Using practice algorithms to deliver cancer survivorship care.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19625-e19625
Author(s):  
Guadalupe R. Palos ◽  
Fran Zandstra ◽  
Ludivine Russell ◽  
Jacklyn J Flores ◽  
Yvette DeJesus ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Survivors ◽  
Psychosocial Functioning ◽  
Phase 1 ◽  
Comprehensive Cancer Center ◽  
Cancer Site ◽  
Cancer Center ◽  
Survivorship Care ◽  
Disease Specific

e19625 Background: Clinical practice algorithms provide a framework to guide providers’ practice in delivering care to long-term cancer survivors. Here we describe how algorithms were developed in a comprehensive cancer center and types of metrics used to evaluate their feasibility. Methods: Survivorship practice algorithms were based on a multidisciplinary care approach successfully used to build screening and treatment algorithms. This model consisted of four phases: development, adoption, implementation, and evaluation of algorithms. Phase 1, expert clinicians and researchers identified and agreed upon a specific cancer site. Group-consensus and literature reviews/syntheses were used to determine eligibility criteria to transition patients to survivorship care. Phase 2, reviews and approval processes were conducted by credentialing and regulatory committees to ensure adoption of the algorithms into clinical practice. Phase 3, pilot programs were conducted to implement the algorithm(s) in disease-specific survivorship clinics. Phase 4, metrics to evaluate progress included the number of algorithms and providers’ use of and adherence to the algorithms. Results: Between 09/2008 – 12/2011, nine multidisciplinary disease-specific survivorship clinics were operationalized. Thirty-seven practice algorithms were developed to provide survivorship care based on each survivor’s specific needs. The algorithms’ framework included: 1) surveillance for recurrent or new primary malignancies; 2) primary and secondary cancer prevention recommendations; 3) management of toxicities and latent treatment effects; and 4) assessment of psychosocial functioning. Conclusions: Practice algorithms provide an organized plan to deliver comprehensive and holistic care to long-term survivors. Given the projected increase in cancer survivors, further research is needed to determine how practice algorithms impact providers’ practice and survivors’ outcomes.

Long-term cancer survivorship care: On the radar screen?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20567-e20567
Author(s):  
Rutika Mehta ◽  
Rohit Jain ◽  
Lori Rhodes ◽  
Joseph Abraham ◽  
Kenneth David Miller
Keyword(s):  
Cancer Survivors ◽  
Cancer Treatment ◽  
Breast Cancer Survivors ◽  
Demographic Data ◽  
Cancer Center ◽  
Specific Information ◽  
Survivorship Care ◽  
Coordination Of Care ◽  
Long Term Effects

e20567 Background: Long-term cancer survivors require comprehensive care. The purpose of this study was to describe how survivorship care fits into oncologists’ clinical time, and characterize long-term cancer survivors’ problems and oncology follow-up care. Methods: We abstracted 18,882 medical records of unique cancer patient visits during 2010 at a major NCI-designated cancer center and then evaluated survivor care for one week in April, 2010 to characterize how oncologists spend their clinical time. Finally, we selected three subgroups from the survivor population (n≈100 each) of survivors at 1-5 years, 6-10 years, and >10 years after diagnosis. We collected demographic data, purpose of visit, cancer-specific information, late and long-term effects, and type of care delivered, including surveillance for recurrence, intervention, prevention, and coordination of care. Results: In the larger group of 18,882, only 14% of survivors were more than 10 years post-diagnosis. Approximately two-thirds of the survivors were women. Breast cancer survivors comprised 38%, and survivors of hematologic malignancies accounted for 21% of the population. During the one week studied, the majority of oncologists' patients (74%) were actively receiving treatment; only 5% of their patients were 5 or more years post-diagnosis. Second or secondary malignancies were noted in 8% of patients. Late and long-term effects were uncommon. Approximately 25% of survivors beyond five years were observed to have late effects due to cancer treatment, most common being fatigue, neurological endocrine, and cardiac. Of the 300 selected survivors, sixty-two percent received only surveillance care during their visit. Only 3% of these patients received an entire array of survivorship care that included surveillance, intervention, co-ordination and prevention. Conclusions: A small proportion of oncologists’ visits were with long-term cancer survivors (5-14%) of whom only 25% had late or long-term effects of cancer treatment so overall very few of office visits were with long-term survivors who had late and long-term complications. All visits involved surveillance for cancer recurrence but there was little focus on prevention, intervention, and coordination of care for cancer survivors.

Analysis of financial sustainability of survivorship clinics led by advanced practice providers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11560-11560
Author(s):  
Maria Alma Rodriguez ◽  
Guadalupe R. Palos ◽  
Katherine Ramsey Gilmore ◽  
Paula A. Lewis-Patterson ◽  
Patricia Chapman ◽  
...  
Keyword(s):  
Physician Assistants ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Advanced Practice ◽  
Survivorship Care ◽  
Manage Care ◽  
Recovery Percentage ◽  
Long Term Survivors ◽  
Delivery Models

11560 Background: Disease specific Survivorship Care Clinics (SCs) have been established within a comprehensive cancer center. Clinics are staffed by Advanced Practice Providers (APPs), Physician Assistants and Advanced Practice Registered Nurses, with experience in the management of each disease type. To determine the sustainability of this model of survivorship care, we analyzed the professional fees’ revenue generated by APPs’ billings for 6 clinics and then compared the APPs’ salaries across all clinics. Methods: A retrospective analysis was conducted of 6 survivorship clinic’s patient volumes and clinic days supported by APPs from 9/1/16-4/30/17. The full FTE salary of the APPs, including benefits were prorated to the time dedicated to each of the SCs. Institutional financial data was used to align professional fees to actual reimbursements received. Salary recovery percentage was calculated as the ratio of reimbursement received to prorated FTE salary. Results: Table shows variation in APPs’ salary commensurate to FTE proportion. Results also indicate there was an average of 99% professional fee recovery. Clinics with an FTE proportion > 0.5 had recovery higher than the anticipated prorated salary, suggesting there is a threshold to maximize efficacy and sustainability. Conclusions: APPs professional fees for care provided to cancer survivors are reimbursable, across disease types or payers, and proportionally supports their salaries. Our findings suggest delivery models based on APPs to manage care of long-term survivors can be self-supporting.[Table: see text]

NP model of survivorship care: Lessons learned.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 26-26
Author(s):  
Gretchen Dawson ◽  
Stacy Wentworth
Keyword(s):  
Cancer Survivors ◽  
Nurse Practitioners ◽  
Primary Care Providers ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers ◽  
Term Care ◽  
Healthcare Needs

26 Background: The number of cancer survivors is expected to reach 20 million by 2026. As patient volumes increase, oncologists are tasked with seeing more patients, often allowing less time for survivorship-related concerns. In an effort to address this issue, nurse practitioners (NPs) are equipped to aid survivors by managing late/long-term side effects of treatment, monitor for recurrence, provide survivorship care plan (SCP), and promote overall health and wellness. Methods: When initiating a survivorship program, our community cancer center utilized survivorship nurse practitioners (SNP) to address increasing patient volumes and patients’ survivorship issues. By beginning with breast cancer survivors, we were able to meet patients prospectively at diagnosis to provide support and introduce survivorship. SNP later saw patients in designated Survivorship Clinic, after completing treatment and in long-term survivorship to address physical/psychosocial concerns, place appropriate referrals, and promote overall wellness. Collaboration with local Primary Care Providers (PCP) was integral for the long-term care of survivors. Results: In 9 months, prospective data collection surveys helped to better understand patients’ needs, allocation of appropriate resources, and measure patient empowerment. Collaboration with EMR team helped address patient volumes and workflow. Future collaboration of survivors’ healthcare needs with PCP was done by routing 162 completed SCPs to patient-designated PCP and mailing over 185 survivorship program introduction letters to community PCPs. Conclusions: Meeting patients prospectively aided in promoting the importance of survivorship helped provide evaluation of our survivorship program’s growth and development. However, patients introduced to survivorship at diagnosis required a formal referral at the completion of treatment, which disrupted workflow. Collaborating with EMR team to develop survivorship referrals, survivorship clinic templates, and SCP reports were important. Continued work with PCPs will be integral to future success. NPs provide survivorship-focused care in the oncology setting, while meeting continued demands of a growing cancer survivorship patient population.

Implementation of a novel primary care-centered clinic for survivorship care.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 41-41
Author(s):  
Archana Radhakrishnan ◽  
Youngjee Choi ◽  
Zackary Berger ◽  
Craig Evan Pollack ◽  
Sydney Morss Dy ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Cancer Care ◽  
Psychosocial Support ◽  
Primary Care Providers ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers

41 Background: Patients often face challenges in transitioning to the survivorship stage of cancer care and coordinating with primary care. Prior research has highlighted the uncertainty in who provides survivorship care, leaving patients “lost in transition”. Integrating primary care providers (PCP) into cancer care offers one potential solution. Expanding traditional PCP roles to participating throughout the cancer continuum and familiarizing PCPs with cancer patients’ needs can address this gap. We describe an innovative model of incorporating PCPs to delivering primary care to cancer survivors at a large academic institution. Methods: As one part of a plan to address an identified need for improving survivorship care for cancer patients at Johns Hopkins, PCPs and cancer survivorship care experts developed the Primary Care for Cancer Survivors clinic (PCCS) in 11/2015. The clinic receives referrals from the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and patients are seen for either a one-time consultation or can transition their primary care to the clinic. We also are creating a database of internal and external referrals to meet the specific needs identified by patients. We descriptively analyzed the utilization of PCCS from 11/2015 through 9/2016. Results: A total of 35 patients have been seen at PCCS. The average age of patients was 56.8 (SD 12.4) and 32 were female and 3 were male. 24 patients identified as white, 8 black, 1 Asian, and 2 others. Most patients transitioned their PC to the clinic (n = 30). The majority of patients had breast (n = 19) and colorectal cancer (n = 5); 10 patients had metastatic disease (3 have deceased). Commonly, referrals were made to physical therapy, including pelvic rehabilitation and lymphedema management, and nutrition counseling. Conclusions: Patients with a wide variety of cancers and at all stages of disease were seen for survivorship care in the PCCS clinic. Integrating nutrition care, psychosocial support, exercise programs, and palliative care were key early factors in meeting patients’ needs. Continuing to assess and meet survivors’ individual needs and build referral networks are important next steps in the development of the clinic.

With a little help from my friends: A multi-disciplinary approach to cancer survivorship.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24082-e24082
Author(s):  
Scott Capozza ◽  
Maura Harrigan ◽  
Javin Brita ◽  
Angela Khairallah ◽  
Tara B. Sanft
Keyword(s):  
Side Effects ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Health Care Providers ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers ◽  
Cancer Related Fatigue

e24082 Background: Long term cancer survivorship care is an integral part of the overall arc of oncology care. There is currently no standard of care for survivorship care beyond dissemination of a Survivorship Care Plan and data evaluating current models is limited. Furthermore, the most current Commission on Cancer recommendations suggest that a multi-disciplinary approach to cancer survivorship will best address the late and long-term side effects that survivors experience1. Methods: A multi-disciplinary adult cancer survivorship clinic at Yale Cancer Center and Yale New Haven Hospital was established in October 2006. This clinic is overseen by a medical oncologist and features the medical expertise of four distinct providers: an advance practice practitioner (such as an APRN or PA), a licensed clinical social worker, an oncology board-certified registered dietitian and an oncology board-certified physical therapist. Survivors meet with each provider for 30 minutes. A follow-up visit is scheduled 2-3 months later to assess the interventions discussed at the first visit and make modifications as necessary. This comprehensive approach allows the providers to address a wide array of late and long-term side effects from cancer treatment, including fear of recurrence, cancer related fatigue and weight management. Beginning with evidence-based research in their respective fields, each provider can create an individualized plan to address these concerns. Results: The National Comprehensive Cancer Network's Distress Thermometer demonstrated an almost 75% decrease in distress in cancer survivors pre- to post initial visit (n = 1,116 patients). Additionally, cancer-related fatigue, as measured by the MD Anderson Brief Fatigue Inventory, decreased by almost 50% from first to second visit (n = 313 patients). Conclusions: This poster is the first to demonstrate the feasibility of implementing a multi-disciplinary cancer survivorship clinic to address the late and long-term side effects of cancer survivors. Further research evaluating the correlation between improved access to long term survivorship care, as well as the health care providers required to provide optimal care in this setting, is needed. 1. American College of Surgeons Comminssion on Cancer, https://www.facs.org/-/media/files/quality-programs/cancer/coc/optimal_resources_for_cancer_care_2020_standards.ashx . Accessed February 10th, 2020.

Frailty Status and Cognitive Function Should Guide Prescribing in Long-term Care Facilities

2021 ◽  
Vol 36 (10) ◽  
pp. 469-473
Author(s):  
Shin J. Liau ◽  
J. Simon Bell
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Long Term Care ◽  
Adverse Drug Events ◽  
Cognitive Status ◽  
Term Care ◽  
Care Facilities ◽  
Disease Specific

Frailty, dementia and complex multimorbidity are highly prevalent among residents of long-term care facilities (LTCFs). Prescribing for residents of LTCFs is often informed by disease-specific clinical practice guidelines based on research conducted among younger and more robust adults. However, frailty and cognitive impairment may modify medication benefits and risks. Residents with frailty and advanced dementia may be at increased susceptibility to adverse drug events (ADEs) and often have a lower likelihood of achieving long-term therapeutic benefit from chronic preventative medications. For this reason, there is a strong rationale for deprescribing, particularlyamong residents with high medication burdens, swallowing difficulties or limited dexterity. Conversely, frailty and dementia have also been associated with under-prescribing of clinically indicated medications. Unnecessarily withholding treatment based on assumed risk may deprive vulnerable population groups from receiving evidence-based care. There is a need for specific evidence regarding medication benefits and risks in LTCF residents with frailty and dementia. Observational studies conducted using routinely collected health data may complement evidence from randomized controlled trials that often exclude people living with dementia, frailty and in LTCFs. Balancing over- and under-prescribing requires consideration of each resident’s frailty and cognitive status, therapeutic goals, time-to-benefit, potential ADEs, and individual values or preferences. Incorporating frailty screening into medication review may also provide better alignment of medication regimens to changing goals of care. Timely identification of frail residents as part of treatment decision-making may assist with targeting interventions to minimize and monitor for ADEs. Shifting away from rigid application of conventional disease-specific clinical practice guidelines may provide an individualized and more holistic assessment of medication benefits and risks in the LTCF setting.

scholarly journals A culturally specific dietary plan to manage weight gain among African American breast cancer survivors

2012 ◽  
Vol 21 (2) ◽  
pp. 97-105 ◽  
Author(s):  
Kathleen A Griffith ◽  
Renee Royak-Schaler ◽  
Kim Nesbitt ◽  
Min Zhan ◽  
Adriane Kozlovsky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Vegetable Intake ◽  
Survival Rates ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Daily Consumption ◽  
Culturally Specific ◽  
Fat Consumption

Breast cancer survival rates are lower in African Americans (AAs) than in Caucasians, owing in part to a higher prevalence of obesity in the former, which increases the risk of recurrence and mortality. The Women’s Intervention Nutrition Study (WINS) found that Caucasian women who followed a low-fat eating plan experienced a lower rate of cancer recurrence than women who maintained their usual diets. The purpose of this study was to test the feasibility of a WINS plan tailored to the cultural needs of AA breast cancer survivors. This feasibility pilot study was conducted at a university National Cancer Institute-designated comprehensive cancer center outpatient clinic with AA breast cancer survivors. The culturally specific WINS (WINS-c) plan included eight individual counseling sessions, five educational group meetings, and follow-up telephone calls over a 1-year period. Outcome measures included dietary fat, triglyceride, insulin and glucose levels, and fruit and vegetable intake. Participants ( n = 8) had a mean age of 61.1 years (standard error of the mean (SEM) 3.1 years) and a mean BMI of 32 kg/m2 (SEM 4.25 kg/m)2. Baseline daily fat consumption decreased from 64.6 g (range 36.8–119.6g) to 44.0 g (21.6–73.4g) at 52 weeks ( p = 0.07). Mean daily consumption of fruits and vegetables increased by 36% and 15%, respectively. Mean triglyceride levels decreased at 12 months ( p < 0.05). Sustained hyperinsulinemia was noted in most participants, including those without diabetes. Mean calcium and vitamin D consumption decreased over the 1-year study period. In AA breast cancer survivors, the WINS-c program resulted in a trend toward reduced fat consumption and may represent a sustainable approach in this population for improvement of diet quality after breast cancer.

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