scholarly journals Follow-Up Care for Breast and Colorectal Cancer Across the Globe: Survey Findings From 27 Countries

2020 ◽  
pp. 1394-1411 ◽  
Author(s):  
Michelle A. Mollica ◽  
Deborah K. Mayer ◽  
Kevin C. Oeffinger ◽  
Youngmee Kim ◽  
Susan S. Buckenmaier ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Survivorship Care ◽  
Middle Income ◽  
Control Plan ◽  
Middle Income Countries ◽  
Study Results ◽  
Follow Up Care

PURPOSE The purpose of this study was to describe follow-up care for breast and colorectal cancer survivors in countries with varying levels of resources and highlight challenges regarding posttreatment survivorship care. METHODS We surveyed one key stakeholder from each of 27 countries with expertise in survivorship care on questions including the components/structure of follow-up care, delivery of treatment summaries and survivorship care plans, and involvement of primary care in survivorship. Descriptive analyses were performed to characterize results across countries and variations between the WHO income categories (low, middle, high). We also performed a qualitative content analysis of narratives related to survivorship care challenges to identify major themes. RESULTS Seven low- or /lower-middle-income countries (LIC/LMIC), seven upper-middle-income countries (UMIC), and 13 high-income countries (HICs) were included in this study. Results indicate that 44.4% of countries with a National Cancer Control Plan currently address survivorship care. Additional findings indicate that HICs use guidelines more often than those in LICs/LMICs and UMICs. There was great variation among countries regardless of income level. Common challenges include issues with workforce, communication and care coordination, distance/transportation issues, psychosocial support, and lack of focus on follow-up care. CONCLUSION This information can guide researchers, providers, and policy makers in efforts to improve the quality of survivorship care on a national and global basis. As the number of cancer survivors increases globally, countries will need to prioritize their long-term needs. Future efforts should focus on efforts to bridge oncology and primary care, building international partnerships, and implementation of guidelines.

Patient preferences for cancer survivorship care: Results of an online survey.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12064-12064
Author(s):  
Deanna J. Attai ◽  
Matthew S. Katz ◽  
Elani Streja ◽  
Jui-Ting Hsiung ◽  
Beverly A Zavaleta ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Patient Preferences ◽  
Early Stage ◽  
Cancer Type ◽  
Survivorship Care ◽  
Follow Up Care ◽  
History Of

12064 Background: Nearly 17 million cancer survivors live in the United States. Workforce shortages are projected to diminish the number of available medical oncologists (MOs) to care for newly diagnosed patients with cancer and for the growing number of cancer survivors. Models of survivorship care include oncologist-led, primary care-led, and shared care approaches. Recent proposals recommend a risk-stratified approach to care, guided by individual and cancer-specific factors, but there is little evidence regarding patient preferences for non-oncologist survivorship care. Methods: We developed a survey in partnership with patient advocates. The primary endpoints were patient-reported comfort with survivorship care by a primary care provider (PCP) or in a dedicated survivorship clinic. We distributed the survey to online, cancer-specific patient communities from June to August 2020. Logistic regression analyses were adjusted for patient age, race and ethnicity, insurance, and cancer type and stage. Results: Of 1166 responses, 975 surveys were complete and available for analysis. Respondents were primarily women (91%), white (92%), and US residents (73%); 78% had a college or graduate degree. Two-thirds had private insurance. Thirty-six different cancer types were reported; 61% of respondents had breast cancer, and 25% were treated for more than one type of cancer. Most respondents (83%) had nonmetastatic disease, 74% reported experiencing late effects of cancer therapy, and almost all (93%) had a PCP. Only 21% of respondents were comfortable seeing a PCP (versus MO) for survivorship care, including cancer follow-up, side effect management, and monitoring for recurrence or progression. About half (55%) were comfortable with follow-up in a survivorship clinic instead of with their MO. Multivariable analyses showed no significant associations between age, race or ethnicity, insurance, cancer type, or stage at diagnosis and comfort with follow-up care from a PCP or in a survivorship clinic. In analyses restricted to the 439 respondents with a history of early-stage breast cancer, the 239 (54%) who were within 1 to 5 years of diagnosis were less comfortable with PCP versus MO follow-up, compared with the 52 (12%) who were > 15 years from diagnosis (OR 0.40; 95% CI 0.20–0.75; p= 0.004). In this sub-analysis, time from diagnosis was not associated with comfort being seen in a survivorship clinic. Conclusions: In our study, most patients with a history of cancer were not comfortable receiving follow-up care from their PCP. It is often recommended that survivors of early-stage breast cancer transition to primary care for follow-up and surveillance, but our study revealed comfort with this approach only many years after diagnosis. While both PCP survivorship training and patient confidence in PCP follow up is needed, preferences of cancer survivors should be considered in designing new models of survivorship care.

scholarly journals Factors Associated with Meeting the Psychosocial Needs of Cancer Survivors in Nova Scotia, Canada

2020 ◽  
Vol 28 (1) ◽  
pp. 13-25
Author(s):  
Soleil Chahine ◽  
Gordon Walsh ◽  
Robin Urquhart
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Cancer Survivors ◽  
Sociodemographic Factors ◽  
Patient Navigator ◽  
Care Providers ◽  
Psychosocial Needs ◽  
Factors Associated ◽  
Follow Up Care

Purpose: The purpose of this study is to describe the psychosocial needs of cancer survivors and examine whether sociodemographic factors and health care providers accessed are associated with needs being met. Methods: All Nova Scotia survivors meeting specific inclusion and exclusion criteria are identified from the Nova Scotia Cancer Registry and sent an 83-item survey to assess psychosocial concerns and whether and how their needs were met. Descriptive statistics (frequencies, percentages) and Chi-square analyses are used to examine associations between sociodemographic and provider factors and outcomes. Results: Anxiety and fear of recurrence, depression, and changes in sexual intimacy are major areas of concern for survivors. Various sociodemographic factors, such as immigration status, education, employment, and internet use, are associated with reported psychosocial health and having one’s needs met. Having both a specialist and primary care provider in charge of follow-up care is associated with a significantly (p < 0.05) higher degree of psychosocial and informational needs met compared to only one physician or no follow-up physician in charge. Accessing a patient navigator also is significantly associated with a higher degree of needs met. Conclusions: Our study identifies the most prevalent psychosocial needs of cancer survivors and the factors associated with having a higher degree of needs met, including certain sociodemographic factors, follow-up care by both a primary care practitioner and specialist, and accessing a patient navigator.

A Decision Support System (DSS) for Colorectal Cancer Follow-Up Program via a Semantic Framework

2015 ◽  
Vol 10 (1) ◽  
pp. 17-38 ◽  
Author(s):  
Kalpdrum Passi ◽  
Hongtao Zhao
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Decision Support ◽  
Cancer Patients ◽  
Support System ◽  
Web Application ◽  
Semantic Framework ◽  
Follow Up Care ◽  
The Web

This paper offers insights into evolving a decision support system (DSS) to aid primary care physicians and/or nurses in the post-surgical care of patients with Colorectal Cancer in a clinical setting. Presently, the oncologists in the cancer center, who are familiar with the Clinical Practice Guidelines (CPGs), are primarily responsible for the provision of follow-up care to their patients on the basis of the CPGs; in contrast, the attending primary care physician and/or nurse assisting the oncologist may be unfamiliar with these guidelines. These caregivers would, therefore, either require hardcopies of the CPGs or can be aided via a DSS for them to be able to provide the appropriate follow-up care for the respective cancer patients. Clearly, the Colorectal Cancer follow-up CPGs have to be analyzed and the ontology representing the knowledge embedded in the guidelines designed prior to realizing such a DSS. The designed ontology is often coded into Web Ontology Language (OWL) as a standard ontology that can be accessed through the Web. The authors' research team designed and presented the semantic framework of the web application, using the designed ontology that combines the current Web technology with database storage to achieve a unified development of the DSS. The authors also designed a user-friendly interface of the Web application to provide medical practitioners the functionality of the CPGs and the flexibility to customize the desired follow-up care schedule. The resulting DSS provides the physicians with follow-up program for the Colorectal Cancer patients based on the CPGs. The system was built using the semantic framework for the follow-up program and queries on the system are executed through SPARQL query engine.

scholarly journals Population-Based Longitudinal Study of Follow-Up Care for Patients With Colorectal Cancer in Nova Scotia

2012 ◽  
Vol 8 (4) ◽  
pp. 246-252 ◽  
Author(s):  
Robin Urquhart ◽  
Amy Folkes ◽  
Geoffrey Porter ◽  
Cynthia Kendell ◽  
Martha Cox ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Longitudinal Study ◽  
Nova Scotia ◽  
Continuity Of Care ◽  
Guideline Adherence ◽  
Population Based ◽  
Follow Up Care

Transitioning routine follow-up to primary care could potentially increase guideline adherence by improving access to and continuity of care.

Improving service delivery to cancer survivors in primary care settings project.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 52-52
Author(s):  
Lewis E. Foxhall
Keyword(s):  
Primary Care ◽  
Colon Cancer ◽  
Cancer Survivors ◽  
Care Management ◽  
Survivorship Care ◽  
Behavioral Counseling ◽  
Colon Cancers ◽  
Screening And Prevention

52 Background: An estimated 14 million cancer survivors live in the U.S., with up to 18 million expected by 2020. Methods: We established a partnership with three Texas family medicine training programs to provide interactive educational sessions focused on survivors’ needs for primary prevention and lifestyle counseling, surveillance and screening, and prevention of psychosocial and long-term effects. Surveys assessing resident and PCP knowledge, self-efficacy, and practices regarding survivorship care management were administered through REDCap in July 2016 and 2017. Results: Baseline response rates were 64% (60/94) and 59% (55/93) at follow-up. Compared to baseline, providers at follow-up were significantly more likely to report being “very confident” in their knowledge about: appropriate surveillance to detect recurrent breast cancer (5% vs 24%; p = 0.01); long-term physical effects of colon cancer and its treatment (8% vs 18%; p = 0.04); potential adverse psychosocial outcomes of colon cancer treatment (24% vs 44%; p = 0.01); appropriate screening for new primary breast (29% vs 61%; p < 0.001) and colon cancers (27% vs 51%; p = 0.01); and preventive lifestyle/behavioral counseling for breast (39% vs 59%; p = 0.03) and colon cancers (37% vs 59%; p = 0.01). Participants were also more likely to “strongly agree” that they have the skills necessary to: provide follow-up care related to the colon cancer and its treatment (10% vs 28%; p = 0.02); initiate appropriate screening for other new primary cancers for breast (28% vs 56%; p < 0.01) and colon cancer survivors (28% vs 58%; p < 0.01); and conduct lifestyle/behavioral counseling to prevent cancer for breast (33% vs 53%; p = 0.03) and colon cancer survivors (34% vs 55%; p = 0.02). Conclusions: Preliminary results suggest our project has improved provider knowledge, self-efficacy, and practices regarding survivorship care management, with the highest levels in areas pertaining to screening and prevention. We aim to continue this trajectory of improvement in subsequent project years and disseminate the project to other primary care training sites in Texas and beyond.

Variations in recommended surveillance in colorectal cancer survivorship care plans.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 13-13
Author(s):  
Alaina Chodoff ◽  
Katherine Clegg Smith ◽  
Aishwarya Shukla ◽  
Amanda L. Blackford ◽  
Nita Ahuja ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Risk ◽  
Controlled Trial ◽  
Center Frequency ◽  
Cancer Center ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans ◽  
Follow Up Care

13 Background: Survivorship care plans (SCPs) outline pertinent information about a cancer survivor’s treatment and follow-up care. We describe the content of colorectal cancer (CRC) SCPs, completed as part of a randomized controlled trial of SCPs, and evaluate whether follow-up recommendations are guideline concordant. Methods: We analyzed 74 CRC SCPs from an academic and community cancer center. Frequency distributions and descriptive statistics were calculated for the entire cohort and separately by recruiting site. Follow-up recommendations were compared to American Cancer Society (ACS), American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines (Table). Results: Content routinely provided in SCPs (>80%) included patient demographics, cancer diagnosis, treatment details (surgery, chemotherapy, radiation therapy) as well as treatment-related side effects. SCP content specified less frequently included cancer stage, cancer risk (predisposing conditions), and recommendations for genetic counseling/testing and health promotion. Nearly all SCPs from the community site provided uniform, guideline-concordant follow-up. At the academic site, on average, more than 15 follow-up recommendations were listed for each surveillance modality, except colonoscopy. Among the SCPs that specified the frequency of follow-up care, the rate of guideline-concordant recommendations was 15/42 (36%) for follow-up visits, 29/43 (67%) for imaging, 12/45 (27%) for laboratory and 39/39 (100%) for colonoscopy. Conclusions: SCPs consistently provided information about CRC diagnosis and treatment, but often omitted information about cancer risk, staging and prognosis. There was considerable variation between cancer centers in the follow-up recommendations suggested for CRC survivors. Future work to improve the consistency of SCP follow-up recommendations with guidelines may be needed. Clinical trial information: NCT03035773 . [Table: see text]

Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors

2009 ◽  
Vol 27 (20) ◽  
pp. 3338-3345 ◽  
Author(s):  
M. Elisabeth Del Giudice ◽  
Eva Grunfeld ◽  
Bart J. Harvey ◽  
Eugenia Piliotis ◽  
Sunil Verma
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Primary Care Physicians ◽  
Mail Survey ◽  
Patient Specific ◽  
Urban Centers ◽  
Optimal Care ◽  
Adult Cancer Survivors ◽  
Follow Up Care

Purpose Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown. Methods A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined. Results A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 ± 2.3 years had elapsed for prostate cancer, 2.6 ± 2.6 years for colorectal cancer, 2.8 ± 2.5 years for breast cancer, and 3.2 ± 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence. Conclusion With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.

scholarly journals Follow-up Care Delivery Among Colorectal Cancer Survivors Most Often Seen by Primary and Subspecialty Care Physicians

2009 ◽  
Vol 24 (S2) ◽  
pp. 472-479 ◽  
Author(s):  
David A. Haggstrom ◽  
Neeraj K. Arora ◽  
Paul Helft ◽  
Marla L. Clayman ◽  
Ingrid Oakley-Girvan
Keyword(s):  
Colorectal Cancer ◽  
Cancer Survivors ◽  
Care Delivery ◽  
Colorectal Cancer Survivors ◽  
Follow Up Care

scholarly journals Results of Cancer Control Education for Primary Care Providers in Low- and Middle-Income Countries

2017 ◽  
Vol 3 (2_suppl) ◽  
pp. 18s-18s
Author(s):  
Vanessa J. Eaton ◽  
Megan K. Kremzier ◽  
Doug Pyle
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Cancer Control ◽  
Primary Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Health ◽  
Care Course ◽  
Low And Middle Income

Abstract 28 Background: The global burden of cancer is growing in low- and middle-income countries where availability of specialists to treat cancer is acutely low. To detect cancer earlier, patients must be educated about their risk for cancer and be screened when appropriate. In response to a growing need for cancer education in primary health care, ASCO International created the Cancer Control in Primary Care course, which was piloted in 2015. The purpose of the program is to increase the knowledge of primary health workers so as to recognize signs and symptoms of cancer, increase their ability to talk with patients about their risk, and to know how and when to refer patients for additional screening or diagnostic testing. Methods: ASCO collects data from participants in two stages: an on-site evaluation and a follow-up survey 12 months after the workshop. The survey instruments include questions about practice changes, learning objectives, and demographic information. Results: Follow-up surveys have been conducted for four courses. Ninety-three percent of respondents have reported that they made practice changes after the course. In addition, 90% reported that communication with patients about their risk for cancer had increased, 76% reported that they are screening patients for cancer more than before, and 74% reported that they have worked with specialists to plan treatment for their patients with cancer. Conclusion: Results of the Cancer Control in Primary Care course are positive, and ASCO will continue to collaborate with society and institutional partners to train primary health workers around the world to raise awareness of cancer. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

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