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Sandell T, Schütze H, Miller A. Acceptability of a shared cancer follow-up model of care between general practitioners and radiation oncologists: A qualitative evaluation. Health Expect 2023; 26:2441-2452. [PMID: 37583292 PMCID: PMC10632636 DOI: 10.1111/hex.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Facilitators to implement shared cancer follow-up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two-way information sharing and clear follow-up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. METHODS Semi-structured interviews were conducted pre- and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. RESULTS Thirty-two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow-up care, however, patients were concerned about the GPs cancer-specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low-risk, stable patients around 2-3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow-up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. CONCLUSION Patients, GPs and ROs felt this shared cancer follow-up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. PATIENT OR PUBLIC CONTRIBUTION Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed.
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Affiliation(s)
- Tiffany Sandell
- School of Graduate MedicineFaculty of Science, Medicine and Health, University of WollongongWollongongNew South WalesAustralia
- Illawarra Shoalhaven Local Health District, Cancer ServicesNowraNew South WalesAustralia
| | - Heike Schütze
- School of Graduate MedicineFaculty of Science, Medicine and Health, University of WollongongWollongongNew South WalesAustralia
- Office of Medical EducationFaculty of Medicine and Health, University of New South WalesSydneyNew South WalesAustralia
| | - Andrew Miller
- Illawarra Shoalhaven Local Health District, Cancer ServicesNowraNew South WalesAustralia
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Sandell T, Schütze H, Miller A, Ivers R. Patients' acceptance of a shared cancer follow-up model of care between general practitioners and radiation oncologists: A population-based survey using the theoretical Framework of Acceptability. BMC PRIMARY CARE 2023; 24:86. [PMID: 36973691 PMCID: PMC10044765 DOI: 10.1186/s12875-023-02032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION International and national guidelines highlight the need for general practitioner involvement during and after active cancer treatment and throughout long-term follow-up care. This paper aimed to evaluate patients' acceptance of radiation oncology shared follow-up care using the Theoretical Framework of Acceptability (TFA). METHODS This cross-sectional study was conducted at two cancer care centres in the Illawarra Shoalhaven region of Australia. A sample of patients scheduled for a radiation oncology follow-up consultation in 2021 were sent a 32-point self-complete paper-based survey. Data were analysed using descriptive, parametric and non-parametric statistical analysis. This paper followed the Checklist for Reporting of Survey Studies (CROSS). RESULTS Of the 414 surveys returned (45% response rate), the acceptance for radiation oncology shared cancer follow-up care was high (80%). Patients treated with only radiotherapy were 1.7 times more likely to accept shared follow-up care than those treated with multiple modalities. Patients who preferred follow-up care for fewer than three years were 7.5 times more likely to accept shared care than those who preferred follow-up care for five years. Patients who travelled more than 20 minutes to their radiation oncologist or to the rural cancer centre were slightly more likely to accept shared care than those who travelled less than twenty minutes to the regional cancer centre. A high understanding of shared care (Intervention Coherence) and a positive feeling towards shared care (Affective Attitude) were significant predictive factors in accepting shared radiation oncology follow-up care. CONCLUSION Health services need to ensure patient preferences are considered to provide patient-centred cancer follow-up care. Shared cancer follow-up care implementation should start with patients who prefer a shorter follow-up period and understand the benefits of shared care. However, patients' involvement needs to be considered alongside other clinical risk profiles and organisational factors. Future qualitative research using the TFA constructs is warranted to inform clinical practice change.
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Affiliation(s)
- Tiffany Sandell
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Cancer Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
| | - Heike Schütze
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Andrew Miller
- Cancer Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Rowena Ivers
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Nguyen P, Azizi-Mehr P, Townsley C, Zahedi A. Outcomes of Early Transition of Low-Risk Thyroid Cancer Patients from Specialist to Primary Care. Curr Oncol 2022; 29:7672-7679. [PMID: 36290883 PMCID: PMC9600329 DOI: 10.3390/curroncol29100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recently published clinical pathways for management of thyroid cancer outlined the criteria for transitioning low-risk patients to primary care within one to five years from diagnosis. However, discharge patterns among endocrinologists remain heterogeneous as there lacks a consensus regarding post-treatment care for thyroid cancer patients. OBJECTIVE This study described general characteristics and outcomes of thyroid cancer patients who were discharged from specialist care and transitioned to a primary care-based follow-up clinic. METHODS Thyroid cancer patients seen in the After Cancer Treatment Transition (ACTT) clinic at Women's College Hospital (Toronto, Canada) were included in the study. Electronic medical records were reviewed between May and October 2021 to collect patient characteristics and outcomes. Descriptive statistics were calculated. RESULTS The study cohort included 148 thyroid cancer patients and 76% were female. All cases were papillary thyroid cancer and most diagnoses were classified as T2 (42%), N0 (55%), M0 (91%), and stage 1 (83%). Nearly all patients (n = 147) had complete thyroidectomy. Levels of thyroglobulin and thyroglobulin antibodies (TgAb) were low overall, with only 5% of the study cohort deemed TgAb positive. Mean levels of thyroid stimulating hormone (TSH) measured at 2 time points (1.37 mIU/L, 1.42 mIU/L) were within normal range. About 91% of the study cohort had normal TSH levels and 82% met target TSH levels. There were 2 cases of recurrence; however, investigation determined that they were not initially appropriate candidates for transition to primary care. Nearly 99% (n = 146) of patients had excellent response to therapy, showed no evidence of disease recurrence, and have not required re-referral to specialist care. CONCLUSIONS These findings may reassure specialists that low-risk, stable thyroid cancer patients can be safely transitioned to primary care for post-treatment follow-up.
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Affiliation(s)
- Patricia Nguyen
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | | | - Carol Townsley
- After Cancer Treatment Transition (ACTT) Program, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Afshan Zahedi
- Thyroid Program, Women’s College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada
- Correspondence:
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Sandell T, Schütze H. Factors influencing the translation of shared cancer follow-up care into clinical practice: a systematic review. BMJ Open 2022; 12:e055460. [PMID: 36038175 PMCID: PMC9438010 DOI: 10.1136/bmjopen-2021-055460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care and the need to find alternative models of care. Shared cancer follow-up care in general practice is a safe option in terms of quality of life and cancer recurrence; however, there are barriers to translating this into practice. This review aimed to identify factors that influence the translation of shared cancer follow-up care into clinical practice. METHODS Systematic review. Seven electronic databases: MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psychinfo, Health Source: Nursing/Academic Edition and Psychology and Behavioural Sciences Collection, were searched for published papers between January 1999 and December 2021. The narrative review included papers if they were available in full-text, English, peer-reviewed and focused on shared cancer follow-up care. RESULTS Thirty-eight papers were included in the final review. Five main themes emerged: (1) reciprocal clinical information sharing is needed between oncologists and general practitioners, and needs to be timely and relevant; (2) responsibility of care should be shared with the oncologist overseeing care; (3) general practitioners skills and knowledge to provide cancer follow-up care; (4) need for clinical management guidelines and rapid referral to support general practitioners to provide shared follow-up care and (5) continuity of care and satisfaction of care is vital for shared care. CONCLUSION The acceptability of shared cancer follow-up care is increasing. Several barriers still exist to translating this into practice. Work is required to develop a shared-care model that can support general practitioners, while the oncologist can oversee the care and implement two-way communication between general and oncologists' clinics. The move towards integrating electronic healthcare records and web-based platforms for information exchange provides a promise to the timely exchange of information. PROSPERO REGISTRATION NUMBER CRD42020191538.
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Affiliation(s)
- Tiffany Sandell
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Radiation Oncology, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Heike Schütze
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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Doescher MP, Nagykaldi Z, Zhao YD, Dwyer K. Oncology and Primary Care Provider Views on Cancer Survivorship Care: Mind the Gap. J Am Board Fam Med 2022; 35:329-340. [PMID: 35379720 PMCID: PMC10897935 DOI: 10.3122/jabfm.2022.02.210286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022] Open
Abstract
CONTEXT Coordination between oncology and primary care practices in cancer survivorship is lacking. OBJECTIVE To identify cancer care coordination perceptions, knowledge, and practices in a sample of Oklahoma oncology care providers (ONCs) and primary care providers (PCPs) regarding post-treatment care of adult cancer survivors. DESIGN Cross-sectional, statewide survey by mail/web link in 2014/5. SETTING PCPs identified through a primary care research network, primary care organization membership lists; ONCs identified through www.Healthgrades.com. PARTICIPANTS Contacts who were clinically active and seeing cancer patients were eligible. The final sample size included 101 ONCs and 58 PCPs who reported actively seeing cancer patients. MEASURES Responses to predominately Likert scale or ranked-order questions derived from the Survey of Physician Attitudes Regarding the Care of Cancer Survivors. ANALYSES Chi square and t tests were performed to test bivariate associations between provider type and survey measures. RESULTS Statistically significant differences (P < .05) between ONC and PCP perceptions were observed for several questions on communication between the 2 provider types, ONC perceptions of PCP ability to address survivorship care, and responsibilities for post-treatment care. CONCLUSIONS Highly discrepant perspectives between ONCs and PCPs regarding communications and responsibilities for survivorship care may lead to adverse health outcomes. Interventions aimed at improving care coordination for cancer survivors should define each provider group's responsibilities in survivorship care, and create structures and processes that foster clear channels of communication between ONC and PCP practices.
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Affiliation(s)
- Mark P Doescher
- From Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MPD); College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZN); Stephenson Cancer Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (YDZ); Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK (KD).
| | - Zsolt Nagykaldi
- From Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MPD); College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZN); Stephenson Cancer Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (YDZ); Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK (KD)
| | - Yan Daniel Zhao
- From Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MPD); College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZN); Stephenson Cancer Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (YDZ); Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK (KD)
| | - Kathleen Dwyer
- From Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MPD); College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZN); Stephenson Cancer Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (YDZ); Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK (KD)
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Angarita FA, Jedrzejko N, Eisen D, Muraca M, Ash M, Osman F. Primary Care Physicians' Perspectives in Leading Breast Cancer Follow-Up Care. Clin Breast Cancer 2021; 22:e497-e505. [PMID: 34955431 DOI: 10.1016/j.clbc.2021.11.011] [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: 06/29/2021] [Revised: 10/24/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Limited data exist on the barriers associated with transitioning breast cancer follow-up care to primary care physicians (PCPs). This study aimed to describe the current perspectives of PCPs in managing breast cancer follow-up. METHOD An online survey was distributed to PCPs in Toronto, ON, Canada. Questions examined PCPs' view of transitioning breast cancer follow-up care to their practices. RESULTS Of 800 PCPs invited, 126 responded (response rate: 15.7%). The types of practice models amongst respondents included blended capitation (42.9%), blended salary (27%), and fee-for-service (17.5%). Seventy-seven percent of respondents stated they provided follow-up care. Approximately half of the respondents stated they were somewhat comfortable providing follow-up care. PCP-led follow-up care was considered either very (49.2%) or somewhat appropriate (30.2%). When asked about financial remuneration, 43.7% of respondents stated it was somewhat important. The factors that influenced the feasibility of PCP-led follow-up care included receipt of a detailed follow-up care plan provided by the specialist after discharge (81%), the ability to re-refer to specialists rapidly (56.3%), and the ability to obtain regular updates of best practice changes (59.5%). The preferred means of educational updates included E-mail (40.5%), continuing medical education events (30.2%), and electronic medical records (19.8%). When the fee model was taken into consideration there was no significant difference in opinions regarding follow-up care. CONCLUSIONS Transitioning to a PCP-led model was supported by most of the PCPs who participated in this study. Their perspective on PCP-led follow up care and barriers associated with implementation of this model of care needs to be further explored with future studies that include larger sample size and a more diverse PCP population.
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Affiliation(s)
- Fernando A Angarita
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Division of Surgical Oncology, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Nicole Jedrzejko
- Department of Surgery, Division of General Surgery, University of British Columbia, Vancouver, BC, Canada
| | - David Eisen
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Maria Muraca
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Marla Ash
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Fahima Osman
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Surgery, North York General Hospital, Toronto, ON, Canada.
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Factors associated with endocrine therapy adherence among post-menopausal women treated for early-stage breast cancer in Ontario, Canada. Breast Cancer Res Treat 2019; 179:217-227. [PMID: 31571072 DOI: 10.1007/s10549-019-05430-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Adherence to adjuvant endocrine therapy among post-menopausal breast cancer patients is an important survivorship care issue. We explored factors associated with endocrine therapy adherence and survival in a large real-world population-based study. METHODS We used health administrative databases to follow women (aged ≥ 66 years) who were diagnosed with breast cancer and started on adjuvant endocrine therapy from 2005 to 2010. Adherence was measured by medical possession ratio (MPR) and characterized as low (< 39% MPR), intermediate (40-79% MPR), or high (≥ 80% MPR) over a 5-year period. We investigated factors associated with adherence using a multinomial logistic regression model. Factors associated with all-cause mortality (5 years after starting endocrine therapy) were investigated using a multivariable Cox proportional hazards model. RESULTS We identified 5692 eligible patients starting adjuvant endocrine therapy who had low, intermediate, and high adherence rates of 13% (n = 749), 13% (n = 733), and 74% (n = 4210), respectively. Lower rates of adherence were associated with increased age [low vs. high adherence: odds ratio (OR) 1.03, 95% CI 1.02-1.05 (per year); intermediate vs. high adherence: OR 1.02, 95% CI 1.01-1.04 (per year)]. High adherence was associated with previous use of adjuvant chemotherapy (low versus high adherence OR 0.42, 95% CI 0.30-0.59) and short-term follow-up with a medical oncologist within 4 months of starting endocrine therapy (low versus high adherence OR 0.83, 95% CI 0.69-0.99). Unadjusted analysis showed increased survival among patients with high endocrine therapy adherence. However, an independent association was no longer clearly detected after controlling for confounders. CONCLUSION Interventions to improve adjuvant endocrine therapy adherence are warranted. Non-adherence may be a more significant issue among elderly patients. Short-term follow-up visit by a patient's medical oncologist after starting endocrine therapy may help to improve compliance.
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Bispo Júnior JP, Moreira DC. Educação permanente e apoio matricial: formação, vivências e práticas dos profissionais dos Núcleos de Apoio à Saúde da Família e das equipes apoiadas. CAD SAUDE PUBLICA 2017; 33:e00108116. [DOI: 10.1590/0102-311x00108116] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/28/2016] [Indexed: 11/21/2022] Open
Abstract
Resumo: Este estudo objetivou compreender e analisar como os processos de educação permanente são vivenciados pelos profissionais dos Núcleos de Apoio à Saúde da Família (NASF) e das equipes de saúde da família (EqSF). Buscou ainda compreender como o apoio matricial, como estratégia de educação permanente, estava incorporado ao trabalho desses profissionais. Estudo de casos múltiplos, com abordagem qualitativa, realizado em seis municípios da Região Sudoeste da Bahia, Brasil, que contavam com NASF do tipo I. Foram realizadas entrevistas semiestruturadas com 43 profissionais do NASF e 40 com médicos e enfermeiros das equipes apoiadas. As entrevistas foram categorizadas e analisadas por meio da técnica da análise de conteúdo temática. Os resultados evidenciaram que as ações de educação permanente são insuficientes e inadequadas, com oferta de treinamentos esporádicos desenvolvidos por meio de metodologia tradicional de ensino. Evidencia-se a não institucionalidade da educação permanente como política nos municípios estudados. A formação sobre o apoio matricial e o processo de trabalho do NASF mostrou-se frágil para ambos os grupos, o que interfere na função de apoio e na gestão do cuidado. Foi evidenciada a diminuta atuação dos NASF como promotores de educação permanente para as equipes apoiadas.
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Dossett LA, Hudson JN, Morris AM, Lee MC, Roetzheim RG, Fetters MD, Quinn GP. The primary care provider (PCP)-cancer specialist relationship: A systematic review and mixed-methods meta-synthesis. CA Cancer J Clin 2017; 67:156-169. [PMID: 27727446 PMCID: PMC5342924 DOI: 10.3322/caac.21385] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Although they are critical to models of coordinated care, the relationship and communication between primary care providers (PCPs) and cancer specialists throughout the cancer continuum are poorly understood. By using predefined search terms, the authors conducted a systematic review of the literature in 3 databases to examine the relationship and communication between PCPs and cancer specialists. Among 301 articles identified, 35 met all inclusion criteria and were reviewed in-depth. Findings from qualitative, quantitative, and disaggregated mixed-methods studies were integrated using meta-synthesis. Six themes were identified and incorporated into a preliminary conceptual model of the PCP-cancer specialist relationship: 1) poor and delayed communication between PCPs and cancer specialists, 2) cancer specialists' endorsement of a specialist-based model of care, 3) PCPs' belief that they play an important role in the cancer continuum, 4) PCPs' willingness to participate in the cancer continuum, 5) cancer specialists' and PCPs' uncertainty regarding the PCP's oncology knowledge/experience, and 6) discrepancies between PCPs and cancer specialists regarding roles. These data indicate a pervasive need for improved communication, delineation, and coordination of responsibilities between PCPs and cancer specialists. Future interventions aimed at these deficiencies may improve patient and physician satisfaction and cancer care coordination. CA Cancer J Clin 2017;67:156-169. © 2016 American Cancer Society.
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Affiliation(s)
- Lesly A Dossett
- Assistant Professor, Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Janella N Hudson
- Postdoctoral Fellow, Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Arden M Morris
- Associate Professor, Department of Surgery and Center for Health Outcomes and Policy, University of Michigan Health System, Ann Arbor, MI
| | - M Catherine Lee
- Associate Member, Comprehensive Breast Program, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Richard G Roetzheim
- Professor, Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL
- Senior Member, Department of Health Outcomes and Behavior and Comprehensive Breast Program, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Michael D Fetters
- Professor, Department of Family Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Gwendolyn P Quinn
- Senior Member, Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, Tampa, FL
- Professor, Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
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Luctkar-Flude M. Are primary care providers implementing evidence-based care for breast cancer survivors? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2015; 61:978-984. [PMID: 26889509 PMCID: PMC4642911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To describe the implementation of key best practice guideline recommendations for posttreatment breast cancer survivorship care by primary care providers (PCPs). DESIGN Descriptive cross-sectional survey. SETTING Southeastern Ontario. PARTICIPANTS Eighty-two PCPs: 62 family physicians (FPs) and 20 primary health care nurse practitioners (PHCNPs). MAIN OUTCOME MEASURES Twenty-one “need-to-know” breast cancer survivorship care guideline recommendations rated by participants as “implemented routinely,” “aware of guideline recommendation but not implemented routinely,” or “not aware of guideline recommendation.” RESULTS Overall, FPs and PHCNPs in our sample reported similar practice patterns in terms of implementation of breast cancer survivorship guideline recommendations. The PCPs reported routinely implementing approximately half (46.4%, 9.7 of 21) of the key guideline recommendations with breast cancer survivors in their practices. Implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care, such as mammography and weight management. Knowledge and practice gaps were highest for recommendations related to screening for and management of long-term effects such as fatigue and distress. There were only a few minor differences reported between FPs and PHCNPs. CONCLUSION There are knowledge and practice gaps related to implementation of the key guideline recommendations for breast cancer survivorship care in the primary care setting that could be targeted for improvement through educational or other interventions.
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Luctkar-Flude M, Aiken A, McColl MA, Tranmer J. A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting. Fam Pract 2015; 32:129-40. [PMID: 25500746 DOI: 10.1093/fampra/cmu082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Breast cancer survivors continue to experience physical and psychosocial health care needs post-treatment. Primary care involvement is increasing as cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up. Research suggests primary care providers (PCPs) are willing to provide survivorship care but many lack knowledge and confidence to provide evidence-based care. Although clinical practice guidelines (CPGs) exist for follow-up surveillance and certain aspects of survivorship care, no single comprehensive guideline addresses all significant breast cancer survivorship issues encountered in primary care. PURPOSE The purpose of this research was to create a comprehensive clinical practice framework to guide the provision of breast cancer survivorship care in primary care settings. METHODS This study consisted of an extensive search, appraisal and synthesis of CPGs for post-treatment breast cancer care using a modified Delphi method. Breast cancer survivorship issues and relevant CPGs were mapped to four essential components of survivorship care to create a comprehensive clinical practice framework to guide provision of breast cancer survivorship care. RESULTS The completed framework consists of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations and a one-page list of guideline sources. The framework and key guideline recommendations were verified by a panel of experts for comprehensiveness, importance and relevance to primary care. CONCLUSIONS This framework may serve as a tool to remind PCPs about issues impacting breast cancer survivors, as well as the evidence-based recommendations and resources to provide the associated care.
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Affiliation(s)
| | - Alice Aiken
- Faculty of Health Sciences, School of Rehabilitation Therapy, Canadian Institute for Military and Veteran Health Research
| | - Mary Ann McColl
- Faculty of Health Sciences, School of Rehabilitation Therapy, Centre for Health Services and Policy Research and
| | - Joan Tranmer
- Faculty of Health Sciences, School of Nursing, Department of Public Health Sciences, Queen's University, Kingston, Canada
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Attard CL, Pepper AN, Brown ST, Thompson MF, Thuresson PO, Yunger S, Dent S, Paterson AH, Wells GA. Cost-effectiveness analysis of neoadjuvant pertuzumab and trastuzumab therapy for locally advanced, inflammatory, or early HER2-positive breast cancer in Canada. J Med Econ 2015; 18:173-88. [PMID: 25347449 DOI: 10.3111/13696998.2014.979938] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The NeoSphere trial demonstrated that the addition of pertuzumab to trastuzumab and docetaxel for the neoadjuvant treatment of HER2-positive locally advanced, inflammatory, or early breast cancer (eBC) resulted in a significant improvement in pathological complete response (pCR). Furthermore, the TRYPHAENA trial supported the benefit of neoadjuvant dual anti-HER2 therapy. Survival data from these trials is not yet available; however, other studies have demonstrated a correlation between pCR and improved event-free survival (EFS) and overall survival (OS) in this patient population. This study represents the first Canadian cost-effectiveness analysis of pertuzumab in the neoadjuvant treatment of HER2-positive eBC. METHODS A cost-utility analysis (CUA) was conducted using a three health state Markov model ('event-free', 'relapsed', and 'dead'). Two separate analyses were conducted; the first considering total pCR (ypT0/is ypN0) data from NeoSphere, and the second from TRYPHAENA. Published EFS and OS data partitioned for patients achieving/not achieving pCR were used in combination with the percentage achieving pCR in the pertuzumab trials to estimate survival. This CUA included published utility values and direct medical costs including drugs, treatment administration, management of adverse events, supportive care, and subsequent therapy. To address uncertainty, a probabilistic sensitivity analysis (PSA) and alternative scenarios were explored. RESULTS Both analyses suggested that the addition of pertuzumab resulted in increased life-years and quality-adjusted life-years (QALYs). The incremental cost per QALY ranged from $25,388 (CAD; NeoSphere analysis) to $46,196 (TRYPHAENA analysis). Sensitivity analyses further support the use of pertuzumab, with cost-effectiveness ratios ranging from $9230-$64,421. At a threshold of $100,000, the addition of pertuzumab was cost-effective in nearly all scenarios (93% NeoSphere; 79% TRYPHAENA). CONCLUSION Given the improvement in clinical efficacy and a favorable cost per QALY, the addition of pertuzumab in the neoadjuvant setting represents an attractive treatment option for HER2-positive eBC patients.
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Affiliation(s)
- C L Attard
- Cornerstone Research Group Inc. , Burlington, ON , Canada
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Out-of-hospital follow-up after low risk breast cancer within a care network: 14-year results. Breast 2014; 23:407-12. [PMID: 24656635 DOI: 10.1016/j.breast.2014.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/05/2014] [Accepted: 02/22/2014] [Indexed: 11/23/2022] Open
Abstract
The delegation of low-risk breast cancer patients' follow-up to non-hospital practitionners (NHP), including gynaecologists and general practitioners, has been assessed prospectively within a care network in the Paris region. Patients with early stage breast cancer were eligible. The follow-up protocol was built according to international guidelines. By 2012, 289 NHPs were following 2266 patients treated in 11 centres. Median follow-up time was 7.4 years. The mean intervals between two consecutive consultations were 9.5 [9.2-9.8] months for women supposed to be monitored every 6 months and 12.5 [12.2-12.8] for those requiring annual monitoring. The relapse rate was 3.2% [2.1-4.3] at 5 years and 7.8% [5.9-9.7] at 10 years. Seventy one percent of relapses were diagnosed on a scheduled assessment. Only 6% were lost-to-follow-up. Delegating follow-up after low risk breast cancer to NHPs in a care network is feasible, well accepted and provides an alternative to follow-up in specialized centres.
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Choi KH, Park SM, Lee K, Kim KH, Park JS, Han SH. Prevalence, Awareness, Control, and Treatment of Hypertension and Diabetes in Korean Cancer Survivors: A Cross-Sectional Analysis of the Fourth and Fifth Korea National Health and Nutrition Examination Surveys. Asian Pac J Cancer Prev 2013; 14:7685-92. [DOI: 10.7314/apjcp.2013.14.12.7685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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