scholarly journals 01 Adolescent and Young Adult Central Nervous System Tumour Survivors: Documentation of late-effects risks and screening recommendations in British Columbia, Canada

2018 ◽  
Vol 45 (S3) ◽  
pp. S1-S1
Author(s):  
A. Fuchsia Howard ◽  
Jordan Tran ◽  
Avril Ullett ◽  
Michael McKenzie ◽  
Karen Goddard
Keyword(s):  
Primary Care ◽  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Young Adult ◽  
Late Effects ◽  
Medical Records ◽  
Primary Care Providers ◽  
Adolescent And Young Adult ◽  
Care Providers

Survivors of adolescent and young adult (AYA) central nervous system (CNS) neoplasms are at risk for late effects (LE) - treatment-related health problems occurring more than 5 years after therapy). Since, in Canada, AYA survivors are usually followed in the community, information must be conveyed to primary care providers to guide risk-based follow-up care. Objective: To assess documentation of LE risks and screening recommendations (SR) in medical records of AYA CNS tumor survivors treated with radiation therapy. Methods: The medical records of all patients diagnosed with a CNS neoplasm (benign or malignant) at ages 15-39 years, treated between 1985 and 2010 in the province of British Columbia, surviving >5 years and discharged to the community were assessed. Documentation of LE and SR were extracted, and analyzed descriptively. Results: Among 132 survivors (52% female), treated with radiation therapy (95% partial brain, 10% craniospinal, 8% partial spine, and 4% whole brain) and chemotherapy (17%), 19% of charts included no documentation of LE risks, 26% included only non-specific documentation, and 55% had minimal documentation (1 or 2 LE). Documentation of at least one specific LE increased from 24% in 1980-1989, to 54% in 1990-1999, to 86% in 2000 – 2010. Based on treatment information, all survivors were at high-risk for LE, such as radiation induced neoplasm, meningioma and cerebrovascular events. Yet, SR were documented in only 25% of charts. Conclusions: The documentation of LE risks and screening recommendations has been limited, highlighting the need to improve written communication with primary care providers.

Factors associated with delays in diagnosis of pediatric, adolescent and young adult patients with central nervous system tumors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13532-e13532
Author(s):  
Diane Marie Puccetti ◽  
Lena Winestone ◽  
Jeffrey McPheeters ◽  
Jennifer Jill Wilkes ◽  
Henry J. Henk ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Young Adult ◽  
Adolescent And Young Adult ◽  
Urgent Care ◽  
Cns Tumors ◽  
Cancer Symptoms ◽  
Delay In Diagnosis ◽  
Factors Associated ◽  
Delays In Diagnosis

e13532 Background: Central Nervous System (CNS) tumors are the most common solid tumor in children and have the highest mortality. Delays in diagnosis (Dx) may lead to reduced survival. We identify factors associated with delays in Dx in pediatric, adolescent and young adult (AYA) patients with CNS tumors. Methods: A retrospective cohort from the OptumLabs Data Warehouse, which includes claims data for privately insured enrollees in a large US health plan, was identified. Patients diagnosed with CNS tumors between 2001-17 continuously enrolled 6 months prior to diagnosis (Dx) were included. The onset of cancer symptoms was identified by the date of the first encounter associated with cancer symptoms. Time to Dx was calculated as the days between cancer symptom onset and Dx date. The likelihood of presenting with symptoms and the time to Dx (among those with symptoms) was modeled using logistic regression and included sociodemographic and clinical factors. A delay in Dx was defined as > 3 months after a symptom. Results: We identified 6,627 eligible patients, 5,637 (85%) of whom presented with symptoms prior to Dx. Likelihood of a delay appears greatest in those first presenting to a specialist (OR 1.28 vs PCP; P = .24 ) but lowest in those presenting to Urgent care/ER (OR .56 vs PCP; P < 0.001) and was greatest among children < 5 years of age were more likely to present with a symptom (table). However, among those with a symptom, children < 5 had the longest time to Dx (Median 122 days). Males were less likely to present with a symptom prior to Dx (OR .80, P = 0.040) and when experiencing a symptom they experienced shorter time to Dx compared to females (Median 85 vs 110 days). Race, income, and census region were not significant predictors of either likelihood of presenting with symptoms or delay in time to Dx. Conclusions: This study indicates that young children < 5 years had a longer delay in diagnosis compared to older patients. [Table: see text]

Barriers to caring for survivors of childhood cancer: Primary care providers’ and oncologists’ perspectives.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19194-e19194
Author(s):  
Aminat Adewumi ◽  
Cynthia Gerhardt ◽  
Randal S. Olshefski ◽  
Micah Skeens
Keyword(s):  
Primary Care ◽  
Childhood Cancer ◽  
Late Effects ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Paper Copy ◽  
Primary Care Providers ◽  
Comfort Level ◽  
Care Providers ◽  
Survivors Of Childhood Cancer

e19194 Background: Advances in treatment have resulted in a growing population of childhood cancer survivors. As most survivors will develop at least one late effect from treatment, it is important to continue to monitor their health. The incidence of late effects increases with age and often are not clinically apparent until decades after cancer treatment. The Institute of Medicine has recommended models of care delivery that include collaboration between oncologists and primary care physicians (PCP). Thus, we explored PCP and pediatric oncologists’ perceptions and experiences with survivors of childhood cancer in primary care. Methods: Recruitment of primary care physicians occurred utilizing the state Board of Medicine listings. A link and a paper copy of the survey were supplied via mail to approximately 3,000 pediatricians. Pediatric oncologists from a large Midwestern hospital completed the survey via email. Results: A total of 197 participants (19 oncologists/ 178 PCPs) completed the survey. The response rate was 95% for oncologists and 6% for PCPs. Although most PCPs (76%, n=134) had cared for a childhood cancer survivor, some respondents (16%, n=8) reported an unwillingness to care for a survivor. Using a ten-point scale, PCPs mean comfort level in caring for survivors of pediatric cancer was 5.78 ( SD= 2.37). PCPs identified the following barriers: limited knowledge of late effects (64%; n=114), lack of communication with oncologist (47%; n=83), and comfort level (38%; n=67). Nearly all oncologists (86%, n=19) reported referring patients to PCPs. Oncologists typically (83%, n=15) referred patients within the first year after treatment. Overall, oncologists were comfortable referring survivors to a PCP ( M=7.5; SD=1.97) and over half were satisfied with the PCP’s care of survivors (57%, n=12). Years in practice and sex of the oncologist were unrelated to comfort level referring to PCP. Conclusions: Barriers faced by PCPs in caring for survivors illustrate a need for increased education and communication between PCPs and oncologists. Attention to these concerns may improve follow-up care and comfort in the referral process.

scholarly journals The effect of a Housing First intervention on primary care retention among homeless individuals with mental illness

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246859
Author(s):  
Adam Whisler ◽  
Naheed Dosani ◽  
Matthew J. To ◽  
Kristen O’Brien ◽  
Samantha Young ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Care Provider ◽  
Primary Care Provider ◽  
Medical Records ◽  
Primary Care Providers ◽  
Retention Rates ◽  
Housing First ◽  
Care Providers ◽  
Treatment As Usual

Background Primary care retention, defined as ongoing periodic contact with a consistent primary care provider, is beneficial for people with serious chronic illnesses. This study examined the effect of a Housing First intervention on primary care retention among homeless individuals with mental illness. Methods Two hundred individuals enrolled in the Toronto site of the At Home Project and randomized to Housing First or Treatment As Usual were studied. Medical records were reviewed to determine if participants were retained in primary care, defined as having at least one visit with the same primary care provider in each of two consecutive six-month periods during the 12 month period preceding and following randomization. Results Medical records were obtained for 47 individuals randomized to Housing First and 40 individuals randomized to Treatment As Usual. During the one year period following randomization, the proportion of Housing First and Treatment As Usual participants retained in primary care was not significantly different (38.3% vs. 47.5%, p = 0.39). The change in primary care retention rates from the year preceding randomization to the year following randomization was +10.6% in the Housing First group and -5.0% in the Treatment As Usual group. Conclusion Among homeless individuals with mental illness, Housing First did not significantly affect primary care retention over the follow-up period. These findings suggest Housing First interventions may need to place greater emphasis on connecting clients with primary care providers.

scholarly journals Body mass index and waist circumference documentation in Canadian primary care electronic medical records

2020 ◽  
Author(s):  
Cliff Lindeman ◽  
Allyson Jones ◽  
Michael Cummings ◽  
Anh N. Q. Pham ◽  
PhD Carla RD ◽  
...  
Keyword(s):  
Primary Care ◽  
Body Mass Index ◽  
Waist Circumference ◽  
Electronic Medical Records ◽  
Body Mass ◽  
Medical Records ◽  
Primary Care Providers ◽  
Research Database ◽  
Care Providers ◽  
Surveillance Network

Abstract Background: Electronic medical records (EMR) are commonly used in primary care to document patient measurements including height and weight that are then used to produce body mass index (BMI) scores. However, little is known about the proportion of waist circumference (WC) documentation compared to BMI and the characteristics of patients with these measures. This study used a pan-Canadian research database, sourced from primary care EMRs, to describe BMI and WC documentation in primary care. Methods: A retrospective cohort design of primary care providers participating in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), this study presented descriptive, observational findings of EMR inputs. Frequencies and percentages of median BMI and WC documentation in CPCSSN EMRs and patient demographic characteristics are compared. Results: Of 707,819 Canadian patients aged of 40 or older, at least one BMI input was recorded for 58.6% and 11.5% had WC notations. The majority of patients (98.1%) with at least one WC measurement also had a BMI measurement while conversely 19.2% of patients with at least one BMI measurement also had a WC measurement. The most common median BMI category was overweight (36.9%) and median WC was 95.0 centimetres (IQR = 21.5).Conclusions: This study reports the documentation of obesity and overweight in select Canadian primary care EMRs infrequently recorded WC when compared to BMI. Future studies should examine the frequency and categories of anthropometric measurements in people with commonly managed chronic conditions and whether BMI and WC inputs are missing at random. Trial registration: Not applicable for this study.

Survivorship workshop delivery to primary care providers.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 2-2
Author(s):  
Genevieve Chaput ◽  
Kristin Hendricks ◽  
Vinita D'Souza ◽  
Sarah Khan ◽  
Laura Naismith
Keyword(s):  
Primary Care ◽  
Late Effects ◽  
Cardiovascular Health ◽  
Care Delivery ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Data Ethics ◽  
Integral Role ◽  
Specific Outcome

2 Background: There are approximately 15 million cancer survivors (CS) in North America. In addition to higher risk of recurrence, over 50% of CS are afflicted with late effects. CS are burdened with more medical conditions than the general population. CS visit specialists during treatment, and 75% of them also see their primary care provider (PCP) during and after treatments. Despite their integral role in survivorship care, PCP lack survivorship knowledge and have low confidence regarding CS care, supporting the urgent need to educate them about CS issues and surveillance needs. This study aimed to assess the educational benefit of a survivorship workshop targeting PCP in Montreal, Canada. Methods: An accredited workshop based on NCCN’s 8 common survivor issues was developed and delivered to 155 PCP at 5 sites. Matched pre and post surveys were designed using Likert scale and short-answer questions, and were completed on a voluntary basis by PCP. Specific outcome measures were based on the first 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behaviour. Data analysis included an open-coding approach to identify major themes of qualitative data. Ethics approval was granted. Results: Response rate was 64%. 95% indicated high satisfaction and relevancy of content for primary care. Using t-tests to compare pre and post responses, results were statistically significant for both “list 2 standards of survivorship” and “name 2 late-effects of cancer treatment” survey items, indicating an increase in both standards and late effects identified post workshop. 99% expressed behavioural intent to incorporate survivorship information into practice. Conclusions: Much research has focused on identifying PCP barriers to optimal survivorship care delivery such as limited topic proficiency, yet further efforts are warranted to close that knowledge gap. Our findings revealed increased knowledge of CS issues and surveillance needs post workshop. 3 months survey data is being collected to evaluate for actual practice changes and willingness to manage specific CS issues (i.e. treating depression). A second workshop targeting cardiovascular health promotion interventions has been created: delivery is anticipated early 2016.

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