abstract
PURPOSE OF REVIEW The disruption to people's lives, including financial impacts, morbidity and loss of life caused by the Coronavirus disease (COVID-19) pandemic requires a dramatic transformation of cancer care delivery, including supportive care. This paper focuses on issues of supportive care in the context of the pandemic, and the extent to which these issues will impact supportive cancer care post-COVID-19. RECENT FINDINGS Cancer care, including supportive care delivery, has had to be dramatically altered during the COVID-19 pandemic, including reallocation of human resources, repurposing of existing physical space, amplified use of telehealth and other remote patient monitoring technologies, changes to treatment and follow-up care patient schedules, among others. These changes have resulted in psychosocial sequelae for cancer patients (including anxiety, stress, loss of control), financial toxicity, and risk of disengagement from treatment and follow-up care. SUMMARY COVID-19 has seriously disrupted cancer treatment and supportive care for patients and survivors. This paper highlights implications for clinical practice during and post-COVID-19, including the durability of practice adaptations and opportunities for research into mechanisms to support supportive care post the pandemic, including the advancement of eHealth technologies and alternative models of care that integrate community resources, primary care and allied health disciplines.
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Affiliation(s)
- Fredrick D Ashbury
- Department of Oncology, University of Calgary, Alberta
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- VieCure, Denver, CO
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Kenzik KM, Williams GR, Bhakta N, Robison LL, Landier W, Goyal G, Mehta A, Bhatia S. Healthcare utilization and spending among older patients diagnosed with Non-Hodgkin lymphoma. J Geriatr Oncol 2021; 12:1225-1232. [PMID: 34176753 DOI: 10.1016/j.jgo.2021.06.006] [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: 05/05/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Developing appropriate care models for patients diagnosed with non-Hodgkin lymphoma (NHL) >65y require examination of current healthcare utilization patterns and cost, but non-malignant condition-specific utilization and Medicare spending among older patients has not been characterized. METHODS Using SEER-Medicare, 14,533 patients diagnosed with NHL at age > 65 between 2008 and 2015 and a comparable non-cancer cohort (n = 14,533) were identified. Hospitalizations and outpatient visits for 109 non-malignant conditions were grouped into ten categories, allowing condition-specific utilization and spending calculation from diagnosis to 5y, censoring at blood or marrow transplantation, 6mo prior to death or end (12/31/2016). Using the 90th percentile as a cut-off, factors associated with high-hospitalization rates and high-spending were evaluated. RESULTS Patients with NHL were 1.5-fold more likely to be hospitalized and 1.8-fold more likely to experience outpatient visits when compared with the non-cancer cohort. Patients with NHL had greater aging-related, cardiovascular, and gastrointestinal hospitalizations than controls (p < 0.001). Average Medicare spending/visit was higher for patients with NHL (hospitalization: $16,950 vs. $13,474, p < 0.001; outpatient: $1176 vs. $392, p < 0.001). Factors associated with high-utilization and high-spending included diffuse large B cell lymphoma subtype, non-white race, and residence in low-education area. CONCLUSIONS Older patients with NHL experienced higher utilization and higher spending per-utilization compared to a non-cancer cohort over five years from cancer diagnosis. Clinical and demographic sub-groups demonstrated increased risk for the highest spending and utilization. The substantial utilization and spending for non-malignant conditions among older patients with NHL provides quantifiable evidence for survivor-adapted healthcare management policies.
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Affiliation(s)
- Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, USA.
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Pediatric Oncology, University of Alabama at Birmingham, USA
| | - Gaurav Goyal
- Division of Hematology and Oncology, University of Alabama at Birmingham, USA
| | - Amitkumar Mehta
- Division of Hematology and Oncology, University of Alabama at Birmingham, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Pediatric Oncology, University of Alabama at Birmingham, USA
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Leach CR, Alfano CM, Potts J, Gallicchio L, Yabroff KR, Oeffinger KC, Hahn EE, Shulman LN, Hudson SV. Personalized Cancer Follow-Up Care Pathways: A Delphi Consensus of Research Priorities. J Natl Cancer Inst 2021; 112:1183-1189. [PMID: 32333765 DOI: 10.1093/jnci/djaa053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 12/24/2022] Open
Abstract
Development of personalized, stratified follow-up care pathways where care intensity and setting vary with needs could improve cancer survivor outcomes and efficiency of health-care delivery. Advancing such an approach in the United States requires identification and prioritization of the most pressing research and data needed to create and implement personalized care pathway models. Cancer survivorship research and care experts (n = 39) participated in an in-person workshop on this topic in 2018. Using a modified Delphi technique-a structured, validated system for identifying consensus-an expert panel identified critical research questions related to operationalizing personalized, stratified follow-up care pathways for individuals diagnosed with cancer. Consensus for the top priority research questions was achieved iteratively through 3 rounds: item generation, item consolidation, and selection of the final list of priority research questions. From the 28 research questions that were generated, 11 research priority questions were identified. The questions were categorized into 4 priority themes: determining outcome measures for new care pathways, developing and evaluating new care pathways, incentivizing new care pathway delivery, and providing technology and infrastructure to support self-management. Existing data sources to begin answering questions were also identified. Although existing data sources, including cancer registry, electronic medical record, and health insurance claims data, can be enhanced to begin addressing some questions, additional research resources are needed to address these priority questions.
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Affiliation(s)
- Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc, Atlanta, GA, USA
| | | | - Jessica Potts
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Inc, Atlanta, GA, USA; 6Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Kevin C Oeffinger
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Erin E Hahn
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Covington KR, Marshall T, Campbell G, Williams GR, Fu JB, Kendig TD, Howe N, Alfano CM, Pergolotti M. Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. Support Care Cancer 2021; 29:6469-6480. [PMID: 33900458 DOI: 10.1007/s00520-021-06208-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Participation in exercise or rehabilitation services is recommended to optimize health, functioning, and well-being across the cancer continuum of care. However, limited knowledge of individual needs and complex decision-making are barriers to connect the right survivor to the right exercise/rehabilitation service at the right time. In this article, we define the levels of exercise/rehabilitation services, provide a conceptual model to improve understanding of individual needs, and describe the development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. METHODS From literature review, we synthesized defining characteristics of exercise/rehabilitation services and individual characteristics associated with safety and efficacy for each service. We developed a visual model to conceptualize the need for each level of specialized care, then organized individual characteristics into a risk-stratified algorithm. Iterative review with a multidisciplinary expert panel was conducted until consensus was reached on algorithm content and format. RESULTS We identified eight defining features of the four levels of exercise/rehabilitation services and provide a conceptual model of to guide individualized navigation for each service across the continuum of care. The EXCEEDS algorithm includes a risk-stratified series of eleven dichotomous questions, organized in two sections and ten domains. CONCLUSIONS The EXCEEDS algorithm is an evidence-based decision support tool that provides a common language to describe exercise/rehabilitation services, a practical model to understand individualized needs, and step-by-step decision support guidance. The EXCEEDS algorithm is designed to be used at point of care or point of need by multidisciplinary users, including survivors. Thus, implementation may improve care coordination for cancer exercise/rehabilitation services.
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Affiliation(s)
- Kelley R Covington
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA. .,Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA.
| | | | - Grace Campbell
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.,Department of Occupational Therapy, University of Pittsburgh School of Health & Rehabilitation Sciences, Pittsburgh, PA, USA.,UPMC Hillman Cancer Center at UPMC Magee Women's Hospital, Pittsburgh, PA, USA
| | - Grant R Williams
- Department of Medicine, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tiffany D Kendig
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA.,Kessler Institute of Rehabilitation, West Orange, NJ, USA
| | - Nancy Howe
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA.,Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
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Skorstad M, de Rooij BH, Jeppesen MM, Bergholdt SH, Ezendam NPM, Bohlin T, Jensen PT, Lindemann K, van de Poll L, Vistad I. Self-management and adherence to recommended follow-up after gynaecological cancer: results from the international InCHARGE study. Int J Gynecol Cancer 2021; 31:1106-1115. [PMID: 33858949 DOI: 10.1136/ijgc-2020-002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the relationship between self-management skills and adherence to follow-up guidelines among gynecological cancer survivors in the Netherlands, Norway, and Denmark, and to assess the relationship between adherence to follow-up programs and use of additional healthcare services. METHODS For this international, multicenter, cross-sectional study, we recruited gynecological cancer survivors 1-5 years after completion of treatment. Information on follow-up visits, use of healthcare resources, self-management (measured by the Health Education Impact Questionnaire), clinical characteristics, and demographics were obtained by validated questionnaires. Participants were categorized as adherent if they attended the number of follow-up visits recommended by national guidelines, non-adherent if they had fewer visits than recommended, or over-users if they had more visits than recommended. RESULTS Of 4455 invited survivors, 2428 (55%) returned the questionnaires, and 911 survivors were included in the analyses. Survivors with high self-management most frequently adhered to recommended follow-up. Non-adherent survivors showed lower self-management in the health-directed activity domain (OR 1.54, 95% CI 1.03 to 2.32) than adherent survivors. No other associations between self-management and follow-up adherence were revealed. Non-adherent survivors tended to have endometrial cancer, surgical treatment only, be older, and be Danish residents. Over-users reported more follow-up visits and also used additional healthcare services more frequently than adherent survivors. CONCLUSION Low self-management appears to reduce the likelihood of adherence to national guidelines for gynecological cancer follow-up. Focusing on patient education for survivors at risk of low self-management to ensure adherence to recommended follow-up may improve personalization of follow-up.
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Affiliation(s)
- Mette Skorstad
- Department of Gynaecology and Obstetrics, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Belle H de Rooij
- Department of Medical and Clinical Psychology, IKNL, Utrecht, Utrecht, Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Mette Moustgaard Jeppesen
- Department of Gynaecology and Obstetrics, Hospital Lillebaelt Middelfart Hospital, Middelfart, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Stinne Holm Bergholdt
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Nicole Paulina Maria Ezendam
- Department of Medical and Clinical Psychology, IKNL, Utrecht, Utrecht, Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Tonje Bohlin
- Department of Gynaecology and Obstetrics, Vestfold Hospital Trust, Tonsberg, Norway
| | - Pernille Tine Jensen
- Faculty of Health Science, Aarhus University, Aarhus, Denmark.,Department of Gynecology and Obstetrics, Aarhus Universitetshospital, Aarhus, Denmark
| | - Kristina Lindemann
- Department of Gynecological Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lonneke van de Poll
- Department of Medical and Clinical Psychology, IKNL, Utrecht, Utrecht, Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.,Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Ingvild Vistad
- Department of Gynaecology and Obstetrics, Sorlandet Hospital Kristiansand, Kristiansand, Norway.,Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
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Sun V, Reb A, Debay M, Fakih M, Ferrell B. Rationale and Design of a Telehealth Self-Management, Shared Care Intervention for Post-treatment Survivors of Lung and Colorectal Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:414-420. [PMID: 33415649 PMCID: PMC7994229 DOI: 10.1007/s13187-021-01958-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 05/05/2023]
Abstract
Survivors of lung and colorectal cancer have high post-treatment needs; the majority are older and suffer from greater comorbidities and poor quality of life (QOL). They remain underrepresented in research, leading to significant disparities in post-treatment outcomes. Personalized post-treatment follow-up care and care coordination among healthcare teams is a priority for survivors of lung and colorectal cancer. However, there are few evidence-based interventions that address survivors' post-treatment needs beyond the use of a follow-up care plan. This paper describes the rationale and design of an evidence-informed telehealth intervention that integrates shared care coordination between oncology/primary care and self-management skills building to empower post-treatment survivors of lung and colorectal cancer. The intervention design was informed by (1) contemporary published evidence on cancer survivorship, (2) our previous research in lung and colorectal cancer survivorship, (3) the chronic care self-management model (CCM), and (4) shared post-treatment follow-up care between oncology and primary care. A two-arm, parallel randomized controlled trial will determine the efficacy of the telehealth intervention to improve cancer care delivery and survivor-specific outcomes. ClinicalTrials.gov Identifier: NCT04428905.
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Affiliation(s)
- Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, CA, USA.
- Department of Surgery, City of Hope, Duarte, CA, USA.
| | - Anne Reb
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Marc Debay
- Department of Family Medicine, University of California, Riverside, CA, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Betty Ferrell
- Department of Population Sciences, City of Hope, Duarte, CA, USA
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Vena JA, Copel LC. A Meta-Ethnography of the Experiences of Adults with Lymphoma During Acute and Chronic Survivorship. Semin Oncol Nurs 2021; 37:151142. [PMID: 33773881 DOI: 10.1016/j.soncn.2021.151142] [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: 10/21/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The acute and chronic phases of cancer survivorship are the periods of treatment, post-treatment, and early remission. During acute and chronic survivorship, adults with lymphoma have reported both positive and negative changes in health-related quality of life. This meta-ethnography aims to appraise the experiences of adults with lymphoma at the acute and chronic survivorship phases. DATA SOURCES This qualitative review used the established meta-ethnography framework from Noblit and Hare and is outlined following the meta-ethnography reporting guidance (eMERGe). A systematic literature search using four unique databases was completed, including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Ovid Emcare, and Clarivate Web of Science. CONCLUSION In total, nine research studies were included in this review. Study characteristics and sample evidence were extracted from the included studies to produce the synthesis. The review and synthesis formed three main themes and six subthemes that reflect the challenges of cancer treatment and post-treatment, the communication and support from others, and how lymphoma patients reframe and reprioritize during and following treatment. IMPLICATIONS FOR NURSING PRACTICE This meta-ethnography provides a comprehensive analysis of adults' experiences with lymphoma at the acute and chronic survivorship phases. Several approaches for the management and care of lymphoma patients were found in this review, including integrating patient support groups from diagnosis through post-treatment, tailored psychological health care services, personalized care and delivery pathways at post-treatment, and the promotion of strategies to cope with cancer in remission. Additional research should examine younger and older adults to discover age-related issues in lymphoma populations in addition to disparities among minority patients with lymphoma and those from low socioeconomic backgrounds.
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Affiliation(s)
- Joseph A Vena
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA.
| | - Linda C Copel
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA
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Gallicchio L, Tonorezos E, de Moor JS, Elena J, Farrell M, Green P, Mitchell SA, Mollica MA, Perna F, Gottlieb Saiontz N, Zhu L, Rowland J, Mayer DK. Evidence Gaps in Cancer Survivorship Care: A Report from the 2019 National Cancer Institute Cancer Survivorship Workshop. J Natl Cancer Inst 2021; 113:1136-1142. [PMID: 33755126 DOI: 10.1093/jnci/djab049] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022] Open
Abstract
Today, there are more than 16.9 million cancer survivors in the United States; this number is projected to grow to 22.2 million by 2030. While much progress has been made in understanding cancer survivors needs and in improving survivorship care since the seminal 2006 Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition, there is a need to identify evidence gaps and research priorities pertaining to cancer survivorship. Thus, in April 2019, the National Cancer Institute convened grant-funded extramural cancer survivorship researchers, representatives of professional organizations, cancer survivors, and advocates for a one-day in-person meeting. At this meeting, and in a subsequent webinar aimed at soliciting input from the wider survivorship community, evidence gaps and ideas for next steps in the following six areas, identified from the 2006 Institute of Medicine report, were discussed: surveillance for recurrence and new cancers, management of long-term and late physical effects, management of long-term and late psychosocial effects, health promotion, care coordination, and financial hardship. Identified evidence gaps and next steps across the areas included the need to understand and address disparities among cancer survivors, to conduct longitudinal studies as well as longer-term (>5 years post-diagnosis) follow-up studies, to leverage existing data, and to incorporate implementation science strategies to translate findings into practice. Designing studies to address these broad evidence gaps, as well as those identified in each area, will expand our understanding of cancer survivors' diverse needs, ultimately leading to the development and delivery of more comprehensive evidence-based quality care.
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Affiliation(s)
- Lisa Gallicchio
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Emily Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Janet S de Moor
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Joanne Elena
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Margaret Farrell
- Division of Communications and Marketing, Office of the Director, National Institutes of Health
| | - Paige Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Sandra A Mitchell
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Michelle A Mollica
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Frank Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Nicole Gottlieb Saiontz
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Li Zhu
- Statistical Research and Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Julia Rowland
- Smith Center for Healing and the Arts, Washington DC
| | - Deborah K Mayer
- School of Nursing, University of North Carolina at Chapel Hill; University of North Carolina Lineberger Comprehensive Cancer Center
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Smith SR, Vargo M, Zucker D, Shahpar S, Gerber L, Henderson M, Jay G, Lee M, Cheville A. Psychometric Characteristics and Validity of the PROMIS Cancer Function Brief 3D Profile. Arch Phys Med Rehabil 2021; 103:S146-S161. [PMID: 33548209 DOI: 10.1016/j.apmr.2020.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To develop an item response theory (IRT)-calibrated, patient-reported outcome measure (the PROMIS Cancer Function Brief 3D Profile) of physical function, including associations with fatigue and social participation, in cancer rehabilitation patients. DESIGN Large-scale field testing, graded response model IRT analyses, and multivariate regression analysis. SETTING Six cancer rehabilitation clinics associated with cancer centers across the United States. PARTICIPANTS Adults (N=616) treated in outpatient cancer rehabilitation medicine clinics. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The PROMIS(r) Cancer Function 3D Profile (including existing items from PROMIS(r) item banks). RESULTS A total of 616 patients completed 21 items in the initial item pool. Nine items were removed because of comparatively lower information that they provide according to the IRT item calibrations, low item-total correlations, or bimodal distributions. The remaining items generated a 12-item short form. Regression analyses determined that the items were responsive to and representative of the patient population across trait ranges and multiple domains and subdomains of function. CONCLUSIONS This psychometric investigation supports the use of the PROMIS Cancer Function Brief 3D Profile for evaluating function in outpatient cancer rehabilitation patients.
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Affiliation(s)
- Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.
| | - Mary Vargo
- Case Western Reserve University, Cleveland
| | - David Zucker
- Cancer Rehabilitation Medicine Services, Swedish Cancer Institute, Swedish Health Services, Seattle, Washington
| | | | - Lynn Gerber
- George Mason University, Fairfax, Virginia; Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maryanne Henderson
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD
| | - Gina Jay
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Minji Lee
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, United States
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, United States
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Smith SR, Vargo M, Zucker DS, Henderson M, Shahpar S, Wisotzky EM, Custodio C, Basford J, Jay G, Gerber L, Cheville A. The Cancer Rehabilitation Medicine Metrics Consortium: A Path to Enhanced, Multi-Site Outcome Assessment to Enhance Care and Demonstrate Value. Front Oncol 2021; 10:625700. [PMID: 33614506 PMCID: PMC7887295 DOI: 10.3389/fonc.2020.625700] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/18/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose A primary objective stated at the Cancer Rehabilitation Symposium at the National Institutes of Health was to improve outcome measurement. The purpose of this project was for the Cancer Rehabilitation Medicine Metrics Consortium (CRMMC) to develop an assessment tool to evaluate function in cancer patients via a data-driven and methodologically sound process. There is no agreed-upon measure of physical and cognitive function for cancer patients, making it difficult to demonstrate the value of rehabilitation interventions. Cancer patients are a particularly challenging population, with many tumor- and treatment-related variables impacting function. Methods Investigators from nine different cancer rehabilitation programs participated in a modified-Delphi process to delineate necessary aspects of an ideal patient assessment tool, including instrument type, domains evaluated, applicability across a range of patient traits, clinical feasibility, and item response characteristics. This involved numerous meetings, data review, and analysis of items involved in patient assessment. Results The CRMMC developed a 21-item patient-reported outcome measure based on item response theory. The process by which the short form was developed was documented and provides a framework for other clinicians to follow. Conclusion This document provides a framework for rehabilitation providers to follow when developing an assessment tool. This process is described in a stepwise fashion for reproducibility even in different, non-cancer populations.
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Affiliation(s)
- Sean R Smith
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, United States
| | - Mary Vargo
- Case Western Reserve University, Cleveland, OH, United States
| | - David S Zucker
- Cancer Rehabilitation Medicine Services, Swedish Cancer Institute, Swedish Health Services, Seattle, WA, United States
| | - Maryanne Henderson
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | | | - Eric M Wisotzky
- MedStar National Rehabilitation Hospital, Washington, DC, United States
| | - Christian Custodio
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jeffrey Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Gina Jay
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, United States
| | - Lynn Gerber
- Center for Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, United States
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
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Stout NL, Brunelle C, Scheiman N, Thawer H. Surveillance Protocols for Survivors at Risk for Lymphedema. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-020-00402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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McLaughlin SA, Stout NL, Schaverien MV. Avoiding the Swell: Advances in Lymphedema Prevention, Detection, and Management. Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32315238 DOI: 10.1200/edbk_280471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lymphedema is a feared complication of cancer treatments that negatively affects survivors' quality of life. The true incidence of lymphedema is difficult to determine given its long latency period. As the number of survivors of cancer is increasing in the United States, lymphedema is poised to be a major health concern. The most noteworthy risk factor for lymphedema is comprehensive lymph node dissection. The last 2 decades have witnessed a dramatic shift in cancer treatment in an attempt to systematically de-escalate therapeutic interventions, specifically seeking to shift treatment away from routine lymph node dissection in favor of sentinel node biopsy or radiation strategies, thereby reducing the risk for lymphedema while maintaining survival outcomes. A growing body of robust evidence supports prospective screening and thereby a prospective surveillance model (PSM) for early diagnosis and intervention for the prevention and treatment of lymphedema. Finally, investigators are actively evaluating the effectiveness of contemporary surgical procedures in ameliorating the symptoms and disability of patients with lymphedema and reducing the risk of future episodes of cellulitis, with outcomes of surgery significantly better than with conservative therapy alone. In this article, we review the current data surrounding these initiatives.
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Affiliation(s)
| | - Nicole L Stout
- Department of Hematology Oncology, West Virginia University Cancer Institute, Morgantown, WV
| | - Mark V Schaverien
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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Schmitz KH, Stout NL, Maitin-Shepard M, Campbell A, Schwartz AL, Grimmett C, Meyerhardt JA, Sokolof JM. Moving through cancer: Setting the agenda to make exercise standard in oncology practice. Cancer 2020; 127:476-484. [PMID: 33090477 DOI: 10.1002/cncr.33245] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 01/02/2023]
Abstract
LAY SUMMARY International evidence-based guidelines support the prescription of exercise for all individuals living with and beyond cancer. This article describes the agenda of the newly formed Moving Through Cancer initiative, which has a primary objective of making exercise standard practice in oncology by 2029.
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Affiliation(s)
- Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Nicole L Stout
- Section of Hematology/Oncology, Department of Medicine, West Virginia University Cancer Institute, Morgantown, West Virginia
| | | | - Anna Campbell
- School of Applied Science, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Anna L Schwartz
- School of Nursing, Northern Arizona University, Flagstaff, Arizona
| | - Chloe Grimmett
- Department of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jeffrey A Meyerhardt
- Division of Gastrointestinal Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jonas M Sokolof
- Department of Physical Medicine and Rehabilitation, New York University Grossman School of Medicine, New York, New York
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Sleight AG, Boyd P, Klein WMP, Jensen RE. Spiritual peace and life meaning may buffer the effect of anxiety on physical well-being in newly diagnosed cancer survivors. Psychooncology 2020; 30:52-58. [PMID: 32840948 DOI: 10.1002/pon.5533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the extent to which spiritual well-being moderates the relationship between anxiety and physical well-being in a diverse, community-based cohort of newly diagnosed cancer survivors. METHODS Data originated from the Measuring Your Health (MY-Health) study cohort (n = 5506), comprising people assessed within 6-13 months of cancer diagnosis. Life meaning/peace was assessed using the 8-item subscale of the Spiritual Well-Being Scale (FACIT-Sp-12). Anxiety was measured with an 11-item PROMIS Anxiety short form, and physical well-being was assessed using the 7-item FACT-G subscale. Multiple linear regression models were used to assess relationships among variables. RESULTS Life meaning and peace was negatively associated with anxiety, b = -0.56 (P < .001) and positively associated with physical well-being, b = 0.43 (P = <.001) after adjusting for race, education, income, and age. A significant interaction between life meaning/peace and anxiety emerged (P < .001) indicating that spiritual well-being moderates the relationship between anxiety and physical well-being. Specifically, for cancer survivors high in anxiety, physical well-being was dependent on levels of life meaning/peace, b = 0.19, P < .001. For those low in anxiety, physical well-being was not associated with levels of life meaning/peace, b = 0.01, P = .541. Differences in cancer clinical factors (cancer stage at diagnosis, cancer type) did not significantly impact results. CONCLUSIONS Further research is needed to assess how spiritual well-being may buffer the negative effect of anxiety on physical well-being. A clinical focus on spiritual well-being topics such as peace and life meaning may help cancer survivors of all types as they transition into follow-up care.
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Affiliation(s)
- Alix G Sleight
- Department of Physical Medicine & Rehabilitation Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Patrick Boyd
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - William M P Klein
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Roxanne E Jensen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Nolan TS, Hatfield R, Browning KK, Kue J, Klemanski DL. Survivorship Fellowship: Evaluation and Evolution of a Program for Advanced Practice Providers. Clin J Oncol Nurs 2020; 23:575-578. [PMID: 31730593 DOI: 10.1188/19.cjon.575-578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A comprehensive cancer center in the midwestern United States implemented a stakeholder-engaged quality improvement process to extend its existing one-year advanced practice provider (APP) fellowship program consisting of general oncology education and clinical experience to include an additional survivorship clinical rotation. APP fellowship alumni and program stakeholders reported noticeable benefits and greater importance attributed to program participation, validating inclusion of a survivorship clinic rotation as part of the fellowship program.
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Affiliation(s)
- Timiya S Nolan
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (The James)
| | - Rachée Hatfield
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (The James)
| | | | | | - Dori L Klemanski
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (The James)
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Sharing Cancer Survivorship Care between Oncology and Primary Care Providers: A Qualitative Study of Health Care Professionals' Experiences. J Clin Med 2020; 9:jcm9092991. [PMID: 32947973 PMCID: PMC7563389 DOI: 10.3390/jcm9092991] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022] Open
Abstract
Survivorship care that is shared between oncology and primary care providers may be a suitable model to effectively and efficiently care for the growing survivor population, however recommendations supporting implementation are lacking. This qualitative study aimed to explore health care professionals’ (HCPs) perceived facilitators and barriers to the implementation, delivery and sustainability of shared survivorship care. Data were collected via semi-structured focus groups and analysed by inductive thematic analysis. Results identified four overarching themes: (1) considerations for HCPs; (2) considerations regarding patients; (3) considerations for planning and process; and (4) policy implications. For HCPs, subthemes included general practitioner (GP, primary care physician) knowledge and need for further training, having clear protocols for follow-up, and direct communication channels between providers. Patient considerations included identifying patients suitable for shared care, discussing shared care with patients early in their cancer journey, and patients’ relationships with their GPs. Regarding process, subthemes included rapid referral pathways back to hospital, care coordination, and ongoing data collection to inform refinement of a dynamic model. Finally, policy implications included development of policy to support a consistent shared care model, and reliable and sustainable funding mechanisms. Based on study findings, a set of recommendations for practice and policy were developed.
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Lisy K, Kent J, Piper A, Jefford M. Facilitators and barriers to shared primary and specialist cancer care: a systematic review. Support Care Cancer 2020; 29:85-96. [PMID: 32803729 DOI: 10.1007/s00520-020-05624-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To care for the growing population of cancer survivors, health services worldwide must reconsider how to deliver care to people living with and beyond a cancer diagnosis. Shared care, defined as cancer care that is shared between specialist and primary care providers, is one model that has been investigated; however, practical guidance to support implementation is lacking. This systematic review aimed to explore facilitators and barriers to implementing shared cancer care and to develop practice and policy recommendations to support implementation. METHODS A systematic literature search was conducted in June 2019 across MEDLINE, Embase, Emcare, and PsycINFO databases. Quantitative and qualitative data relevant to the review question were extracted and synthesized following a mixed methods approach. RESULTS Thirteen papers were included in the review, 10 qualitative and three quantitative. Included articles were from Australia (n = 8), the USA (n = 3), and one each from the UK and the Netherlands. Sixteen themes were developed under four categories of patient, healthcare professional, process, and policy factors. Key themes included the perceived need for primary care provider training, having clearly defined roles for each healthcare provider, providing general practitioners with diagnostic and treatment summaries, as well as protocols or guidelines for follow-up care, ensuring rapid and accurate communication between providers, utilizing electronic medical records and survivorship care plans as communication tools, and developing consistent policy to reduce fragmentation across services. CONCLUSION Recommendations for practice and policy were generated based on review findings that may support broader implementation of shared cancer care.
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Affiliation(s)
- Karolina Lisy
- Department of Cancer Experiences 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, The University of Melbourne, Parkville, Victoria, Australia.
| | - Jennifer Kent
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amanda Piper
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Cancer Experiences 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, The University of Melbourne, Parkville, Victoria, Australia
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