Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review

Outcomes of cancer survivorship education and training for primary care providers: a systematic review

Purpose

To identify published literature regarding cancer survivorship education programs for primary care providers (PCPs) and assess their outcomes.

Methods

PubMed, Embase, and CINAHL databases were searched between January 2005 and September 2020. The Quality of Cancer Survivorship Care Framework and Kirkpatrick’s 4-level evaluation model were used to summarize program content and outcomes, respectively. Data extraction and critical appraisal were conducted by two authors.

Results

Twenty-one studies were included, describing self-directed online courses (n=4), presentations (n=2), workshops and training sessions (n=6), placement programs (n=3), a live webinar, a fellowship program, a referral program, a survivorship conference, a dual in-person workshop and webinar, and an in-person seminar and online webinar series. Eight studies described the use of a learner framework or theory to guide program development. All 21 programs were generally beneficial to PCP learners (e.g., increased confidence, knowledge, behavior change); however, methodological bias suggests caution in accepting claims. Three studies reported positive outcomes at the patient level (i.e., satisfaction with care) and organizational level (i.e., increased screening referrals, changes to institution practice standards).

Conclusions

A range of cancer survivorship PCP education programs exist. Evidence for clinical effectiveness was rarely reported. Future educational programs should be tailored to PCPs, utilize an evidence-based survivorship framework, and evaluate patient- and system-level outcomes.

Implications for Cancer Survivors

PCPs have an important role in addressing the diverse health care needs of cancer survivors. Improving the content, approach, and evaluation of PCP-focused cancer survivorship education programs could have a positive impact on health outcomes among cancer survivors.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11764-021-01018-6.

GP experience and understandings of providing follow-up care in prostate cancer survivors in England

Survival times for prostate cancer have increased substantially, meaning more survivors will be discharged to General Practitioners' (GP) services. The detection of recurrence and monitoring of symptoms and long-term side-effects in prostate cancer survivors requires the active involvement of GPs in their follow-up care. In order to address this, the transition and discharge from hospital to primary care must be managed effectively. The objective of this study was to examine the preparedness, concerns and experiences of GPs in relation to their role in providing follow-up care to prostate cancer survivors. Purposive sampling was used to recruit GPs with experience in providing care to prostate cancer survivors. Twenty semi-structured telephone interviews were conducted with GPs across England. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Participants described their current role in the follow-up pathway, a number of challenges and barriers in assuming this role, and potential ways to resolve these and improve their involvement. They expressed a range of views about their preparedness and willingness to take over follow-up care after discharge for this group of patients. GPs had reservations about workload, lack of resources, expertise and deficiencies in communication with hospitals. Findings from this study suggest that GPs will be ready to take over the follow-up care of prostate cancer survivors if better information, additional training and adequate resources are provided and communication lines with hospital specialists are clear. Understanding the issues faced by GPs and overcoming identified barriers to providing follow-up care to prostate cancer survivors will provide the insight necessary to make the process of transferring care from secondary to primary teams a more straightforward task for all stakeholders.

The Effectiveness of Shared Care in Cancer Survivors-A Systematic Review

Objectives

To determine whether the shared care model during the follow-up of cancer survivors is effective in terms of patient-reported outcomes, clinical outcomes, and continuity of care.

Methods

Using systematic review methods, studies were searched from six electronic databases-MEDLINE (n = 474), British Nursing Index (n = 320), CINAHL (n = 437), Cochrane Library (n = 370), HMIC (n = 77), and Social Care Online (n = 210). The review considered all health-related outcomes that evaluated the effectiveness of shared care for cancer survivors.

Results

Eight randomised controlled trials and three descriptive papers were identified. The results showed the likelihood of similar effectiveness between shared care and usual care in terms of quality of life, mental health outcomes, unmet needs, and clinical outcomes in cancer survivorship. The reviewed studies indicated that shared care overall is highly acceptable to cancer survivors and primary care practitioners, and shared care might be cheaper than usual care.

Conclusions

The results from this review suggest that the patient satisfaction of shared care is higher than usual care, and the effectiveness of shared care is similar to usual care in cancer survivorship. Interventions that formally involve primary care and improve the communication between primary care and hospital care could support the PCPs in the follow-up.

Enhancing the Return to Work of Cancer Survivors: Development and Feasibility of the Nurse-Led eHealth Intervention Cancer@Work

Background

It is important to enhance the return to work of cancer survivors with an appropriate intervention, as cancer survivors experience problems upon their return to work but consider it an essential part of their recovery.

Objective

The objective of our study was to develop an eHealth intervention to enhance the return to work of cancer survivors and to test the feasibility of the eHealth intervention with end users.

Methods

To develop the intervention we 1) searched the literature, 2) interviewed 7 eHealth experts, 3) interviewed 7 cancer survivors, 2 employers, and 7 occupational physicians, and 4) consulted experts. To test feasibility, we enrolled 39 cancer survivors, 9 supervisors, 7 occupational physicians, 9 general physicians and 2 social workers and gave them access to the eHealth intervention. We also interviewed participants, asked them to fill in a questionnaire, or both, to test which functionalities of the eHealth intervention were appropriate and which aspects needed improvement.

Results

Cancer survivors particularly want information and support regarding the possibility of returning to work, and on financial and legal aspects of their situation. Furthermore, the use of blended care and the personalization of the eHealth intervention were preferred features for increasing compliance. The first version of the eHealth intervention consisted of access to a personal and secure website containing various functionalities for cancer survivors blended with support from their specialized nurse, and a public website for employers, occupational physicians, and general physicians. The eHealth intervention appeared feasible. We adapted it slightly by adding more information on different cancer types and their possible effects on return to work.

Conclusions

A multistakeholder and mixed-method design appeared useful in the development of the eHealth intervention. It was challenging to meet all end user requirements due to legal and privacy constraints. The eHealth intervention appeared feasible, although implementation in daily practice needs to be subject of further research.

ClinicalTrial

Dutch Trial Register number (NTR): 5190; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5190 (Archived by WebCite at http://www.webcitation.org/6hm4WQJqC)