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Haines ER, Gan H, Kupelian A, Roggenkamp B, Lux L, Kumar B, Davies S. The Development and Implementation of Adolescent and Young Adult Oncology Programs: Teen Cancer America's Strategy. J Adolesc Young Adult Oncol 2024; 13:347-351. [PMID: 37922448 DOI: 10.1089/jayao.2023.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023] Open
Abstract
Reflecting a growing recognition that adolescents and young adults (AYAs) with cancer have unique needs that demand novel approaches to care delivery, AYA-specific cancer programs are emerging across the United States to better serve this population. However, the limited availability of health system funding to support such efforts, in combination with the dearth of guidance that exists to guide AYA program development and implementation, has hampered the effective development and implementation of AYA oncology programs. In this article, we describe Teen Cancer America's strategy for partnering with hospitals to address this gap and improve care and outcomes for AYAs with cancer.
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Affiliation(s)
- Emily R Haines
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Hilary Gan
- Teen Cancer America, Los Angeles, California, USA
| | | | | | - Lauren Lux
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Bindu Kumar
- Teen Cancer America, Los Angeles, California, USA
| | - Simon Davies
- Teen Cancer America, Los Angeles, California, USA
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Dupuis LL, Fisher BT, Sugalski AJ, Grimes A, Nuño M, Ramakrishnan S, Beauchemin MP, Robinson PD, Santesso N, Walsh A, Wrightson AR, Yu L, Parsons SK, Sung L. Clinical practice guideline-inconsistent management of fever and neutropenia in pediatric oncology: A Children's Oncology Group study. Pediatr Blood Cancer 2024; 71:e30880. [PMID: 38291716 PMCID: PMC10937100 DOI: 10.1002/pbc.30880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND The primary objective was to measure the proportion of episodes where care delivery was inconsistent with selected recommendations of a clinical practice guideline (CPG) on fever and neutropenia (FN) management. The influence of site size on CPG-inconsistent care delivery, and association between patient outcomes and CPG-inconsistent care were described. METHODS This retrospective, multicenter study included patients less than 21 years old with cancer who were at high risk of poor FN outcomes and were previously enrolled to a Children's Oncology Group (COG) study at participating National Cancer Institute Community Oncology Research Program (NCORP) institutions from January 2014 through December 2015. Patients were randomly selected for chart review by participating sites from a COG-generated list. Care delivered in each episode was adjudicated (CPG-consistent or CPG-inconsistent) against each of five selected recommendations. RESULTS A total of 107 patients from 22 sites, representing 157 FN episodes, were included. The most common CPG-inconsistent care delivered was omission of pulmonary computerized tomography in patients with persistent FN (60.3%). Of 74 episodes where assessment of four (episodes without persistent FN) or five (episodes with persistent FN) recommendations was possible, CPG-inconsistent care was delivered with respect to at least one recommendation in 63 (85%) episodes. Site size was not associated with CPG-inconsistent care delivery. No statistically significant association between CPG-inconsistent care and fever recurrence was observed. CONCLUSIONS In this cohort of pediatric patients at high risk of poor FN outcomes, CPG-inconsistent care was common. Opportunities to optimize resource stewardship by boosting supportive care CPG implementation are highlighted.
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Affiliation(s)
- LL Dupuis
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Pharmacy, The Hospital for Sick Children; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - BT Fisher
- The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, US
| | - AJ Sugalski
- University of Texas Health Science Center San Antonio, San Antonio, Texas, US
| | - A Grimes
- University of Texas Health Science Center San Antonio, San Antonio, Texas, US
| | - M Nuño
- Children’s Oncology Group, Monrovia, USA
| | | | - MP Beauchemin
- Columbia University Irving Medical Center, New York, USA
| | - PD Robinson
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - N Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - A Walsh
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, USA. University of Arizona, Phoenix, USA
| | - AR Wrightson
- Clinical Research Nurse Coordinator, Nemours Center for Cancer and Blood Disorders, Wilmington, USA
| | - L Yu
- LSUHSC/Children’s Hospital, New Orleans, USA
| | - SK Parsons
- Institute for Clinical Research and Health Policy Studies and Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - L Sung
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
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Kumar AJ, Pearson LK, Wong JB, Friedberg JW, Parsons SK, LeClair AM. Understanding treatment decisions for Hodgkin lymphoma: a qualitative study. Leuk Lymphoma 2023; 64:2249-2257. [PMID: 37897330 DOI: 10.1080/10428194.2023.2256913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/03/2023] [Indexed: 10/30/2023]
Abstract
Hodgkin lymphoma (HL) affects older and younger patients and includes multiple options for initial treatment. We sought to examine the decision processes of practicing oncologists caring for patients with newly diagnosed HL. Through semi-structured interviews, we explored their perspectives about treatment decisions. We completed thematic analysis using the Anderson Behavioral Model of Health Services framework to identify factors associated with initial decisions. We completed 22 interviews, grouping findings into contextual factors, individual characteristics, and physician preferences. Paternalism was widely cited, along with collaboration between community and academic colleagues. Participants used sequential therapy but not geriatric assessment in care for older patients. Physicians had varied responses about use of frontline brentuximab vedotin (Bv)-based therapy based on perceptions about benefit versus toxicity. Our work suggests a need to further understand the heterogeneity of clinical practices, especially in the post-approval setting of new therapies.
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Affiliation(s)
- Anita J Kumar
- Tufts Medical Center Institute of Clinical Research & Health Policy Studies, Boston, MA, USA
| | - Laurie K Pearson
- Tufts Medical Center Institute of Clinical Research & Health Policy Studies, Boston, MA, USA
| | | | | | | | - Amy M LeClair
- Tufts Medical Center Institute of Clinical Research & Health Policy Studies, Boston, MA, USA
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Parsons SK, Beauchemin MP, Dupuis L, Sugalski A, Wolfson JA, Santacroce SJ, Marchak JG, Sung L, Roth ME. Children's Oncology Group 2023 blueprint for research: Cancer care delivery research. Pediatr Blood Cancer 2023; 70 Suppl 6:e30579. [PMID: 37469004 PMCID: PMC10686255 DOI: 10.1002/pbc.30579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
The National Cancer Institute (NCI) has a 40-year history of initiatives to encourage the participation of community oncology sites into clinical trials research and clinical care. In 2014, the NCI re-organized to form the NCI Community Oncology Research Program (NCORP) network across seven research bases, including the Children's Oncology Group (COG), and numerous community sites. The COG portfolio for Cancer Care Delivery Research (CCDR), mirroring the larger NCORP network, has included two studies addressing guideline congruence, as an important marker of quality cancer care, and another focusing on financial toxicity, addressing the pervasive problems of healthcare cost. CCDR is a cross-cutting field that frequently examines intersectional aspects of healthcare delivery. With that in mind, we explicitly define domains of CCDR to propel our research agenda into the next phase of the NCORP CCDR program while acknowledging the complex and dynamic fields of clinical care, policy level decisions, research findings, and needs of communities served by the NCORP network that will inform the subsequent research questions. To ensure programmatic success, we will engage a broad interdisciplinary group of investigators and clinicians with expertise and dedication to community oncology and the populations they serve.
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Affiliation(s)
- Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Melissa P. Beauchemin
- Columbia University School of Nursing, CUIMC Minority/Underserved NCI Community Oncology Research Program, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children and Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
| | - Aaron Sugalski
- University Health System Pediatric Blood and Cancer Center, Division Hematology/Oncology, University of Texas Health San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, Texas
| | - Julie Anna Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham
| | - Sheila J. Santacroce
- School of Nursing and Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina
| | - Jordan G. Marchak
- Emory University School of Medicine, Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta, Georgia
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Michael E. Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Roth ME, Grimes AC, Reed DR, Weiss AR, Mittal N, Parsons SK, Freyer DR. Children's Oncology Group 2023 blueprint for research: Adolescent and young adult oncology. Pediatr Blood Cancer 2023; 70 Suppl 6:e30564. [PMID: 37439574 PMCID: PMC10630986 DOI: 10.1002/pbc.30564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023]
Abstract
Over the past few decades, 5-year cancer survival has steadily improved for all adolescents and young adults (AYA, 15-39 years at diagnosis) combined. While encouraging, this progress simultaneously highlights a compelling need for improving survival in higher risk AYA subsets and for addressing health outcomes and health-related quality of life (HRQoL) among long-term survivors. The Children's Oncology Group (COG), in collaboration with the National Cancer Institute (NCI) and the adult network groups within the NCI National Clinical Trials Network (NCTN), has developed a large and growing portfolio of therapeutic AYA cancer clinical trials to identify optimal treatment approaches for common AYA cancers. Additional initiatives, led by the COG AYA Oncology Discipline Committee for increasing collaboration between the COG and the adult network groups, optimizing AYA clinical trial enrollment, and standardizing the assessment of HRQoL, have been highly successful to date. Further, NCTN-wide collaborations are currently underway focused on improving survival for AYA malignancies with poor prognosis and, through development of supportive care and care delivery trials, reducing the short- and long-term toxicity caused by cancer treatment. Leveraging the research infrastructure within the NCTN and the NCI Community Oncology Research Program, the COG will continue to champion meaningful advancements in health and survival for AYAs with cancer.
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Affiliation(s)
- Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Allison C Grimes
- Department of Pediatrics, UT Health Science Center San Antonio, San Antonio, Texas, USA
| | - Damon R Reed
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, Florida, USA
| | - Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Maine, USA
| | - Nupur Mittal
- Department of Pediatrics, Rush Medical College, Chicago, Illinois, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - David R Freyer
- Departments of Pediatrics, Medicine, and Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Beauchemin MP, Roth ME, Parsons SK. Reducing Adolescent and Young Adult Cancer Outcome Disparities Through Optimized Care Delivery: A Blueprint from the Children's Oncology Group. J Adolesc Young Adult Oncol 2023; 12:314-323. [PMID: 36716260 PMCID: PMC10282820 DOI: 10.1089/jayao.2022.0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Achieving equitable, high-quality cancer care delivery across socioeconomically and biologically diverse populations requires multilevel interventions, including those at the patient, provider, institution, and policy levels that influence cost, quality, and access to care. For adolescent and young adults (AYAs), who experience suboptimal health outcomes compared with younger and older people with cancer, cancer care delivery is influenced by additional contextual factors unique to the patients' developmental stage, psychosocial and economic status, and cancer subtype. In this review, we highlight the most pressing research needs in AYA cancer care delivery and opportunities to improve outcomes for this population.
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Affiliation(s)
- Melissa P. Beauchemin
- School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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McGee-Avila JK, Richmond J, Henry KA, Stroup AM, Tsui J. Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care. Health Serv Res 2023. [PMID: 37208901 DOI: 10.1111/1475-6773.14182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE To examine geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas. DATA SOURCES/STUDY SETTING We used data from the New Jersey State Cancer Registry from 2012 to 2014. STUDY DESIGN We examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics. DATA COLLECTION/EXTRACTION METHODS Multivariate generalized estimating equation models were used to determine factors associated with receiving cancer treatment within residential counties, residential hospital service areas, and in-state (versus out-of-state) care. PRINCIPAL FINDINGS We observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. Even after adjusting for tumor characteristics, insurance type, and other demographic factors, non-Hispanic Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients (95% CI: 2.80-8.41). Patients insured with Medicaid and those without insurance had higher likelihoods of receiving care within their residential county compared to privately insured individuals. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county (95% CI: 0.00-9.30) and were 2.7% less likely to seek out-of-state care (95% CI: -4.85 to -0.61). CONCLUSIONS Urban populations are not homogenous in their geospatial patterns of cancer care utilization, and individuals living in areas with greater social vulnerability may have limited opportunities to access care outside of their immediate residential county. Geographically tailored efforts, along with socioculturally tailored efforts, are needed to help improve equity in cancer care access.
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Affiliation(s)
| | - Jennifer Richmond
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin A Henry
- Department of Geography, Temple University, Philadelphia, Pennsylvania, USA
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health, Philadelphia, Pennsylvania, USA
| | - Antoinette M Stroup
- Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine at USC, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Quam N, Stenzel AE, Brown K, Jewett P, Parsons HM, Hui J, Ghebre RG, Blaes A, Teoh D, Vogel RI. Perception of Telehealth During the COVID-19 Pandemic Among Survivors of Gynecologic Cancer. Oncologist 2022; 27:512-515. [PMID: 35294028 PMCID: PMC9177115 DOI: 10.1093/oncolo/oyac041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Our objective was to assess gynecologic cancer survivor preferences for telehealth cancer care. Gynecologic cancer survivors participating in a prospective cohort study were invited to complete a cross-sectional survey regarding their experience with and preferences for telehealth. Of 188 participants, 48.9% had undergone a telehealth visit since March 2020, and 53.7% reported a preference for exclusively in-person visits for their cancer care and surveillance. Furthermore, 80.5% of participants were satisfied with the telehealth care they received and 54.8% would recommend telehealth services to patients with similar conditions. Most participants thought a physical examination was critical to detecting recurrence, and concern that their provider may miss something during telehealth visits was greater among those who preferred in-person visits. With many gynecologic cancer survivors preferring in-person care, building a future care model that includes telehealth elements will require adaptations, careful evaluation of patient concerns, as well as patient education on telehealth.
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Affiliation(s)
- Nicholas Quam
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Ashley E Stenzel
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Brown
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Jewett
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Helen M Parsons
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jane Hui
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Rahel G Ghebre
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Anne Blaes
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Deanna Teoh
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
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Wood EH, Leach M, Villicana G, Goldman Rosas L, Duron Y, O'Brien DG, Koontz Z, Patel MI. A Community-Engaged Process for Adapting a Proven Community Health Worker Model to Integrate Precision Cancer Care Delivery for Low-income Latinx Adults With Cancer. Health Promot Pract 2022; 24:491-501. [PMID: 35658733 DOI: 10.1177/15248399221096415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Disparities in precision cancer care delivery among low-income Latinx adults are well described. In prior work, we developed a community health worker-led goals of care and cancer symptom assessment intervention. The objective of this study was to adapt this intervention for a community setting, incorporating precision cancer care delivery. METHODS We used a two-phased systematic approach to adapt an evidence-based intervention for our community. Specifically, we used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify barriers and facilitators to precision cancer care delivery via 1-hr interviews with Latinx adults with cancer, Latinx caregivers, community leaders, primary care and oncology clinicians, and community health workers. Interviews were recorded, transcribed, and analyzed using the constant comparative method and grounded theory analysis. Phase 2 involved interviews with key community advisors using the Expert Panels Method to decide on final adaptations. RESULTS Using this community-engaged approach, we identified specific intervention adaptations to ensure precision cancer care delivery in a community setting, which included: (a) expansion of the intervention inclusion criteria and mode of delivery; (b) integration of low-literacy precision cancer care intervention activities in Spanish in collaboration with community-based organizations; (c) ensuring goals reflective of patient and community priorities. CONCLUSIONS This systematic and community-engaged approach to adapt an intervention for use in delivering precision cancer care strengthened an evidence-based approach to promote the needs and preferences of patients and key community stakeholders.
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Affiliation(s)
- Emily H Wood
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | - Manali I Patel
- Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Potiaumpai M, Doerksen SE, Chinchilli VM, Wu H, Wang L, Lintz R, Schmitz KH. Cost evaluation of an exercise oncology intervention: The exercise in all chemotherapy trial. Cancer Rep (Hoboken) 2022; 5:e1490. [PMID: 34236137 PMCID: PMC8955063 DOI: 10.1002/cnr2.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/01/2021] [Accepted: 06/22/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is strong evidence supporting the efficacy of exercise oncology programs to improve physical and psychosocial outcomes during active treatment. However, there is a paucity of evidence on the effect of exercise on healthcare utilization and cost analyzes of exercise oncology programs. AIMS Our objective was to assess the effects of a pragmatic exercise oncology program (ENACT) during active chemotherapy treatment on healthcare utilization and associated costs. METHODS We conducted post-hoc analyzes on 160 ENACT participants and 75 comparison participants matched on cancer site, stage, age range, and gender. We obtained complete healthcare utilization histories for each patient (specific to emergency department [ED] visits and hospital admissions) coinciding with their participation in ENACT. A sub-analysis was conducted for advanced stage breast, gastrointestinal, and pancreatic cancer patients. RESULTS Healthcare costs for patients who participated in the ENACT exercise oncology intervention were numerically lower than healthcare costs for the comparison group, even after accounting for the cost of the intervention. However, the differences were not statistically significant. CONCLUSION Our findings suggest that an exercise oncology program during active chemotherapy treatment are at least cost neutral for all cancer patients, including advanced stage cancers. Additional research is warranted to evaluate the potential for exercise oncology programs to reduce healthcare utilization, particularly in advanced cancer patients.
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Affiliation(s)
- Melanie Potiaumpai
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Shawna E Doerksen
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon M Chinchilli
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Hongke Wu
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Li Wang
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rachel Lintz
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kathryn H Schmitz
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Lage DE, Armstrong K. Accountable care in oncology: Where do we go from here? Cancer 2022; 128:950-952. [PMID: 34767645 PMCID: PMC9466300 DOI: 10.1002/cncr.34021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022]
Abstract
The study by Erfani et al. confirms that ACOs did not achieve the promise
of cancer care cost reduction, but leaves open important questions about the
impacts of accountable care on the quality, coordination, and equity of cancer
care delivery. While the inability of ACOs to deliver cost reductions for
patients with cancer may feel like a step backwards for accountable care in
oncology, the work of Erfani et al. actually represents an important step
forward in the field, settling the important cost question in order to open a
broader conversation on the goals of ACOs and value-based care delivery models
in oncology, the means to evaluate them in a comprehensive, patient-centered
manner, and the urgency of incorporating the needs and voices of diverse
populations in the important work of cancer care delivery reform. The study by Erfani et al. confirms that ACOs did not achieve the promise
of cancer care cost reduction, but leaves open important questions about the
impacts of accountable care on the quality, coordination, and equity of cancer
care delivery.
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Affiliation(s)
- Daniel E. Lage
- Department of Medicine, Massachusetts General Hospital,
Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA,
USA
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital,
Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA,
USA
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Abstract
PURPOSE Rural residents face higher cancer incidence rates and mortality rates, disparities that could be mitigated with health technology interventions, yet a digital divide is also apparent. This paper systematically and critically examines existing literature to understand how digital technologies have been used to support rural oncology care. METHODS PubMed, CINAHL Complete, PsycINFO, and Embase were searched using Medical Subject Headings terms and keywords. Studies were eligible if they presented empirical data investigating the use of technology in rural oncology and were published in English in a peer-reviewed journal within the last decade. The Mixed Methods Appraisal Tool was used to assess methodological quality. FINDINGS Digital health has been less extensively utilized in rural oncology compared with the general cancer population and other chronic diseases. We identified 54 studies that used technology in rural cancer care delivery, a comparatively small number, representing a significant gap in the literature. Studies were classified into 4 categories: Telemedicine (n = 32), phone calls (n = 11), Internet (n = 9), and mobile phone (n = 2). Of the 54 articles, 12 were RCTs, 17 were quasi-experimental, 3 were descriptive, 12 were mixed methods, and 10 were qualitative. Most of the studies involved patients only (n = 31) and were not specific to a cancer type (n = 41). CONCLUSIONS Further implementation and expansion of telemedicine and phone-based strategies in rural cancer care delivery are warranted. Rural cancer survivors value digital approaches to their care. However, social and behavioral determinants of health and access to technology must be considered.
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Affiliation(s)
- Bonny B Morris
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Brianna Rossi
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bernard Fuemmeler
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Kano M, Chen L, Boyce T, Gomez R, Gundelach AC, Jaffe SA, Sussman AL, Dayao ZR, Lobo J, Pestak CR, Rutledge TL. Characterizing Low-Risk Breast and Gynecological Cancer Patients for Transition into an Oncology/Primary Care Coordinated Care Model: Findings from a Survey of Diverse Survivors in a Rural U.S. State. Cancers (Basel) 2021; 13:cancers13174428. [PMID: 34503237 PMCID: PMC8431122 DOI: 10.3390/cancers13174428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 02/01/2023] Open
Abstract
We conducted a survey to characterize the key attributes of racial/ethnic and geographically diverse low-risk breast and gynecologic cancer patients. We collected data regarding patients' access to primary care (PC); compliance with screening recommendations; treatment for comorbidities; logistical barriers to clinic visits; and receipt of survivorship care documentation (SCD). Survey findings informed the development of an oncology/Primary Care Provider (PCP) care coordination intervention to improve care. We distributed a cross-sectional survey among a convenience sample of 150 cancer survivors. Responses were calculated using descriptive statistics and compared based on the distance participants traveled to their appointments at the cancer center (≤30 vs. >30 miles). Of the 150 respondents, 35% traveled >30 miles for follow-up care and 78% reported having one or more comorbid condition(s). PC utilization was high: 88% reported having a PCP, and 91% indicated ≤1 yearly follow-up visit. Participants traveling >30 miles reported higher rates of logistical challenges associated with cancer center visits compared to those traveling ≤30 miles. Nearly half of respondents (46%) had not received SCD. In conclusion, survey studies such as these allow for the systematic assessment of survivor behaviors and care utilization patterns to inform the development of care coordination interventions for diverse, low-risk cancer patients.
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Affiliation(s)
- Miria Kano
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Correspondence: ; Tel.: +1-(505)-925-1115
| | - Lu Chen
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch; Albuquerque, NM 77555, USA;
| | - Tawny Boyce
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Ricardo Gomez
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Amy C. Gundelach
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Shoshana Adler Jaffe
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Andrew L. Sussman
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Zoneddy R. Dayao
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Jolene Lobo
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Claire R. Pestak
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Teresa L. Rutledge
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA
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14
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Stover AM, Kurtzman R, Walker Bissram J, Jansen J, Carr P, Atkinson T, Ellis CT, Freeman AT, Turner K, Basch EM. Stakeholder Perceptions of Key Aspects of High-Quality Cancer Care to Assess with Patient Reported Outcome Measures: A Systematic Review. Cancers (Basel) 2021; 13:cancers13143628. [PMID: 34298841 PMCID: PMC8306432 DOI: 10.3390/cancers13143628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary We conducted a review to identify important symptoms reported by patients on questionnaires (e.g., pain) that can be used to compare cancer centers on how well they provide care. For example, cancer centers could be compared on the percentage of patients with controlled pain after adjusting for demographic and clinical characteristics. Standard review methods were used to identify studies through August 2020. Searches generated 1813 articles and 1779 were coded as not relevant. The remaining 34 studies showed that patients, caregivers, clinicians, and healthcare administrators identify psychosocial care (e.g., distress) and symptom management as critical parts of high-quality care. Patients and caregivers also perceive that maintaining physical function and daily activities are important. Clinicians and healthcare administrators perceive control of specific symptoms to be important (e.g., pain, poor sleep, diarrhea). Results were used to inform testing of symptom questionnaires to compare the quality of care provided by six cancer centers. Abstract Performance measurement is the process of collecting, analyzing, and reporting standardized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and conflicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Correspondence:
| | - Rachel Kurtzman
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC 27599, USA;
| | | | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Thomas Atkinson
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - C. Tyler Ellis
- Department of Surgery, University of Louisville Health, Louisville, KY 40202, USA;
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Ethan M. Basch
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
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15
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Abstract
The availability of advanced omics technologies has largely driven development of precision cancer medicine in the United States, but integration in routine cancer care has been challenging. Here, we consider some parameters that would enable a more coordinated, integrated, efficient, and equitable implementation of precision cancer medicine.
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16
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Dhawan N, Subbiah IM, Yeh JC, Thompson B, Hildner Z, Jawed A, Prommer E, Sinclair C. Healthcare Disparities and the COVID-19 Pandemic: Analysis of Primary Language and Translations of Visitor Policies at NCI-Designated Comprehensive Cancer Centers. J Pain Symptom Manage 2021; 61:e13-e16. [PMID: 33561493 PMCID: PMC7955247 DOI: 10.1016/j.jpainsymman.2021.01.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 12/03/2022]
Abstract
CONTEXT Coronavirus Disease 2019 (COVID-19) has caused unprecedented disruptions to cancer care, including through strict hospital visitation policies. Since a substantial proportion of the U.S. population report a non-English language as their primary language, it is critical that information is disseminated in multiple languages. OBJECTIVES To examine the availability of language translations of visitation restrictions on adult National Cancer Institute-designated comprehensive cancer centers (CCCs) Web sites. METHODS Cross-sectional analysis of visitation policies abstracted from public-facing Web sites of CCCs in June 2020. Using U.S. Census data, CCC's city and state proportions of self-identifying Hispanic/Latinx population were categorized into three cohorts: low (<10%), moderate (10%-20%), and high (>20%). RESULTS As of June 2020, all 50 CCCs published a COVID-19 visitation policy on their Web site. Of these, 33 (66%) posted policies only in English, whereas 17 (34%) included one or more non-English translations. A minority of CCCs published Spanish language resources, which did not differ based on state or city demographics: for example, only 42% (8 of 19), 10% (1 of 10), and 38% (8 of 21) of CCCs published Spanish language resources in cities with low, moderate, and high Hispanic/Latinx populations, respectively. CONCLUSION `Most CCC's did not publish non-English language translations of their visitor policies. Even in cities and states with larger Hispanic/Latinx populations, most CCCs did not publish resources in Spanish. This study highlights a key opportunity to mitigate communication barriers and deliver culturally competent, patient-centered care.
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Affiliation(s)
- Natasha Dhawan
- Department of Hematology and Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ishwaria M Subbiah
- Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Jonathan C Yeh
- Section of Palliative Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Zachary Hildner
- Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Areeba Jawed
- Department of Medicine, Division of Nephrology and Supportive Care, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eric Prommer
- UCLA/VA Hospice and Palliative Medicine Program, UCLA School of Medicine, Los Angeles, California, USA
| | - Christian Sinclair
- Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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17
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Cinar P, Bold R, Bosslet BA, Bota DA, Burgess D, Chew HK, Cohen JG, Elquza E, Gold KA, Kamiya E, Karlan BY, McKay RR, Patel SP, Ternavan K, Welborn J, Yamamoto M, Rugo HS. Planning for post-pandemic cancer care delivery: Recovery or opportunity for redesign? CA Cancer J Clin 2021; 71:34-46. [PMID: 32997807 PMCID: PMC7537198 DOI: 10.3322/caac.21644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/02/2023] Open
Abstract
The delivery of cancer care has never changed as rapidly and dramatically as we have seen with the coronavirus disease 2019 (COVID-19) pandemic. During the early phase of the pandemic, recommendations for the management of oncology patients issued by various professional societies and government agencies did not recognize the significant regional differences in the impact of the pandemic. California initially experienced lower than expected numbers of cases, and the health care system did not experience the same degree of the burden that had been the case in other parts of the country. In light of promising trends in COVID-19 infections and mortality in California, by late April 2020, discussions were initiated for a phased recovery of full-scale cancer services. However, by July 2020, a surge of cases was reported across the nation, including in California. In this review, the authors share the response and recovery planning experience of the University of California (UC) Cancer Consortium in an effort to provide guidance to oncology practices. The UC Cancer Consortium was established in 2017 to bring together 5 UC Comprehensive Cancer Centers: UC Davis Comprehensive Cancer Center, UC Los Angeles Jonsson Comprehensive Cancer Center, UC Irvine Chao Family Comprehensive Cancer Center, UC San Diego Moores Cancer Center, and the UC San Francisco Helen Diller Family Comprehensive Cancer Center. The interventions implemented in each of these cancer centers are highlighted, with a focus on opportunities for a redesign in care delivery models. The authors propose that their experiences gained during this pandemic will enhance pre-pandemic cancer care delivery.
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Affiliation(s)
- Pelin Cinar
- Division of Medical OncologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
- University of California San Francisco Helen Diller Family Comprehensive Cancer CenterSan FranciscoCalifornia
| | - Richard Bold
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Bryn A. Bosslet
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
| | - Daniela A. Bota
- University of California Irvine Chao Family Comprehensive Cancer CenterOrangeCalifornia
| | - Debra Burgess
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Helen K. Chew
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Joshua G. Cohen
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCalifornia
- University of California Los Angeles Jonsson Comprehensive Cancer CenterLos AngelesCalifornia
| | - Emad Elquza
- University of California Irvine Chao Family Comprehensive Cancer CenterOrangeCalifornia
| | - Kathryn A. Gold
- University of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | - Emi Kamiya
- University of California HealthLos AngelesCalifornia
| | - Beth Y. Karlan
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCalifornia
- University of California Los Angeles Jonsson Comprehensive Cancer CenterLos AngelesCalifornia
| | - Rana R. McKay
- University of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | - Sandip P. Patel
- University of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | | | - Jeanna Welborn
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Maki Yamamoto
- University of California Irvine Chao Family Comprehensive Cancer CenterOrangeCalifornia
| | - Hope S. Rugo
- Division of Medical OncologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
- University of California San Francisco Helen Diller Family Comprehensive Cancer CenterSan FranciscoCalifornia
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18
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Pathak S, Narurkar R, Khan MH, Jiang B, Soe MNC, Hwang C, Muppidi M, Aronow WS. Continuing cancer care delivery during the peak of COVID-19 in the Bronx, New York: experience from a public teaching hospital. Arch Med Sci 2021; 17:1109-1113. [PMID: 34336039 PMCID: PMC8314406 DOI: 10.5114/aoms/136299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION We report our experience with cancer care delivery during the peak of COVID-19 pandemic in New York City. METHODS Retrospective analysis of the patients treated from the 1st of March, 2020 to the 8th of May, 2020. RESULTS Team huddles, infection screening and patient selection strategies were implemented. One hundred and seventy patients were treated in 576 visits. Six developed severe COVID-19 requiring hospitalization, two died. Their median Charlson Comorbidity Index was 9, higher than the rest of the cohort. CONCLUSIONS Cancer care delivery is safe and feasible using an approach focused on careful patient selection, team communication and infection control.
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Affiliation(s)
- Surabhi Pathak
- Division of Hematology-Oncology, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - Roshni Narurkar
- Division of Hematology-Oncology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Mohammed Hasan Khan
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Bei Jiang
- Department of Internal Medicine, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - May Nyein Chann Soe
- Department of Internal Medicine, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - Caroline Hwang
- Division of Hematology-Oncology, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - Monica Muppidi
- Division of Hematology-Oncology, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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19
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Schmitz KH, Potiaumpai M, Schleicher EA, Wolf LJ, Doerksen SE, Drabick JJ, Yee NS, Truica CI, Mohamed AA, Shaw BW, Farley DC. The exercise in all chemotherapy trial. Cancer 2020; 127:1507-1516. [PMID: 33332587 DOI: 10.1002/cncr.33390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/29/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiple international organizations have called for exercise to become standard practice in the setting of oncology care. The feasibility of integrating exercise within systemic chemotherapy has not been investigated. METHODS Patients slated to receive infusion therapy between April 2017 and October 2018 were screened for possible inclusion. The study goal was to establish the acceptability and feasibility of embedding an exercise professional into the chemotherapy infusion suite as a method of making exercise a standard part of cancer care. The exercise prescriptions provided to patients were individualized according to results of brief baseline functional testing. RESULTS In all, 544 patients were screened, and their respective treating oncologists deemed 83% of them to be medically eligible to participate. After further eligibility screening, 226 patients were approached. Nearly 71% of these patients (n = 160) accepted the invitation to participate in the Exercise in All Chemotherapy trial. Feasibility was established because 71%, 55%, 69%, and 63% of the aerobic, resistance, balance, and flexibility exercises prescribed to patients were completed. Qualitative data also supported the acceptability and feasibility of the intervention from the perspective of patients and clinicians. The per-patient cost of the intervention was $190.68 to $382.40. CONCLUSIONS Embedding an exercise professional into the chemotherapy infusion suite is an acceptable and feasible approach to making exercise standard practice. Moreover, the cost of the intervention is lower than the cost of other common community programs. Future studies should test whether colocating an exercise professional with infusion therapy could reach more patients in comparison with not colocating. LAY SUMMARY Few studies have tested the implementation of exercise for patients with cancer by embedding an exercise professional directly into the chemotherapy infusion suite. The Exercise in All Chemotherapy trial shows that this approach is both acceptable and feasible from the perspective of clinicians and patients.
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Affiliation(s)
- Kathryn H Schmitz
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Melanie Potiaumpai
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Erica A Schleicher
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Laura J Wolf
- Center for Health Care and Policy Research, Penn State University, University Park, Pennsylvania
| | - Shawna E Doerksen
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joseph J Drabick
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Nelson S Yee
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Cristina I Truica
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ali A Mohamed
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Bethany W Shaw
- Center for Health Care and Policy Research, Penn State University, University Park, Pennsylvania
| | - Diane C Farley
- Center for Health Care and Policy Research, Penn State University, University Park, Pennsylvania
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20
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Kent EE, Wheldon CW, Smith AW, Srinivasan S, Geiger AM. Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review. Cancer 2019. [PMID: 31593319 DOI: 10.1002/cncr.32388:10.1002/cncr.32388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.
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Affiliation(s)
- Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.,ICF, Inc, Fairfax, Virginia
| | - Christopher W Wheldon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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21
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Kent EE, Wheldon CW, Smith AW, Srinivasan S, Geiger AM. Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review. Cancer 2019; 125:4371-4379. [PMID: 31593319 DOI: 10.1002/cncr.32388] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/07/2022]
Abstract
Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.
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Affiliation(s)
- Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
- ICF, Inc, Fairfax, Virginia
| | - Christopher W Wheldon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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22
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Tomasone JR, Vukmirovic M, Brouwers MC, Grunfeld E, Urquhart R, O'Brien MA, Walker M, Webster F, Fitch M. Challenges and insights in implementing coordinated care between oncology and primary care providers: a Canadian perspective. ACTA ACUST UNITED AC 2017; 24:120-123. [PMID: 28490926 DOI: 10.3747/co.24.3426] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We report here on the current state of cancer care coordination in Canada and discuss challenges and insights with respect to the implementation of collaborative models of care. We also make recommendations for future research. This work is based on the findings of the Canadian Team to Improve Community-Based Cancer Care Along the Continuum (canimpact) casebook project. The casebook project identified models of collaborative cancer care by systematically documenting and analyzing Canadian initiatives that aim to improve or enhance care coordination between primary care providers and oncology specialists. The casebook profiles 24 initiatives, most of which focus on breast or colorectal cancer and target survivorship or follow-up care. Current key challenges in cancer care coordination are associated with establishing program support, engaging primary care providers in the provision of care, clearly defining provider roles and responsibilities, and establishing effective project or program planning and evaluation. Researchers studying coordinated models of cancer care should focus on designing knowledge translation strategies with updated and refined governance and on establishing appropriate protocols for both implementation and evaluation.
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Affiliation(s)
- J R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON
| | - M Vukmirovic
- Department of Oncology, McMaster University and the Escarpment Cancer Research Institute, Hamilton, ON
| | - M C Brouwers
- Department of Oncology, McMaster University and the Escarpment Cancer Research Institute, Hamilton, ON
| | - E Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - R Urquhart
- Department of Surgery, Dalhousie University, Halifax, NS
| | - M A O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - M Walker
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON
| | - F Webster
- Department of Family and Community Medicine, University of Toronto, Toronto, ON.,Institute of Health Policy Management and Evaluation, Toronto, ON
| | - M Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
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23
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Klabunde CN, Haggstrom D, Kahn KL, Gray SW, Kim B, Liu B, Eisenstein J, Keating NL. Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28070939 DOI: 10.1111/ecc.12628] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 12/01/2022]
Abstract
Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment.
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Affiliation(s)
- C N Klabunde
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - D Haggstrom
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K L Kahn
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
| | - S W Gray
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - B Kim
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - B Liu
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - J Eisenstein
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - N L Keating
- Department of Health Care Policy, Harvard Medical School and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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24
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Kahn JM, Athale UH, Clavell LA, Cole PD, Leclerc JM, Laverdiere C, Michon B, Schorin MA, Welch JJG, Sallan SE, Silverman LB, Kelly KM. How Variable Is Our Delivery of Information? Approaches to Patient Education About Oral Chemotherapy in the Pediatric Oncology Clinic. J Pediatr Health Care 2017; 31:e1-e6. [PMID: 27461368 PMCID: PMC5154954 DOI: 10.1016/j.pedhc.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/29/2022]
Abstract
In pediatric patients with acute lymphoblastic leukemia, adherence to oral chemotherapy relies largely on a parent's comprehension of the drug's indication and administration guidelines. We assessed how pediatric oncology providers educate families about oral chemotherapy. We conducted a cross-sectional survey of 68 physicians and nurses from 9 institutions in the Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium. The inter-individual approach to patient education is variable and may consist of handouts, treatment calendars, and discussions. The extent of teaching often varies depending on a provider's subjective assessment of a family's needs. Twenty-five percent of providers suggested standardizing patient teaching. When developing educational models, care teams should consider approaches that (a) objectively identify families in need of extensive teaching, (b) designate allotted teaching time by nursing staff during clinic visits, and (c) maintain the variation and dynamism that informs a successful provider-patient relationship.
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25
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Temkin SM, Tanner EJ, Dewdney SB, Minasian LM. Reducing Overtreatment in Gynecologic Oncology: The Case for Less in Endometrial and Ovarian Cancer. Front Oncol 2016; 6:118. [PMID: 27242958 PMCID: PMC4860790 DOI: 10.3389/fonc.2016.00118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023] Open
Abstract
A growing awareness of the harms of overtreatment in cancer care has reached physicians, patients, health policy makers, and medical researchers. Overtreatment exposes patients to the risk of adverse events from procedures or medications that were not necessary. This review examines common practices in gynecologic malignancies that are unlikely to produce direct benefit to patients with these malignancies, but are likely to produce harms. Specifically, we will explore the utility of lymphadenectomy and adjuvant radiation for women with early-stage endometrial cancer; and screening for recurrence and continuous chemotherapy for advanced-stage ovarian cancer patients.
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Affiliation(s)
- Sarah M Temkin
- The Division of Cancer Prevention, The National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Edward J Tanner
- The Kelly Gynecologic Oncology Service, Johns Hopkins School of Medicine , Baltimore, MD , USA
| | - Summer B Dewdney
- Division of Gynecologic Oncology, Rush University School of Medicine , Chicago, IL , USA
| | - Lori M Minasian
- The Division of Cancer Prevention, The National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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26
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Abstract
The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force, and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high-quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and the application in clinical practice. Implementation research strives to address this gap. In this review, we discuss key components of high-quality implementation research. We then apply these concepts to a current cancer care delivery challenge in women's health, specifically the implementation of a surgery decision aid for women newly diagnosed with breast cancer.
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Affiliation(s)
- Taiwo Adesoye
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Caprice C. Greenberg
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Heather B. Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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